5.full Mouth Rehabilitation of The Patient With Severely Attrited Teeth

Full mouth rehabilitation of the patient
with severely worn dentition : a case report
Mi-Young Song, DDS et al , J Adv Prosthodont 2010

INTRODUCTION
The gradual wear of the occlusal surfaces of teeth is a
normal process during the lifetime of a patient. However, excessive occlusal wear
can result in pulpal pathology, occlusal disharmony, impaired function, and
esthetic disfigurement. Tooth wear can be classified as attrition, abrasion, and
erosion depending on its cause.
The severe wear of anterior teeth facilitates the loss of anterior
guidance, which protects the posterior teeth from wear during excursive
movement. The collapse of posterior teeth also results in the loss of normal
occlusal plane and the reduction of the vertical dimension.
VERTICAL DIMENTION AT OCCLUSION
( VDO)
DEFINITION :
• The distance between two selected anatomic or marked points (usually one on
the tip of the nose and the other on the chin) when in maximal intercuspal
position
(GPT 9)
• The rehabilitation of the severely worn dentition using fixed or removable
prostheses is complex and among the most difficult cases to restore when the
space for restoration is not sufficient.
Hence, assessment of the vertical dimension is important for the
management, and careful comprehensive treatment plan is required for each
individual case
• This case explains how a satisfactory clinical result was achieved by restoring
the vertical dimension with an improvement in esthetics and function.
CASE REPORT
• PATIENT DETAILS :
 77 year Old woman
 Chief complaint : Could not eat anything because her teeth were worn too much
 Medical history : Had anticoagulant and analgesic agent due to HT and idiopathic
head ache
• The facial type of patient was square
• Her lip seemed to be under strong tension.
INTRA-ORAL EXAMINATION :
 Generalized loss of tooth substance

 more in maxillary left incisors and mandibular right
incisors
 Maxillary left canine and mandibular right canine
(had root canal treatments) were worn to gingival
level
 Anterior teeth had
1. Sharp enamel edges,
2. Dentinal craters
3. Attritional wear due to loss of posterior support
 Mandibular posterior teeth were missing
• The discrepancy between centric occlusion (CO) and maximum intercuspal
position (MIP) was found when she was guided to CR with bimanual
technique.
• The patient did not have temporomandibular disorder history and soreness of
the mastication muscles
• In the transcranial view , any specific disorder was not found
Determination of alteration in VDO :
1. Loss of posterior support

2. History of wear
3. Phonetic evaluation
4. Interocclusal rest space
5. Facial appearance
POSSIBLE CAUSES OF PATIENT’S WORN DENTITION :
1. Posterior interferences
2. Parafunction
3. Eating habit
4. Dental ignorance
Treatment Options
1. Restoring mandibular edentulous posterior region with implants or
removable partial denture,
2. Full mouth rehabilitation with metal ceramic restoration with or
without crown lengthening procedure
Treatment Procedure
• Casts were mounted on a semi-adjustable
articulator using a face-bow record
• An interocclusal record that was made with the
aid of a Lucia jig and polyvinylsiloxane
occlusal registration material
• The new VDO was set by 5 mm increase in the
incisal guidance pin of the articulator
• An occlusal splint was fabricated
• Offered bilateral contacts of all posterior teeth
in centric relation and anterior guidance in
Occlusal overlay splint was
excursive movements
delivered and monitored for 1
• The anterior guidance disoccluded the posterior month to evaluate patient’s
teeth in all jaw positions except centric relation adaptation to the new VDO.
• CR record using Lucia jig and wax-rim was
taken
• Diagnostic wax-up was performed
• Autopolymerizing acrylic resin (ALIKETM;
GC America, ALSIP, USA) provisional
crowns were fabricated using a vacuum
formed matrix
• mandibular provisional RPD was made to fit
provisional crowns
• The provisional fixed restorations were
cemented with temporary cement
Provisional restorations were

placed after trial period of
• For three months, interim restorations were used as a
guide for the definitive oral rehabilitation
• Improvement in mastication, speech, and facial
esthetics confirmed the patient’s tolerance to the new
mandibular position with the restored VDO
• The anterior guidance and posterior disocclusion on
excursive movements were established
• Adjusted occlusion was transferred to customized
anterior guide table, which was made with acrylic
resin(PATTERN RESIN)
• Final preparation was performed, and definitive
impressions were made with polyvinylsiloxane Customized anterior guide was
impression material made utilizing the duplicated
Provisional restoration casts.
• Bite registration
- was taken using provisional crown and occlusal registration
material (StoneBite; Dreve Dentamid GmbH, Unna, Germany)
• Porcelain fused to metal restorations were made using customized anterior

guide table .They were cemented with resin modified glass ionomer cement
• The amount of occlusal adjustment on the lingual surface of maxillary anterior
teeth was minimal (Because the patient’s anterior guidance table was used in
the production of definitive restoration)
• Definitive mandibular RPD was fabricated and delivered with minor occlusal
adjustment
• The prostheses were designed using mutually protected occlusion.
• Oral hygiene instructions and regular check-up were administered.
Definitive restoration
DISCUSSION
• Turner’s classification and crown lengthening procedure
• Adhesive strategy is used more now-a-days
• Conventional treatment modality was chosen for this case which
includes
A trial overlay splint
Provisional restoration
Careful monitoring and
Definitive prosthesis
• Increase of VDO was determined by patient’s physiologic factor
like interocclusal rest space and speech.
• Trial period for the removable occlusal overlay splints was 1
month and provisional restoration was 3 months.
• Depending on the patient’s situation and adaptation ability, the
interim period can be modified
• The rehabilitation using restoration of crowns and RPD providing
posterior support is affordable
• The education on wearing RPD is necessary
CONCLUSION
Management of patients with a worn dentition is

complex and difficult. Accurate clinical and radiographic
examinations, a diagnostic wax-up, and determining OVD are crucial.
In this clinical report, raising vertical dimension of occlusion
using removable occlusal overlay splint and following fixed
provisional based on accurate diagnosis showed successful full mouth
rehabilitation for severely worn down dentition.
REFERENCES
• Clinical considerations for increasing occlusal vertical dimension: a review J
Abduo,* K Lyons Australian Dental Journal 2012; 57: 2–10
• Prosthodontic treatment of traumatic overlap of the anterior teeth William B.
Akerly, J, Prosthet. Dent.July, 1977
• Enhancing stability : a review of various occlusal Schemes in complete
denture prosthesis krishna prasad DNUJHS Vol. 3, No.2, June 2013, ISSN
2249-7110
• The Occlusal Splint Therapy: A Literature Review Cheranjeevi Jayam Indian
Journal of Dental Sciences.March 2015 Issue:1, Vol.:7
• Full-Mouth Rehabilitation of a Patient with Severely Worn Dentition and
Uneven Occlusal Plane: A Clinical Report Journal of Prosthodontics 21 (2012)
56–64 c 2011 by the American College of Prosthodontists

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Full mouth rehabilitation of the patient

with severely worn dentition : a case report

Mi-Young Song, DDS et al , J Adv Prosthodont 2010

 Generalized loss of tooth substance

1. Loss of posterior support

Provisional restorations were

• Porcelain fused to metal restorations were made using customized anterior

Management of patients with a worn dentition is

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