 Featured Case:
Complex Treatment Planning of
Full Mouth Rehabilitation
Dentistry & Photographs By Dr. John Nosti
Background
Tammy is a 46 year old female who presented to the office with a desire for a nicer smile. Upon clinical examination it was noted that she had some crowding in the maxillary and mandibular anterior segments, including a near cross bite with #27. There were several issues present with her posterior teeth. Including being heavily restored, fractures, deep abfractions (non-carious cervical lesions), flattened porcelain fused to metal crowns, and failing existing restorations.
Full diagnostic tests were performed including a pre-operative T-scan, Joint Vibration Analysis (JVA), Full mouth series, study models, fabrication of a deprogrammer, and photographs. Her Joint Vibration Analysis was normal, however, her T-scan showed unbalanced forces present between the left side and right side of her mouth. Posterior interferences were present with excessive occlusal time (.94 seconds), with working and balancing interferences.
Tammy was asked to wear the deprogrammer to bed at night for 2 weeks. She presented for her early morning appointment on the 15th day wearing the appliance from the night before. It was removed and a composite ball bite was fabricated at the new desired vertical dimension.
A wax-up of the initial 20 units were fabricated to the new desired vertical dimension, desired cosmetic goals, as well as functional and occlusal goals. Tammy underwent the first appointment prepping the anterior 10 teeth in the maxillary and mandibular arches. These were then finalized prior to prepping the molars. The restorative material selected was IPS e.Max with all ceramic work completed by Gold Dust Dental Laboratory. Within two months, the molars were completed, and a final T-scan occlusal equilibration was completed. We designed her occlusion to the Apex of Force position (Centric Relation), with anterior guidance, and immediate posterior disclusion. This occlusion type is most resistant to parafunction when finished with T-scan.
Click Here for a complete discussion regarding diagnosis, treatment plan steps and occlusal considerations on Dentaltown.
|
|
|
|
|
