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Restoration of the Complete
Dentition at an Increased
Vertical Dimension of Occlusion
Case Presentation
In 2013, a 47-year old female presented with profound, generalized
occlusal/incisal wear. Her teeth were sensitive, restorations were failing and she was unhappy with her smile. Examination revealed that
significant vertical dimension of occlusion had been lost. Most of the
clinical crowns were short. Restoration at an increased vertical dimension of occlusion with minimal reduction of occlusal/incisal surfaces
was indicated.
Treatment Plan
Analysis of her occlusion utilizing centric jaw relation mounted study
casts on a Whip Mix semi-adjustable arcon articulator indicated that by
opening the incisal guide pin 6mm it would predictably allow restoration of her dentition by precisely minimizing reduction of tooth structure. This could be accomplished by utilizing a combination of
restorations: full veneer gold crowns all second molars, ceramo-gold
crowns maxillary first molars, mandibular pre-molars and first molars,
porcelain veneers mandibular incisors and canines, ten emax crowns
maxillary anterior and pre-molar teeth. Additionally, restoration of the
posterior dentition initially would minimize complications during the
temporization phase due to the combination of short crown length and
occlusal parafunction. Upon completion of treatment, a night guard
would be fabricated to minimize breakage/wear of the restorations.
Initial Clinical Procedures
In order to evaluate her tolerance to a 6mm increase in vertical dimension of occlusion, she utilized a maxillary occlusal deprogramming
splint for several weeks. The splint was fabricated on a mounted duplicate maxillary cast utilizing clear heat polymerizing polymethyl
methacrylate. She adapted well. Utilizing two sets of cross mounted
casts, the following was accomplished: diagnostic wax-up, fabrication
of heat polymerized acrylic shell temporary splints, reduction guides
and autopolymerizing acrylic maxillary and mandibular incisal indexes.
Next, the incisal indexes were tried in to demonstrate the planned anterior crown length.
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