Opening Vertical Dimension: How Do You Do It? by Evelyn Shine, DDS

Total Page:16

File Type:pdf, Size:1020Kb

Opening Vertical Dimension: How Do You Do It? by Evelyn Shine, DDS Opening vertical dimension: how do you do it? By Evelyn Shine, DDS Introduction Vertical dimension of occlusion is used to denote the superior inferior relationship between the maxilla and the mandible when teeth are in maximum intercuspation. When vertical dimension is decreased significantly, either via loss of teeth or parafunction, the result can be a collapsed bite. RELATED READING | Harmony in prosthodontics As vertical dimension is lost, the proportions of the face are altered; one’s chin becomes recessed, the lower half of the face may look short, and the angles of the mouth can develop chelitis. Loss of vertical dimension results in facial collapse, wrinkles by the nasolabial fold, and appearance of compressed and thin lips, which makes one appear older. RELATED READING | All-On-4 treatment option: a case report Dentures can be fabricated to correct a collapsed bite and increase vertical dimension in patients with missing teeth. Alternatively, vertical dimension can also be increased via an acrylic bite plate and/or fixed prosthodontic work. Case report A 60-year-old male patient presents to the dental office with the following chief complaint: “My lower teeth are getting shorter.” Upon visual extraoral examination, the patient had difficulty keeping his lower jaw still at all times; upon sitting still, the patient’s jaw tremors from side to side. It appears as though the patient may have Parkinson’s disease; however, the patient states that his medical conditions only include diabetes and hypertension. He is taking lisinopril to control his blood pressure. He denied tremors or Parkinson’s. Initial dental exam Fig. 1: Patient’s panographic radiograph Fig. 2: Bitewing and periapical radiographs Patient presents with multiple existing root canals and fixed prosthodontic work. Fig. 3: Intraoral preoperative photographs The patient has ground through the porcelain on the lingual surfaces of the crowns on Nos. 6, 7, and 9. The occlusal surfaces of the posterior teeth and incisal edges of the anterior teeth in the mandibular arch have considerable wear due to the fact that the patient is a bruxer. He is grinding natural tooth structure in the mandible against porcelain in the maxilla. Enamel is softer than porcelain and wears away quicker when the patient functions and grinds his teeth. Fig. 4: Treatment plan The pulp in the patient’s teeth had receded considerably and, therefore, endodontic therapy was not necessary prior to preparing his teeth for full-coverage PFM restorations. Preliminary impressions of the patient’s maxillary and mandibular arch were taken and poured up. A wax-up of the mandibular arch was created, opening the patient’s bite 3 mm. A PVS matrix was then fabricated on top of the wax-up. Fig. 5: Intraoral photographs, temporaries The PVS matrix was then used to build up the occlusal surfaces posterior teeth and incisal edges of anterior teeth in the mandibular arch with composite and open his bite 3 mm. The patient was kept in these temporaries for five months. The patient would return to the office once a month to assess his TMJ and occlusion. Every month, the patient denied TMJ symptoms. Fig. 6: Teeth prepared for PFMs Fig. 7: Metal copings After preparing the teeth for full-coverage PFMs, the patient returns to the office to try in the metal copings. Copings fit appropriately and were sent back to the dental laboratory for porcelain bisque bake. Fig. 8: Bisque bake Fig. 9: Bisque bake try-in Fig. 10: Inserted full-coverage PFMs Upon completion, a maxillary day and night guard was fabricated for the patient, and he was advised to constantly wear this device. Evelyn Shine, DDS, received her Bachelor of Arts in chemistry at New York University and her Doctor of Dental Surgery at New York University College of Dentistry. She then continued her dental training at Maimonides Medical Center in Brooklyn New York where she received advanced training in cosmetic dentistry, pain and anxiety control, treatment of medically complex patients, and in-patient care. .
Recommended publications
  • Changing Vertical Dimension: a Solution Or Problem? by Peter E
    Continuing Education Changing Vertical Dimension: A Solution or Problem? by Peter E. Dawson, DDS Abstract Much of what dentists know about the vertical dimension of occlusion (VDO) has changed from the dogma of a few years ago. Dentists who understand the fundamental concepts of VDO can use those concepts to great advantage in treatment planning. Failure to understand can (and often does) lead to missed diagnoses, failed treatment outcomes, and serious examples of unnecessary overtreatment. This article explains some of the principles that make changes in VDO advantageous and predictable, and exposes some of the misconceptions that are problematical. Learning Objectives After reading this article, the reader should be able to: recognize the importance of vertical dimension as it applies to treatment planning for anterior teeth. discuss why posterior segmental bite-raising appliances are contraindicated. describe how changes in vertical dimension affect buccolingual relationships of posterior teeth. explain why the effect of changing vertical dimension is best studied on face-bow mounted diagnostic casts. The Concept of Balance The equilibrium of the entire masticatory system is dependent on balance.1 The mandible at rest is balanced between the resting lengths of the elevator muscles and the depressor muscles (Figure 1 View Figure). Anything that affects the resting length of either group of opposing muscles can affect the critical relationship of the mandible with the maxilla at the resting position. Because the teeth are not in contact at the rest position and the mandible-to-maxilla relationship is not consistent,2,3 the rest position is not an accurate determinant of the jaw-to-jaw relationship at maximum intercuspation.
    [Show full text]
  • A Guide to Complete Denture Prosthetics
    A Guide to Complete Denture Prosthetics VITA shade taking VITA shade communication VITA shade reproduction VITA shade control Date of issue 11.11 VITA shade, VITA made. Foreword The aim of this Complete Denture Prosthetics Guide is to inform on the development and implementation of the fundamental principles for the fabrication of complete dentures. In this manual the reader will find suggestions concerning clnical cases which present in daily practice. Its many features include an introduction to the anatomy of the human masticatory system, explanations of its functions and problems encountered on the path to achieving well functioning complete dentures. The majority of complete denture cases which present in everyday practice can be addressed with the aid of knowledge contained in this instruction manual. Of course a central recommendation is that there be as close as possible collaboration between dentist and dental technician, both with each other and with the patient. This provides the optimum circumstances for an accurate and seamless flow of information. It follows also that to invest the time required to learn and absorb the patient’s dental history as well as follow the procedural chain in the fabrication procedure will always bring the best possible results. Complete dentures are restorations which demand a high degree of knowledge and skill from their creators. Each working step must yield the maximum result, the sum of which means an increased quality of life for the patient. In regard to the choice of occlusal concept is to be used, is a question best answered by the dentist and dental technician working together as a team.
    [Show full text]
  • Effect of Centric Interference on Canine Tooth Wear Andrey Gaiduchik
    Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 9-2018 Effect of Centric Interference on Canine Tooth Wear Andrey Gaiduchik Follow this and additional works at: http://scholarsrepository.llu.edu/etd Part of the Orthodontics and Orthodontology Commons Recommended Citation Gaiduchik, Andrey, "Effect of Centric Interference on Canine Tooth Wear" (2018). Loma Linda University Electronic Theses, Dissertations & Projects. 512. http://scholarsrepository.llu.edu/etd/512 This Thesis is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Loma Linda University Electronic Theses, Dissertations & Projects by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. LOMA LINDA UNIVERSITY School of Dentistry in conjunction with the Faculty of Graduate Studies ____________________ Effect of Centric Interference on Canine Tooth Wear by Andrey Gaiduchik ____________________ A Thesis submitted in partial satisfaction of the requirements for the degree Master of Science in Orthodontics and Dentofacial Orthopedics ____________________ September 2018 © 2018 Andrey Gaiduchik All Rights Reserved Each person whose signature appears below certifies that this thesis in his opinion is adequate, in scope and quality, as a thesis for the degree Master of Science. , Chairperson V. Leroy Leggitt, Professor of Orthodontics and Dentofacial Orthopedics , Co-Chairperson L. Parnell Taylor, Professor of General Dentistry Joseph M. Caruso, Professor of Orthodontics and Dentofacial Orthopedics iii ACKNOWLEDGEMENTS I would like to express my appreciation for all those who helped me complete my thesis.
    [Show full text]
  • Prediction of Root Form Using Crown Data: Mandibular Left First Premolar
    Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 9-2017 Prediction of Root Form Using Crown Data: Mandibular Left irsF t Premolar Matthew E. Durschlag Follow this and additional works at: http://scholarsrepository.llu.edu/etd Part of the Orthodontics and Orthodontology Commons Recommended Citation Durschlag, Matthew E., "Prediction of Root Form Using Crown Data: Mandibular Left irF st Premolar" (2017). Loma Linda University Electronic Theses, Dissertations & Projects. 463. http://scholarsrepository.llu.edu/etd/463 This Thesis is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Loma Linda University Electronic Theses, Dissertations & Projects by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. LOMA LINDA UNIVERSITY School of Dentistry in conjunction with the Faculty of Graduate Studies __________________ Prediction of Root Form Using Crown Data: Mandibular Left First Premolar by Matthew E. Durschlag __________________ A thesis submitted in partial satisfaction of the requirements for the degree Master of Science in Orthodontics and Dentofacial Orthopedics __________________ September 2017 2017 Matthew Durschlag All Rights Reserved Each person whose signature appears below certifies that this thesis in his opinion is adequate, in scope and quality, as a thesis for the degree Master of Science. , Chairperson Joseph Caruso, Professor of Orthodontics and Dentofacial Orthopedics Mark K. Batesole, Assistant Professor of Orthodontics and Dentofacial Orthopedics Rodrigo Viecilli, Associate Professor of Orthodontics and Dentofacial Orthopedics iii ACKNOWLEDGEMENTS I would like to express my gratitude to Dr.
    [Show full text]
  • Rehabilitation of the Worn Dentition
    CLINICAL Rehabilitation of the worn dentition Nancy Ward, of the Pankey Institute Visiting Faculty presents a case report integrating restorative and orthodontic treatment approaches here are many challenges when treating posterior slide into maximum intercuspation adult patients. Decreased cell turnover, was evident. 4-5 mm pockets in between the Tno potential of growth modification, first and second molars were also noted. The complicated medical histories, and previous oral patient was referred for periodontal treatment disease (periodontal disease, caries, tooth wear, where the periodontal condition was stabilised temporomandibular dysfunction) have been prior to initiating any further treatment. reported as major considerations when treating Problem list: adultsREF1. In adults, often compromises have • Severe wear of the anterior teeth to be made, especially in terms of occlusion • Supra-eruption of the attachment and anterior coupling when the foundation apparatus around the incisors due (ie occlusal relationships) are not going to to wear of the incisal edges be changed. Without proper alignment: • Increased overjet • Poorly aligned teeth can create abnormal Figure 1a: Pre-trial smile • Class II Division 2 with lateral force and stress on surrounding narrow arches (Figure 2). teeth and periodontal structuresREF2 Aims of Treatment: • Severe bruxism and wear of anterior teeth a. Create a Class I canine relationship can cause the attachment apparatus to b. Level align and rotate teeth extrude with the wear of the incisorsREF3 c. Round the arches • Periodontal surgery is often needed to d. Intrude upper central incisors to establish proper gingival architecture create proper gingival architecture • Alignment of the teeth prior to restorative e. Proper alignment of the upper dentistry enables the establishment central and lateral incisors creating of a physiologic occlusion space for restorative material.
    [Show full text]
  • Differences Between Centric Relation and Maximum Intercuspation As Possible Cause for Development of Temporomandibular Disorder Analyzed with T-Scan III
    Published online: 2019-09-23 Original Article Differences between centric relation and maximum intercuspation as possible cause for development of temporomandibular disorder analyzed with T‑scan III Zana D. Lila‑Krasniqi1, Kujtim Sh. Shala1, Teuta Pustina‑Krasniqi1, Teuta Bicaj1, Linda J. Dula1, Ljuben Guguvčevski2 1Department of Prosthetics, Faculty of Medicine, School of Dentistry, Pristina, Kosovo, Correspondence: Dr. Zana D. Lila‑Krasniqi 2Department of Prosthetics, Faculty of Dentistry, Email: [email protected] Skopje, Macedonia ABSTRACT Objective: To compare subjects from the group with fixed dentures, the group who present temporomandibular disorders (TMDs) and a control group considering centric relation (CR) and maximum intercuspation (MIC)/habitual occlusion (Hab. Occl.) and to analyze the related variables also compared and analyzed with electronic system T-scan III. Materials and Methods: A total of 54 subjects were divided into three groups; 17 subjects with fixed dentures, 14 with TMD and 23 controls‑selection based on anamnesis-responded to a Fonseca questionnaire and clinical measurements analyzed with electronic system T-scan III. Occlusal force, presented by percentage (automatically by the T-scan electronic system) was analyzed in CR and in MIC. Results: Data were presented as mean ± standard deviation and differences in P < 0.05 were considered significant. After measurements of the differences between CR and MIC in the three groups were noticed varieties but the P > 0.05 it was not significant in all three groups.Conclusion: In our study, it was concluded that there are not statistically significant differences between CR and MIC in the group of individuals without any symptom or sign of TMD although there are noticed in the group with TMD and fixed dentures disharmonic relation between the arches with overload of the occlusal force on the one side.
    [Show full text]
  • Parameters of Care for the Specialty of Prosthodontics (2020)
    SUPPLEMENT ARTICLE Parameters of Care for the Specialty of Prosthodontics doi: 10.1111/jopr.13176 PREAMBLE—Third Edition THE PARAMETERS OF CARE continue to stand the test of time and reflect the clinical practice of prosthodontics at the specialty level. The specialty is defined by these parameters, the definition approved by the American Dental Association Commission on Dental Education and Licensure (2001), the American Board of Prosthodontics Certifying Examination process and its popula- tion of diplomates, and the ADA Commission on Dental Accreditation (CODA) Standards for Advanced Education Programs in Prosthodontics. The consistency in these four defining documents represents an active philosophy of patient care, learning, and certification that represents prosthodontics. Changes that have occurred in prosthodontic practice since 2005 required an update to the Parameters of Care for the Specialty of Prosthodontics. Advances in digital technologies have led to new methods in all aspects of care. Advances in the application of dental materials to replace missing teeth and supporting tissues require broadening the scope of care regarding the materials selected for patient treatment needs. Merging traditional prosthodontics with innovation means that new materials, new technology, and new approaches must be integrated within the scope of prosthodontic care, including surgical aspects, especially regarding dental implants. This growth occurred while emphasis continued on interdisciplinary referral, collaboration, and care. The Third Edition of the Parameters of Care for the Specialty of Prosthodontics is another defining moment for prosthodontics and its contributions to clinical practice. An additional seven prosthodontic parameters have been added to reflect the changes in clinical practice and fully support the changes in accreditation standards.
    [Show full text]
  • Articulator Selection for Restorative Dentistry
    FIXED PROSTHODONTICS OPERATIVE DENTISTRY DAVID E. BEAUDREQU, SAMUEL E.GUYER, WILLIAM LEFKOWITZ, Section editors Articulator Selection for Restorative Dentistry Sumiya Hobo, D.D.S.,M.D.S.,*Herbert T. Shinningburg, Jr., D.D.S.,** and Lowell D. Whitsett, D.D.S.*** Tokyo, Japan, and Oklahoma City, Okla. The articulator selected, and even more importantly, the skill and care with which it is used, have a direct bearing on the success of fixed or removable restorations. Were the dentist’s only concern the relationship of the opposing teeth at the point of maximum intercuspation, both the design and the use of an articulator would be greatly simplified. Since the position of intercuspation is static, the articulator need act only as a regid hinge-little more than a handle for the cast. The mandible, however, does not act as a simple hinge. Rather, it is capable of rotation about axes in three planes. The occlusal morphology of any restoration for the mouth must accommodate the free passage of the opposing teeth without interfering with the movement of the mandible. Because of their potential for producing disease, occlusal interferences must not be incorporated into restorations placed by the dentist. One method of preventing this problem has been to use fully adjustable articulators which duplicate the mandibular movements with a high degree of precision. Treatments using these articulators are time-consuming and demand great skill by the dentist and the technician. As a result, the cost of such treatment does not make it feasible for most smaller routine treatment plans. Most single crowns and simple fixed partial dentures are fabricated on small hinge articulators that have limited ability to duplicate mandibular movement or none at all.
    [Show full text]
  • 12 Occlusion and Removable Prosthodontics
    Ch12.qxd 10/10/03 11:55 AM Page 111 Occlusion and removable 12 prosthodontics R. Jagger – Occlusal analysis Synopsis – Clinical stages Occlusal considerations for removable – Onlay dentures prostheses are essentially the same as for • Complete dentures fixed restorations. – Occlusion for complete dentures The approach to establishing occlusion for – Occlusal vertical dimension removable partial dentures is usually – Artificial teeth conformative. Partial dentures should not – Balanced occlusion transmit excessive forces to supporting – Lingualised occlusion tissues nor interfere with any contacts in – Occlusion and patient satisfaction intercuspal position or in functional – Clinical stages movements. Occasionally a reconstructive approach using onlays is used. Occlusion for complete dentures has three significant differences: Good occlusal practice for removable dentures is very similar to that described for fixed prostheses. • The absence of natural teeth in edentulous Partial dentures should not transmit excessive forces to patients may present significant difficulties supporting tissues nor interfere in intercuspal position or in determining an acceptable occlusal in functional movements. The occlusal form is usually vertical dimension. conformative with the natural teeth. Occasionally a • Complete denture occlusion is always a reconstructive approach using onlays is used. Occlusion reorganised occlusion. for complete dentures, however, has three significant • Absence of teeth produces problems of differences: denture stability (resistance
    [Show full text]
  • The International Journal of Periodontics & Restorative Dentistry
    Ohyama.qxd 12/7/06 4:38 PM Page 60 The International Journal of Periodontics & Restorative Dentistry Ohyama.qxd 12/7/06 4:38 PM Page 61 61 Recreating an Esthetic Smile: A Multidisciplinary Approach Hiroe Ohyama, DMD, MMSc, PhD* The esthetic restoration/rehabilitation Shigemi Nagai, DDS, MS, PhD* of a patient with a functionally com- Hiro Tokutomi, RDT** promised dentition frequently involves Michael Ferguson, DMD*** a multidisciplinary approach. The suc- cessful integration of esthetics and function does not emerge by chance, but rather as a result of the meticulous development of clearly defined ana- Today’s dental patients are demanding a youthful, attractive smile. The esthetic tomic parameters and their subse- rehabilitation of patients with functionally compromised dentitions frequently quent incorporation into the design of involves a multidisciplinary approach. The realization of esthetic objectives in mul- the prosthesis.1–4 tidisciplinary cases represents a considerable clinical challenge. To a great extent, The restorative and periodontal proper case selection and careful multidisciplinary treatment planning can govern the predictability of procedures. A team approach that includes the clinicians, the elements, such as incisal length, incisal laboratory technician, and the patient is essential to achieve the desired results. plane, incisal profile, incisal display, This clinical report demonstrates a successful multidisciplinary approach to re- tooth shape and color, tooth propor- creating an esthetic smile of a patient whose anterior maxillary dentition had been tion, tooth-to-tooth proportions, gin- functionally and esthetically compromised by prosthetic and periodontal prob- gival architecture, and gingival display lems. (Int J Periodontics Restorative Dent 2007;27:61–69.) should be considered in the creation of a pleasing smile.
    [Show full text]
  • Occlusion in Complete Dentures
    1 OCCLUSION IN COMPLETE DENTURES C P Owen Introduction Occlusion has been described as the most important subject in all the disciplines of dentistry, and for good reason, because the way the teeth come together, and function together, is as important to most of us now as it was to our ancestors, who lived on diets much more difficult to cope with. When, as dentists, we are faced with the problem of replacing occlusal surfaces, either by restorations in natural teeth, or replacement of some or all of the teeth, then a thorough knowledge of the way teeth come together and function together, is essential. Occlusion has unfortunately also been described as one of the most confusing subjects in all the disciplines of dentistry (mostly by each generation of dental students). Attempts to understand occlusion have ranged from the mechanical, mathematical and geometrical analysis of tooth contact and jaw movement, to the biological and functional analyses based on the behaviour of natural dentitions under different environmental (mostly dietary) conditions. All of these analyses have their place but they need to be brought together into a unified concept, and this is rarely done. However, there are rational ways to study occlusion, and studying occlusion in complete dentures is a good starting point, because of the need to place an entire dentition within a system so that the edentulous patient can once again function with the minimum of discomfort and the maximum possible efficiency. Natural occlusion and artificial occlusion Development of the occlusion The evolution and development of the dentition and temporomandibular joint is a useful study in that it gives us clues as to how our present dentition functions.
    [Show full text]
  • Principles of Removable Partial Denture Design
    د.فائزة Lec. 23 Prosthodontics Principles of removable partial denture design The supporting structures for removable partial dentures (abutment teeth and residual ridges) are living things and are subjected to forces. The ability of living things to tolerate force is dependent upon the magnitude or intensity of the forces. The forces occurring through the removable partial denture can be widely distributed, directed, and minimized by the selection, the design and the location of components of removable partial denture and by developing a harmonious occlusion. Types of partial dentures 1. Removable partial denture, which includes the cobalt chromium and acrylic removable partial denture. 2. Fixed partial denture. 3. Implant supported partial denture, this could be fixed (implant retained partial denture) or removable (implant support partial denture). General principle 1. Utilize what is present. Whenever possible, select a design that fits the teeth and soft tissues, rather than choosing one that requires tissue alteration. The goal is to avoid gross, unnecessary preparations. 2. Minimize the framework elements. Whenever possible, the fewest number of minor connectors should be used. This decreases the potential for plaque adhesion. [3rd year / College of Dentistry/University of Baghdad (2018-2019)] Page 1 3. Plan for future. Planning for the future might involve designing castings with rest seats and guiding planes so they may subsequently be used as partial denture abutments, if required in the future. 4. Consider caries susceptibility. Cast clasps cover more tooth surface than wrought clasps. The latter would be preferred if caries incidence is higher than usual. 5. Avoid placing rest seats or guiding planes on direct restorations such as amalgam.
    [Show full text]