"Intrusion via Hyperocclusion". Andrews Intrusion Phenomenon. Part 3.

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Posted on By Anton Andrews In Orthodontics

45y.o healthy, non-smoker female presented with #30-32 failed bridge due to the first molar mesial root fracture.
3 months after the extractions and immediate implants placement + GBR , the case was scanned with TRIOS intraorally.
Ideal emergence profile without "black triangles" to ensure self-cleansabilty of restorations was designed using Andrews RRR (Reversed Restorative Rehabilitation) method.
Besides that occlusal part of restorations designed in HYPEROCCLUSION (1.5-2 mm ) with upper molars to achieve non-invasive intrusion.
The STL file was sent to a milling center for Full Contour Zirconia CAM and sintering.
Once received Full Contour Zirconia Crowns were stained and glazed on site. Cemented with abutments outside the mouth and delivered in screw-retained fashion.
Posterior Pano was obtained in new occlusion to confirm the seat of the crowns and as the base-line for "intrusion via hyperocclusion."
Disscussion? Literature?

CAD design in hyperocclusion
CAD Overloaded Posterior implants

Treatment sequence x-rays
Andrews RRR

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Anton. Very impressive design and use of technology! I am very interested in this concept of yours. IMO it reasonably makes sense and could work. With that said, I can't help but think of other variables that need to be controlled in this approach. For example, how do you address the possible passive eruption of the other teeth in dis-occlusion? Is it possible you could level the plane of occlusion on the right side and worsen the plane of occlusion on the left side? In addition, what is the tangible benefit of intrusion of only #'s 2 and 3? Very nice work and level of skill displayed. Thank you for sharing. Chuck


Thank you for compliments, Charles.
You are absolutely right asking all these questions.
To answer occlusal related ones, it depends what occlusal platform or philosophy we base our discussion on.
I use gneuromuscular occlusal concept In my full moth rehabs when i need to change a bite.
Most dentists believe in CR.
For those, it is really hard to understand my approach, since the mandible is being repositioned forward with simultaneous pitch movement, totally opposite direction if compared to CR.
Other teeth movements are expected but very minor compared to target ones.
I have plans to attach a segment wire to #2,3,4,5 to intrude the premolars as well.


Anton, I´m very surprised about this case. As I told you my approach was very different. Endo uppers, ostectomy, new gingival level, and crowns and posts. And then, the lower crowns.
I would like to follow this case!
Thanks for sharing.


it is hard to follow you in this particular area.
Digital planning is quite shareable and I enjoy it.
Question arise about implant position and prosthetic strategy as Campos point out.
And your clinical approach of Hyperocclusion is quite innovative: I wonder about lateral disclusion, bilateral occlusion, neuromuscular feed back pattern and TMJ response.
You are saying patient is having no problem neither subjectively nor over the implant.
I'd like to see the case follow up and how did you manage to plan in advance the angle needed to a correct intrusion with no lateral deviation: do consider that you had to glue the crown to the T-Base causing some inaccuracy (that you can easily see comparing the two crown on X-ray).
Good issue for discussion.


Thank you Armando.
I will post follow-ups.
I do not understand what discrepancy do you see on x-rays?


Nice digital technology. I am aware of what you are trying to do but how will you address the posterior occlusion bilateraly without orthodontic treatment? how about TMJ in the future?


According to principles of Gneuromuscular dentistry this patient will benefit from pitch mandibular movement which had occurred in hyperocclusion. Minor super eruption of other discluded teeth will act as a positive "side effect".
TMJ will only benefit , as it will become Decompressed.
Currently there's bilateral chronic TMJ artrosis caused by steep anterior guidance which pushed the mandible into retruded position.


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