Prosthetic restoration of the patient with inaccurate pronunciation after prosthesis fabrication through systematic diagnosis and treatment procedure: A case report

Yu-Sung Choi; Seong-Min Lee

doi:10.4047/jkap.2016.54.4.413

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Choi and Lee: Prosthetic restoration of the patient with inaccurate pronunciation after prosthesis fabrication through systematic diagnosis and treatment procedure: A case report

Case Report

J Korean Acad Prosthodont 2016;54(4):413-422.

Published online: NaN October 2016

DOI: https://doi.org/10.4047/jkap.2016.54.4.413

Prosthetic restoration of the patient with inaccurate pronunciation after prosthesis fabrication through systematic diagnosis and treatment procedure: A case report

Yu-Sung Choi^∗, Seong-Min Lee

Department of Prosthodontics, School of Dentistry, Dankook University, Cheonan, Republic of Korea

∗Corresponding Author: Yu-Sung Choi Department of Prosthodontics, School of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Republic of Korea +82 (0)41 550 1979: e-mail, yu0324@hanmail.net

Received 16 March 201615 April 2016 Accepted 19 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, there are cases where anterior esthetic prostheses are fabricated for better esthetics, but biologic, mechanical factors could be overlooked, too focusing on esthetic factor. This leads to changes in neutral zone, dentition, position of tongue and lips, occlusion and anterior guidance causing inaccurate pronunciation. Therefore, consideration of systematic diagnosis and treatment procedure are required. In this case, prosthesis was refabricated through a systematic diagnosis and treatment procedure using four factor (acoustic analysis, esthetic analysis, occlusion, neutral zone) for the patient who complained of inaccurate pronunciation and esthetics of the fixed prosthesis fabricated 10 years ago. Thus, by promoting functional, esthetic recovery, this case report demonstrates satisfying results to both the patient and dentist. (J Korean Acad Prosthodont 2016;54:413-22)

Keywords: Pronunciation, Acoustic analysis, Esthetic analysis, Occlusion, Neutral zone

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Fig. 1.

Lower formant value in phonetic analysis by Praat software before treatment.

Fig. 2.

Initial extraoral examination. (A) Facial midline with the midline of central incisors in frontal view, (B) Rickett's E-plane indicating the distance to the upper lip less than 4 mm and nasio-labial angle less than 90^° in lateral view.

Fig. 3.

Initial intraoral examination. (A) Old prosthesis in right lateral view, (B) Generalized gingival recession and inappropriate zenith line in frontal view, (C) Extrusion of the maxillary left central incisor in left lateral view.

Fig. 4.

Old prosthesis and generalized gingival recession in initial panoramic radiograph.

Fig. 5.

Semi-articulator mounting procedures for diagnosis. (A) Facebow transfer, (B) Mounting the diagnostic model to an articulator in lateral view.

Fig. 6.

Analysis of diagnostic model. (A) Inappropriate emergence profile in right lateral view, (B) Lower width/length ratio of maxillary anterior teeth in frontal view, (C) Excessive overjet and overbite in left lateral view.

Fig. 7.

First temporary bridge fabrication by generalized anterior guidance. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

Fig. 8.

Abutment evaluation after old prosthesis removal. (A) Maxillary occlusal view, (B) Mandibular occlusal view.

Fig. 9.

Secondary temporary bridge fabrication by piezography technique and generalized anterior guidance. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

Fig. 10.

Customized anterior guidance table fabrication. (A) Increased length of maxillary central and lateral teeth in diagnostic model, (B) Customized anterior guidance table.

Fig. 11.

Full contour wax-up try-in for final temporary bridge fabrication. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

Fig. 12.

Third and final temporary bridge fabrication by customized anterior guidance. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

Fig. 13.

Fourth temporary bridge fabrication. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

Fig. 14.

Final temporary bridge evaluation by smile line. (A) Improved smile line in frontal view, (B) Improved upper lip line in lateral view.

Fig. 15.

Final impression taking. (A) Maxillary impression, (B) Mandibular impression.

Fig. 16.

Duplicated final temporary bridge fabrication for CAD-CAM. (A) Maxillary temporary bridge, (B) Mandibular temporary bridge.

Fig. 17.

Duplicated final temporary bridge evaluation by smile line. (A) Frontal view, (B) Improved smile line.

Fig 18.

Final prosthesis fabricaion by calculating the length of the teeth using the width/length ratio of 78%. (A) Right lateral view, (B) Determination of the size of the lateral incisors and canines using principles of tooth proportions, the "golden proportion" in frontal view, (C) Left lateral view.