Management of Localized Anterior Tooth Wear Using a Modified Sandwich Technique and the Dahl Concept: A Case Report

SUMMARY This case report illustrates a minimally invasive segmental rehabilitation of localized anterior tooth wear using a modification of the sandwich technique, a combination of indirect palatal composite veneers and direct labial composite restorations, at an increased occlusal vertical dimension (the Dahl concept).

Effect of flask closure method on occlusal vertical dimension of complete upper and lower dentures

The movement of teeth during processing of complete dentures disturbs the harmonious occlusal scheme established at the final wax try-in stage. Aims and objectives: to investigate the effect of RS flask closure on occlusal vertical dimensions of complete dentures. The mean occlusal vertical dimension of complete maxillary and mandibular dentures fabricated by the conventional flask closure were measured and compared with that of dentures fabricated by RS flask closure. Design: A pre-test post-test control group experimental design. Methods: Thirty sets of complete maxillary and mandibular wax trial dentures were randomly assigned to experimental groups. Fifteen sets were assigned to conventional flask closure and the remainder to RS flask closure. Compression molding with a long curing cycle was performed for the processing of the dentures. Pre-processing and post-processing occlusal vertical dimensions were determined. Results: The mean occlusal vertical dimensions of wax trial dentures assigned to either group were similar. The data produced substantial evidence to reject the null hypothesis that the post-processing mean occlusal vertical dimensions of both groups were equal. Conclusion: The occlusal vertical dimensions produced by dentures clamped by the RS flask closure were significantly less than those produced by dentures clamped by the conventional flask closure.

A Prosthodontic Approach as a Complementary Solution for a Complicated Orthodontic Treatment of a Patient with Cleidocranial Dysplasia

This clinical report describes a prosthodontic rehabilitation of a 29-year-old patient with cleidocranial dysplasia (CCD), who, after completing an orthodontic treatment, was not satisfied with the aesthetic outcome. Besides aesthetics, the patient complained about mastication muscles pain, and clicking while eating but was not aware about her unilateral open bite on the right side. The aim of this treatment was to improve smile appearance and patient’s well-being, as well as to restore the proper occlusal vertical dimension (OVD) along with complete intercuspation and to establish masticatory function. The first phase of the treatment concentrated on eliminating the muscle pain and temporomandibular joint (TMJ) clicking with a repositioning splint. During the second phase, the functional and aesthetic rehabilitation was obtained using adhesive prosthesis overlays and veneers.

Alteration of the Occlusal Vertical Dimension for Prosthetic Restoration Using a Target Tracking System

Clinicians and researchers have used various methods to reproduce the maxillomandibular relationship and mandibular movement of individual patients using an articulator, with efforts being made to reduce errors associated with the conventional technique. When a change to a vertical dimension is required during the conventional prosthesis construction process, the maxillary and mandibular casts are mounted on the mechanical articulator using a facebow and bite registration and the elevation of the anterior guide pin of the articulator is used. However, this can inevitably cause errors due to differences between the articulator hinge movement and the actual trajectory of the patient. There has recently been increasing interest in tracking the trajectory of jaw motion of a patient, and this paper presents a new technique for altering the vertical dimension based on the measured trajectory. Target materials for performing tracking are attached to the maxillary and mandibular anterior teeth to record opening and closing movements of the patient’s mouth in real time and align the patient’s scanned intraoral data or cast data. The movements of the targets are replaced with the movement of the patient’s oral scan data. Additionally, then the occlusal vertical dimension is set to a new position based on the obtained trajectory. After determining the optimal vertical dimension with consideration of the space required for restoration, maxillary and mandibular STL files are exported and the designed cast is created using a 3D printer. The printed cast is mounted on an articulator for subsequent procedures. This approach maintains the patient’s actual maxillomandibular relationship at various vertical heights and can also reduce the chair time required when adjusting for errors.

The “Prosthetic Orthodontic Approach”: An Application of the Biologically Oriented Preparation Technique Protocol

In this study, three cases involving patients who required multidisciplinary treatment for the aesthetic and functional rehabilitation of the maxillary or mandibular arch are described. In particular, an indication for preprosthetic orthodontic treatment, such as orthodontic extrusion, tooth realignment, correction of malocclusion, and diastemata closure, was present in all cases. Preprosthetic orthodontic treatment to resolve these issues before the restorative procedures was proposed; however, all patients refused preprosthetic orthodontic treatment. Thus, to restore aesthetics and function, solely a feather-edge prosthetic protocol has been used. The biologically oriented preparation technique was used to prepare the teeth that were moved in the established direction by preparing the abutment more on one side than the opposite. This so called “prosthetic orthodontic approach” allowed resolving clinical issues that would typically require preprosthetic orthodontic treatment, such as complete clinical crown loss, occlusal vertical dimension loss, tooth misalignment, malocclusion, tooth agenesis, and severe multiple diastemata. The degree of reciprocal movement of the prepared teeth achievable through this approach was minor and not comparable to a traditional wide-range orthodontic movement. Besides, the technique resulted in a modification of the gingival tissues and improvement of their thickness although it is unclear what effect this technique has on the gingival biotype. None of the patients had prosthetic or periodontal complications for at least 12 months following the procedure. Gingival health was excellent, and the prosthetic procedure did not affect the pulp survival of the vital teeth. The biologically oriented preparation technique used with a prosthetic orthodontic approach can effectively manage complicated cases without the need for preprosthetic orthodontics.