Dentaltown July 2015 - (Page 40)
prosthodontics
feature
Multi-Disciplinary
Rehabilitation Case
by Andrew Chandrapal, BDS, MFGDP, DPDS, MClinDent(Pros)
R
ehabilitation of worn and failing
dentition can hold many issues
that complicate the process.
This case presents a number of
clinical issues such as tooth surface loss
(TSL) through erosion, abrasion, posterior
super-eruption, lack of posterior support,
hypodontia and periodontal attachment
loss. Within this myriad of complications,
the clinician is expected to gather data,
plan, execute and maintain such dentitions.
This case highlights some of the techniques employed to achieve a predictable
outcome, despite complications.
The patient, who I will refer to as Mr.
V, had been a routine patient in private
practice for many years. The patient was
fully aware of the level of tooth surface
loss and occlusal breakdown, although he
remained symptom-free and functional
for a number of years (Fig. 1; see p. 42).
Following the breakdown of a posterior
tooth, the patient decided to investigate
the possibility of improving functionality
and aesthetics while retaining many of the
individual features of his dentition so the
aesthetic change was not too extreme.
The initial visits were focused on data
collection and establishing a risk assessment and profile for this patient. This exercise proved to be invaluable given the scale
of treatment being proposed to get the patient to a predictable desired outcome.
The patient was provided with updated medical and dental histories that
pertained to levels of risk allowing the clinician to form a prognostic value to key
areas such as periodontal, dento-facial,
functional and bio-mechanical prognoses
(Fig. 2; see p. 42).
40
JULY 2015 // dentaltown.com
Clinical observations
*
*
*
*
*
*
*
*
*
*
*
*
*
Moderately restored dentition
Moderate risk of periodontal
breakdown
Missing #10
Chronic apical infection to #29
Severe gum recession to upper
posterior teeth-with marked bone
loss to upper molars
Low sinus levels bilaterally
Recently extracted upper right molar
due to deep caries
Stable diastema of 4-5mm between
#8, #9
Front teeth progressively chipping
and wearing down due to edge-toedge centric occlusal position
High biomechanical risk, observed
given levels of chemical erosion and
abrasion
Loss of vertical dimension leading to
slight over-closure
Passive super-eruption of upper
posterior teeth
No current caries
The aim of treatment
*
*
*
*
*
*
Stabilize active disease processes
Augment upper back jaw areas to
accept dental implants
Provide implants to the lower and
upper arches
Gain a stable position for bite and
jaw position
Build up the dentition to meet this
position using a combination of
ceramic, gold and composite in the
most indicated areas of the mouth
Maintain the status for long-term
predictability
Continued on p. 42
http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown July 2015
On Dentaltown.com
Howard Speaks: The Sweetest Taboo
Professional Courtesy: Power Through Participation
Continuing Education Update
Digital Impressions
Tips for Hiring New Team Members
Probing Systems That can Make a Difference in Your Practice
The Six Ways Staff Incentives are Revolutionizing the Dental Industry
A Multidisciplinary Rehabilitation Case
4th of July Emergency
Orthodontic Treatment in the General Dentistry Office
Industry News
TRIBUTE: DR. JOE STEVEN JR. The Story of a Legend, and the Legacy He Left Behind
TRIBUTE: DR. JOE STEVEN JR. Maybe We Should Ban Amalgam … a Profession Divided
TRIBUTE: DR. JOE STEVEN JR. Where are the Olives in Your Practice?
Why Mobile-First Really Means User-First
Continuing Education: Past, Present and Future Trends in Today’s Implantology
Airway Health: Dentistry’s Role in the Hidden Key to Wellness
Product Profi le: Accutron
Staff Pay and Rewards
The Whys and Hows of Adult Sedation Dentistry
A Review of “Uncomplicate Business”
Townie Choice Awards Product Showcase
Poll
Going the Extra Mile in Marketing
Ad Index
e.max—Matching a Dark Central
Product Profi le: Synergy
Dentally Incorrect
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