J Dent Rehabil Appl Sci.  2024 Nov;40(4):279-290. 10.14368/jdras.2024.40.4.279.

Mandibular full arch rehabilitation of a patient with severely worn dentition after completion of maxillary full arch rehabilitation

• Kim YM
• Ahn SG
• Lee JJ
• Park YH
• Kim KA
• Seo JM

• KMID: 2562772
• DOI: http://doi.org/10.14368/jdras.2024.40.4.279

Abstract

Wear of teeth occurs due to various reasons, and full mouth rehabilitation with an accurate diagnosis of the patient can restore the occlusal relationship, aesthetics, and facial appearance and prevent the progression of wear. Restoration of worn dentition must be performed throughout the entire upper and lower arch. If restoration is performed only on the dentition of single arch, various problems may occur. The patient in this case had generalized wear of the maxillary and mandibular dentition and required full-mouth rehabilitation. However, due to the patient’s request, only the maxillary arch was rehabilitated first, and later, due to complications, the mandibular arch was rehabilitated. Purpose of this case report is to consider the problems when only the maxillary full arch was rehabilitated in a patient with generalized tooth wear, and how these were resolved during the mandibular full arch rehabilitation process.

Keyword

full mouth rehabilitation; tooth wear; vertical dimension of occlusion

Figure

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  Fig. 1 Panoramic radiograph before treatment.

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  Fig. 2 Intraoral photographs before treatment. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 3 Provisional restoration and temporary denture. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 4 Panoramic radiograph after implant placement.

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  Fig. 5 Maxillary definitive prostheses fabrication. (A) Frontal view, (B) Right lateral view, (C) Left lateral view.

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  Fig. 6 Setting of maxillary definitive prostheses. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 7 1 year and 3 months follow-up after maxillary rehabilitation. Dislodgement of #35 single crown (black arrow), wear and perforation of #36, 37, 38 implant prostheses (gray arrow) and severe wear of mandibular natural teeth are shown (white arrow). (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 8 Extraoral photographs 1 year and 3 months after maxillary rehabilitation. (A) Frontal view, (B) Lateral view.

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  Fig. 9 Diagnostic wax-up. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Anterior eccentric occlusion (anterior guidance by #11, 21), (G) Right eccentric occlusion (group function by #13, 14, 15), (H) Left eccentric occlusion (group function by #23, 24, 25).

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  Fig. 10 1st provisional restoration of mandibular dentition. (A) Removal of prostheses and preparation of mandibular posterior teeth and implants with anterior jig, (B) Preparation of mandibular anterior teeth after setting of mandibular posterior provisional restoration, (C) Setting of mandibular anterior provisional restoration.

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  Fig. 11 Intraoral photographs after #46 implant placement. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

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  Fig. 12 Final preparation of mandibular dentition and newly fabricated custom abutments of #36, 37, 38 implants.

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  Fig. 13 Computer-aided design (CAD) of mandibular definitive prostheses.

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  Fig. 14 Mandibular definitive prostheses fabrication. (A) Right lateral view, (B) Frontal view, (C) Left lateral view, (D) Mandibular occlusal view.

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  Fig. 15 Setting of Mandibular definitive prostheses. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Anterior eccentric occlusion (anterior guidance by #11, 21), (G) Right eccentric occlusion (group function by #13, 14, 15), (H) Left eccentric occlusion (group function by #23, 24, 25).

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  Fig. 16 Panoramic radiograph after treatment.

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  Fig. 17 4 years follow-up of Maxillary definitive prostheses and 2 years 4 months followup of Mandibular definitive prostheses. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

Reference

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