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. http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown January 2015

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Howard Speaks: Why Too Much Clinical Dentistry is Bad for Business
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Continuing Education
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Anterior Tooth Position in Restorative Dentistry: Applying the Chasolen Triad
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Dentaltown January 2015