Its all about Occlusion

2 Rating(s).


Posted on By yongkun kim In Full Arch & Dentures

Patient presented with chief complaint of not being able to chew properly due to increased mobility of her dentition. Patient had deep anterior overbite with fremitus on MICP. Upper anterior teeth had degree 2+ mobility. Upper premolars had degree 1+. Upon evaluation, it was noticed that her occlusion had been collapsed. Signs and symptoms of posterior bite collapse with loss of OVD was present. Full maxillary arch implant supported hybrid bridge had been recommended by her dentist.

pre op
pre op

Therapeutic VDO
PMMA provisional


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15 Comments


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Dr. Yongkun, excelent treatment outcome. Congratulations.
Just one question: how did you determine between what was best
augment OVD or just crown lengthening? As we don´t see any face pic.
Thanks for posting
Jorge


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Dr Campos,
I agree with you that without cephalometric radiographs its hard to determine precisely if in fact there is loss of VDO. Analyzing teeth landmark relationship and extra oral face profile views, we determined that patient's therapy would benefit from increasing VDO to certain level. Once we set the therapeutic VDO with the aid of removable appliance within patients comfort level, we noticed that we had enough tooth structure to work with without pre prosthetic crown lengthening surgery. BTW, I enjoyed your presentation very much at Dental XP implant summit last year in NY. Thanks for your kind comments.
P.S: profile photos are before and after tx

profile photos


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Dr Yongkun, thanks for your comment abiut Dxp summit Lecture.Looking at thos pre/post pics I can see clearly that you did the best diagnosis and treatment plan. Lips embrassure marks, wrinkles have improved.
Thanks
Jorge


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very nice result, Yongkun!


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Dr Goldstein,
It's a great honor receiving such comments from you. Thanks


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YK... you put a smile on my face. Well thought out and executed. Well done.


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Thanks, Dr Salama
And your comments put a bigger smile on mine
Regards, YK


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Great case and super service to the patient.

I have questions:

1-To increase the VD you start adding to the anterior to determine the anterior guidance?
2-How do you determine the incisal lenght of the upper central?

Regards


Reply

Dr Estrada,
the safest way is to utilize removable appliance such as Hawley appliance with anterior bite plane as a diagnostic device to test patient's tolerance to the new therapeutic VDO. This method is completely reversible, in case set VDO is not acceptable to patient's comfort.
Once VDO is set, occlusal concept of periodontal prosthesis is applied. Shallow fossa, reduced cusp height, and therefore shallow anterior guidance to minimize off axis load.
There are many factors to be considered in determining the length of upper central incisors. But one of prime significance is the phonetics. Similarly in removable prosthodontics, "F" sound determine the length of central incisor. During "F" sound, incised edge of upper central should lightly touch the vermilion border of lower lip.
I didn't meant to be this long but hope it was helpful.
with regards ,
YK


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Amazing case and result. As Mariano asked above, I am a periodontist I don't do the prosthetic work up for cases like these but I would be very interested in learning, so please discuss more about how you decided on ideal VDO and your planning to work this case up. Always enjoy your cases. Such a great service for your patients. Regards, Naheed


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Dr Mohamed,
Thanks for your kind comments.
Rather than trying to identify the "Ideal VDO" , We try to establish VDO that works most favorably the therapeutic occlusion that we are trying to set. Meaning, we set the VDO that we want for therapeutic purpose and test if that is acceptable to the patient in terms of esthetics, phonetics and function.
Its my opinion that if patient has loss of VDO or not is not as relevant as if the VDO needs to be modified for the purpose of achieving most stable and functional occlusion.
Thanks for your generous positive comments
YK


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Yongkun; This is a great case as everyone has previously stated. Diagnosis, Treatment Planning and Execution; these are the fundamentals of dentistry that allows us all to have successful outcome. Thank you for posting this case. I never get tired of seeing beautiful work. Regards, Gerald


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Dr Benjamin,
Thanks for your kind comments.
We will keep trying ...
regards,
YK


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