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문제 정의
- This clinical report describes the re-establishment of a collapsed occlusal plane in a patient who experienced a complicated outcome after prosthetic rehabilitation involving implants.
제안 방법
- Considering the diagnostic wax pattern, the remaining teeth were prepared, and a provisional prosthesis was placed after extraction of the mandibular right lateral incisor due to a poor prognosis. A cone beam computed tomography image was obtained to evaluate the implant installation site in the maxillary anterior region and mandibular right first premolar. Because the bone quality and quantity was favorable enough to achieve good primary stability, the position of the additional implant in the maxillary anterior region for the cross-arch splinting was chosen as the maxillary left incisor, and an internal connection implant (Superline; Dentium, Seoul, Korea) was installed to form natural emergence profile using soft tissue support.
- Accordingly, the treatment goal was to establish anterior guidance providing posterior disclusion and restore the occlusal plane through the correction of curve of Wilson and curve of Spee. Full mouth rehabilitation was planned with additional implant installation for restoring the missing teeth and cross-arch splinting of the maxillary anterior implant prosthesis.
- 15). After placement of the provisional restoration, adaptation of esthetics and occlusion was evaluated during 6 weeks of application. The provisional restoration did not cause any noticeable changes in occlusal morphology or any discomfort.
- To restore posterior occlusal support, external connection implants (USII; Osstem, Busan, Korea) were installed in the mandibular left second premolar and first molar region. After removal of the existing implant prosthesis, a preliminary impression was taken to create a provisional restoration. Analysis of the mounted diagnostic casts at the current OVD revealed sufficient interocclusal space to establish an occlusal plane and to provide an adequate restoration space.
- The definitive prosthesis was placed and adjusted to achieve group function. After taking a definitive impression of the anterior region, the interocclusal record was taken using a recording base and the master casts were attached to the articulator with a cross-mounting technique. In order to reproduce the anterior guidance and contour of the provisional restoration and prevent porcelain chipping of the implant prosthesis, a double scanning technique was used and monolithic zirconia fixed dental prostheses (FDPs) were fabricated.
- 12). Consequently, an additional analysis was planned with regard to the TMJs as posterior controlling factors and masticatory movement.
- 14). Consequently, re-evaluation of occlusal stability was planned with a second provisional restoration to correct the impaired occlusal morphology. During this procedure, customized abutments (Myplant, Raphabio C.
- The remaining teeth were worn, and showed a reverse curve of Wilson and curve of Spee. Following diagnostic procedures, the missing teeth were rehabilitated by installation of implants, and prosthetic treatment was performed on the worn teeth, except for the worn mandibular anterior teeth (Fig. 2). However, on follow-up examination in the following 6 years, the implant-supported fixed prosthesis showed frequent screw loosening, and occlusal overload caused root fracture of the mandibular left first molar and right first premolar (Fig.
- For accurate diagnosis and fabrication of a provisional restoration, a face-bow transfer was performed to mount the diagnostic cast on a semi-adjustable articulator (KaVo Protar Evo 7, KaVo Dental GmbH, Biberach, Germany) by using an interocclusal record made using an anterior programming device (Lucia jig) and silicone bite registration material (Futar D, Kettenbach GmbH & Co. KG, Eschenburg, Germany) (Fig. 8).
- In summary, the patient in this case underwent full mouth rehabilitation 6 years earlier, but experienced complications of the prosthesis, which resulted in collapse of the occlusal plane and inappropriate anterior guidance. For this patient, the flat occlusal plane and the shallow anterior guidance were determined by the analysis of mandibular movement and using a provisional restoration, and these characteristics were reflected in the definitive prosthesis, which improved masticatory function.
- Accordingly, the treatment goal was to establish anterior guidance providing posterior disclusion and restore the occlusal plane through the correction of curve of Wilson and curve of Spee. Full mouth rehabilitation was planned with additional implant installation for restoring the missing teeth and cross-arch splinting of the maxillary anterior implant prosthesis. To restore posterior occlusal support, external connection implants (USII; Osstem, Busan, Korea) were installed in the mandibular left second premolar and first molar region.
- After taking a definitive impression of the anterior region, the interocclusal record was taken using a recording base and the master casts were attached to the articulator with a cross-mounting technique. In order to reproduce the anterior guidance and contour of the provisional restoration and prevent porcelain chipping of the implant prosthesis, a double scanning technique was used and monolithic zirconia fixed dental prostheses (FDPs) were fabricated. The definitive prosthesis was placed and adjusted to achieve group function (Fig.
- The analysis of loss of the occlusal vertical dimension (OVD) was performed considering interocclusal rest space, phonetics, facial appearance, history of occlusal wear, and loss of posterior support. The patient’s interocclusal rest space between the chin tip and nose tip was measured to be 3 mm, and was similar to the normal value of 2 - 4 mm.
- Despite full mouth rehabilitation in this patient 6 years earlier, establishment of an occlusal plane that was not in harmony with the envelope of function caused complications associated with the prosthesis. The prosthesis was reconstructed together with implant installation, and masticatory function was restored by re-establishing the occlusal plane and anterior guidance such that it was compatible with the envelope of function. Currently, the patient shows stable function, but periodic follow-up and maintenance therapy are required.
- As a result, movement of the mandible appeared to have become stronger in order to restore horizontal function, and this is thought to have caused additional wear of the anterior teeth that had not been restored and porcelain chipping of the implant prosthesis in the maxillary anterior region. Therefore, in the second prosthetic treatment, to establish a correct relationship between the incisor edges of the lower anterior teeth and the maxillary anterior teeth, which forms the anterior guidance, replacement of the existing prosthesis and prosthetic restoration of the mandibular anterior teeth were planned.
이론/모형
- 7. Evaluation of occlusal vertical dimension using the Willis method and the McGee method.
- On evaluation of the “s” sound, the distance between the lingual surface of the maxillary incisors and the incisal edge of the mandibular incisors was about 1 mm, and therefore normal. There were no signs of loss of OVD in the facial appearance and the facial height ratio was within normal range according to the Willis method and the McGee method (Fig. 7). According to these evaluations, it was concluded that the patient had probably no or minimal loss of OVD.
성능/효과
- 7). According to these evaluations, it was concluded that the patient had probably no or minimal loss of OVD.
- Following 2 months of use of the first provisional restoration, for which a new occlusal plane was established and the anterior guidance angle was increased, changes in occlusal morphology were observed due to excessive wear of the posterior teeth. For restoration of the impaired occlusal morphology and re-evaluation of occlusal stability, a second provisional restoration was fabricated.
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