Journal List > J Korean Acad Prosthodont > v.53(4) > 1034848

Won, An, Park, Cho, and Huh: Rehabilitation of unstable occlusion caused by inter-dental arch discrepancy

Abstract

Inter-dental arch discrepancy between maxilla and mandible could cause three dimensional occlusal problems, and collapse of occlusal plane, multiple teeth loss and decrease of masticatory efficiency could be observed in patient having unstable occlusal contact. Patient showing posterior bite collapse, unstable occlusal contact and improper anterior guidance should be treated to recover stable centric occlusion, occlusal contact, and anterior guidance in conjunction between prosthodontics and orthodontic treatment. This clinical report describes the favorable results of orthodontic and prosthodontics rehabilitation of patient with above mentioned problems.

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Fig. 1.
Intraoral view at first visit (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Anterior lateral view.
jkap-53-377f1.tif
Fig. 2.
Initial panoramic radiograph.
jkap-53-377f2.tif
Fig. 3.
Transcranial radiograph (A) Initial stage, (B) Provisional restoration stage, (C) Definitive restoration stage.
jkap-53-377f3.tif
Fig. 4.
(A) Extraoral view at first visit, (B) Posteroanterior cephalometric radiograph, (C) Lateral cephalometric radiograph.
jkap-53-377f4.tif
Fig. 5.
The progress of orthodontic treatment (A) Initial leveling of the upper teeth, (B) Retraction of maxillary incisors with chain elastic and initial leveling of the lower teeth, (C) Intrusion of #13 (not seen in the picture) and #44, 45 using the miniscrews to correct scissors bite.
jkap-53-377f5.tif
Fig. 6.
Cephalometric superimposition of initial stage (red) and post-orthodontic stage (blue), (A) Overall superimposition, (B) Maxillary superimposition, (C) Mandibular superimposition.
jkap-53-377f6.tif
Fig. 7.
Intraoral views at post-orthodontic state. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.
jkap-53-377f7.tif
Fig. 8.
Diagnostic wax pattern. (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view, (F) Anterior lateral view.
jkap-53-377f8.tif
Fig. 9.
(A) Facebow transfer, (B), (C) Mounting procedure to semi-adjustable articulator, (D) Customized anterior guidance table.
jkap-53-377f9.tif
Fig. 10.
(A) Working cast with a separate die (maxilla), (B) Working cast with a separate die (mandible), (C) Resin coping and pattern resin (maxilla), (D) Resin coping and pattern resin (mandible).
jkap-53-377f10.tif
Fig. 11.
Interocclusal relationship registrations using provision restorations and resin coping.
jkap-53-377f11.tif
Fig. 12.
Wax pattern for definitive restoration. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Right lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Left lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.
jkap-53-377f12.tif
Fig. 13.
Clinical remounting using anterior programming device and pick-up impression. (A) Anterior programming device, (B) Interocclusal relation recording, (C) Pick-up impression for maxillary prosthesis, (D) Pick-up impression for mandibular prosthesis.
jkap-53-377f13.tif
Fig. 14.
Definitive prosthesis. (A) Working side during right lateral excursion, (B) Maxillary occlusal view, (C) Non-working side during right lateral excursion, (D) Left lateral view at centric occlusion, (E) Frontal view at centric occlusion, (F) Right lateral view at centric occlusion, (G) Non-working side during left lateral excursion, (H) Mandibular occlusal view, (I) Working side during left lateral excursion.
jkap-53-377f14.tif
Fig. 15.
Transversal discrepancy analysis.
jkap-53-377f15.tif
Fig. 16.
Horizontal and vertical overlap analysis of anterior tooth.
jkap-53-377f16.tif
Fig. 17.
Electromyographic recordings of the anterior temporal muscle and masseter muscle, (A) Initial stage, (B) Definitive restoration stage.
jkap-53-377f17.tif
Fig. 18.
Chewing pattern analysis (A) Initial stage of right side (scissor-bite state; chopping chewing pattern), (B) Initial stage of left side, (C) Definitive restoration stage of right side (grinding chewing pattern), (D) Definitive restoration stage of left side.
jkap-53-377f18.tif
Table 1.
Cephalometric measurements of pretreatment and posttreatment
Measurements Unit Korean norm Pretreatment Posttreatment
SNA (®) 81.6 82.3 81.8
SNB (®) 79.1 77.2 75.2
ANB (®) 2.5 5.0 5.0
Go-Me to FH (FMA) (®) 24.3 25.3 23.0
ANS to Me (LAFH) (mm) 71.4 86.0 83.5
Mx 1 to A-Pog (mm) 7.9 15.7 12.1
Mn 1 to A-Pog (mm) 4.6 8.1 7.2
Mx 1 to FH (®) 116.0 118.4 117.0
Mn 1 to MP (IMPA) (®) 95.9 103.7 112.4
Overjet (mm) 3.5 7.7 5.2
Overbite (mm) 1.8 5.5 3.3
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