Dentaltown January 2015 - (Page 30)
restorative
case presentation
APPLYING
THE
CHASOLEN
TRIAD
ANTERIOR TOOTH POSITION IN RESTORATIVE DENTISTRY:
by Howard Chasolen, DMD
O
ften, we see patients in our clinical practices in need of cosmetic and functional reconstruction. These reconstructions
frequently involve the anterior teeth. Worn edges, cosmetic
demands, deep bites and concerns for ongoing parafunction are all
components of a reconstruction that concern dentists.
The Chasolen Triad of Reconstruction describes:
* Aesthetic A and B point
* Vertical occlusal dimension
* Excursive pathway considerations applied to reconstructions
The goal of modern restorative dentistry is to restore any patient, on the continuum of dental presentations, to normal form,
function, contour, comfort and aesthetics. Understanding the anterior and posterior determinants of aesthetics and occlusion allows us
to develop a predictable and repeatable protocol for analyzing and
treating any cosmetic or occlusal presentation. (Fig. 1) Many have
discussed the incisal edge position of anterior teeth and their in uence in dictating overall tooth position, placement and outcome. Dr.
Earl Pound published "Personalized Denture Procedures" in 1973
and discussed the aesthetic and phonetic interrelationships of the
anterior teeth as the guide to a successful denture outcome.
The anterior determinants of tooth position are governed by labial contour, incisal edge position and lingual contour. By beginning
with a systematic approach to tooth position, establishing the labial
and incisal determinants of the maxillary and mandibular teeth are
30
JANUARY 2015 » dentaltown.com
an outcome of lip support, aesthetic profile, lip closure path, tooth
display, curvature of the lower lip and phonetics. The lingual anterior determinants become a customization of the occlusal considerations. The labial and incisal positions are largely determined by
aesthetic parameters and the lingual by occlusal considerations such
as vertical dimension of occlusion, arch relationship, parafunctional
patterns and intended excursive pathway angles. The aesthetic plan
is the architecture and the occlusal plan is the engineering.
If the aesthetic plan is at risk due to engineering concerns, the
aesthetic plan requires modification. or e ample, we all have patients with extensive wear. Some present with a horizontal pattern
and some a vertical pattern (Figs. 2 & 3). If the clinical presentation
is one with a deep bite with vertical or angular vectors of wear (Fig.
4), a particular etiology and diagnosis may be determined. If one
presents with a more end to end wear and a more horizontal vector
of wear, another etiology and diagnosis may be determined.
et's take figures and for e ample. his patient has a worn
dentition secondary to chemical erosion and horizontal, protrusive
parafunction. The patient desires additional tooth display at rest and
during smiling. This requires adding length to the maxillary anterior
teeth. If the teeth are lengthened at the current VOD, there will
be no room for the new length and restorative material, and they
will surely fracture. Therefore, increasing his present VOD may be
necessary. This allows control of not only the space required for the
restoration but the steepness of the anterior pathways to manage
parafunctional damage.
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Table of Contents for the Digital Edition of Dentaltown January 2015
Dentaltown.com Highlights
Howard Speaks: Why Too Much Clinical Dentistry is Bad for Business
Professional Courtesy: Coming Soon: More Denture Patients
Continuing Education
Sleep Apnea Screening and Treatment
Data Encryption: Count the Acronyms
Anterior Tooth Position in Restorative Dentistry: Applying the Chasolen Triad
Poll
Office Visit: Texas Hygienist a Diva of Dings
What is the Current Science Behind Socket Grafting to Preserve Ridge Height?
Pulp Capping: Improving the Prognosis
Industry News
New Products
Should I Extract That Tooth?
Townie Meeting 2015 Preview
Ad Index
Remembering Suzanne Mann
Diagnosis in Endodontics
Quickbooks: Ten Tips to Stay Organized and Efficient
Dentally Incorrect
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