J Dent Rehabil Appl Sci.  2023 Dec;39(4):237-249. 10.14368/jdras.2023.39.4.237.

Maxillary complete denture with posterior zirconia occlusion and mandibular implant support fixed prostheses in completely edentulous patients with orofacial dystonia

• Seo JM
• Jeong CM
• Lee SH

• KMID: 2550433
• DOI: http://doi.org/10.14368/jdras.2023.39.4.237

Abstract

Orofacial dystonia is a neuromotor disorder that causes irregular or repetitive movements of the face, lips, tongue, and jaw involuntarily, also called tic disorder. Edentulous patients with these symptoms experience functional and aesthetic problems, including difficulty using complete dentures, speech and swallowing difficulties, and orofacial pain. In this case, for a patient with orofacial dystonia who experienced complete edentulism at a relatively young age, restorative treatment was performed with a maxillary complete denture with bilateral posterior zirconia occlusal surfaces and a mandibular implant-supported fixed prosthesis, and continuous smile training was performed. The aim was to improve the aesthetics of facial muscles. As a result of the treatment, the patient was very satisfied with not only improved chewing function and aesthetics, but also regained psychological stability and was able to lead a normal daily life, so we would like to report this.

Keyword

orofacial dystonia; complete edentulism; zirconia occlusal surface; maxillary complete denture; implant-supported fixed prosthesis

Figure

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  Fig. 1 Panorama and Intraoral view. (A) Initial panoramic radiograph, (B) Frontal view, (C) Maxillary occlusal view, (D) Mandibular occlusal view.

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  Fig. 2 Extraoral view of patient with Orofacial dystonia. (A) Frontal view with old denture, (B) Frontal view without old denture, (C) Sagittal view without old denture.

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  Fig. 3 Evaluation of diagnostic cast. (A) Mounting study cast on articulator, (B) Maxillary wax denture & Mandibular wax-up for fixed prosthesis.

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  Fig. 4 Evaluation of radiographs for implant treatment. (A) Diagnosis of residual bone by CBCT, (B) Panoramic radiograph after implant placement.

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  Fig. 5 (A) Fabrication of individual tray on study cast, (B) Final impression taking, (C) Beading and boxing, (D) Fabrication of master cast, (E) Fabrication of record base and occlusal rim.

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  Fig. 6 Interocclusal relationship recording and transfer to articulator. (A) Determination of occlusal and vertical dimension, (B, C) Transfer of occlusal plane by POP bow system with interocclusal recording, (D - F) Mounting of maxillary and Mandibular master cast with occlusal rim attached POP bow system on articulator.

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  Fig. 7 Try-in of maxillary wax denture and mandibular provisional bridge with customized abutment. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 8 Delivery of maxillary complete denture and mandibular implant provisional prosthesis. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Design of 3D printing mesh framework at maxilla, (E) Occlusal view of maxilla, (F) Occlusal view of mandible.

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  Fig. 9 Design of mandibular implant prosthesis. (A) Scan data of maxillary complete denture, (B) Scan data of mandibular customized titanium abutments, (C) After removing the temporary prosthesis on the right side of mandible, interocclusal recording was performed using a silicone bite table, followed by unilateral bite scanning, (D) Occlusal relation of maxilla and mandible was completed digitally by repeating the process while sequentially removing the three temporary prostheses, (E) Digital arrangement of mandibular fixed prosthesis, (F) Confirmation of implant screw hole path on mandibular fixed prosthesis.

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  Fig. 10 Delivery of definite prosthesis on mandibular implant fixed prosthesis. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Occlusal view of maxilla, (E) Occlusal view of mandible.

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  Fig. 11 (A) Scanning of maxillary complete denture, (B) Scanning after preparation of posterior artifcial teeth, (C) Design of a veneer-type zirconia occlusal surface by overlapping the (A) file with the (B) file, (D) Right posterior zirconia occlusion, (E) Maxillary complete denture with zirconia occlusion, (F) Left posterior zirconia occlusion.

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  Fig. 12 After 6 months, maxillary complete denture with zirconia occlusion and mandibular implant fixed prosthesis. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Maxillary occlusal view, (E) Mandibular occlusal view, (F) Right lateral movement, (G) Protrusive movement, (H) Left lateral movement.

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  Fig. 13 Evaluation of TMJ (A) Right centric occlusion, (B) Right maximum opening, (C) Left maximum opening, (D) Left centric occlusion.

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  Fig. 14 Post-treatment panoramic radiograph.

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  Fig. 15 Post-treatment extraoral view (A) Frontal smile view, (B) Lateral smile view.

Reference

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