Limited Interocclusal Space Research Articles

Conservative Management of Extensively Damaged Endodontically Treated Tooth using Ceramic Endocrown and Deep Margin Elevation: A Clinical Report

Introduction: The restoration of endodontically treated molar continued to be a challenging issue. After endodontic treatment, generally the tooth is exposed to a higher risk of fracture. Endocrown as a minimal invasive restoration could be a wise alternative for restoring molars with large coronal destruction and limited interocclusal space. Observation: Through this work, we present a clinical case report of an endocrown-type restoration, fabricated from lithium disilicate ceramic (IPS e.Max CAD) in a maxillary first molar with extensive coronal destruction associated to cervical margin relocation. Discussion: We discuss the indication and use of endocrown to replace single crowns with intraradicular retention. The supragingival margins of the endocrown preparation simplify rubber dam isolation, and the adhesive procedure that’s why deep marginal elevation in this case was performed.

Unconventional implant strategy for patients with a limited interocclusal space in the posterior region: a case report

BackgroundImplant prostheses require sufficient interocclusal space. In cases of limited interocclusal space, reducing or extracting over-erupted opposing teeth, orthodontic intrusion, or surgical reconstruction of the edentulous space are commonly used to restore the interocclusal space. However, there are disadvantages to these approaches.Case presentationThe present case report describes a patient with a limited interocclusal space managed using an unconventional implant strategy.ConclusionsThe patient presented satisfactory outcomes without any signs of implant failure, suggesting that the unconventional implant treatment strategy is a useful option for patients with a limited interocclusal space in the posterior region. This unconventional implant surgery provides a minimally invasive treatment alternative.

Guided Endodontics Modified for Treating Molars by Using an Intracoronal Guide Technique

The aim of this case report was to show the concept of guided endodontics in a maxillary first molar with limited interocclusal space. Guided endodontics involves merging cone-beam computed tomographic imaging and a surface scan of the tooth in order to create a guide to perform a drill path into the seemingly obliterated root canal. In the molar region, the interocclusal space is often too small to accommodate the guide, bur, and handpiece at once, and, therefore, a modified approach is presented. A 52-year-old man was referred because the dentist had failed to localize the distobuccal root canal of a maxillary molar (#3) associated with apical pathosis. After reopening and rubber dam placement, a glide path was established for both the palatal first mesiobuccal root canal and the second mesiobuccal using a size 10 hand file and coronal flaring. Further instrumentation to the working length was achieved by reciprocating file size 25. All 3 canals were temporarily filled with calcium hydroxide. For the distobuccal root canal, guided endodontics was chosen in order to avoid further impairment of the tooth because negotiation of the canal failed even with the use of the operating microscope. Following the merged data obtained from the cone-beam computed tomographic and surface scans, a translucent SICAT Optiguide (SICAT, Bonn, Germany) was constructed containing a sleeve representing the proper direction of a drill path in order to reach the distobuccal root canal. The access cavity was temporarily filled with a composite material made for light-curing. Before light curing, the Optiguide was replaced on the teeth, and a steel pin was pressed through the sleeve and the composite whereby the proper drill path direction was transferred into the composite. After polymerization and removal of the Optiguide and pin from the composite base sleeve, the guided drilling could be performed. This case report is the first on guided access preparation in a molar with pulp canal obliteration and limited interocclusal space. The demand for more interocclusal space was solved by transforming the virtual drill path into a composite-based intracoronal guide. The use of digital technology was essential.

A clinical analysis of screw-retained implant-supported casted integrated abutment crowns in the molar region with limited interocclusal space

To observe the clinical effects of screw-retained implant-supported casted abutment integrated crowns (IACs) in the molar region with limited interocclusal space. This study involved 507 implants in 376 patients with limited interocclusal space in the molar region. All implants were inserted to the jaw by standard one-stage protocol. Screw-retained IACs were used as the final prosthesis. With 6 to 24 months follow-up, the clinical effects of screw-retained IACs were recorded and analyzed using SPSS 17.0 software package. During 6 to 24 months of follow-up, the implant survival rate was 99.61%. 37 patients had ceramic fracture which mainly happened in the group with 3-4 mm interocclusal space. In each group, porcelain fused to metal (PFM) prosthesis had ceramic fracture more easily than PFM prosthesis without porcelain on occlusal surface(P<0.05). As the interocclusal space became smaller, the probability of collapsing porcelain increased(P<0.05).13 patients had screw loosening. 13 patients suffered from gingival swelling and bleeding, they were given periodontal treatment and oral hygiene instruction. Patients were satisfied with the restoration results. Screw-retained IACs can be used to repair missing teeth in the molar region with limited interocclusal space.

Complexity of comprehensive care treatments in undergraduate dental programs: The benefits of observing and assisting experienced faculty members.

ObjectiveTo improve the confidence of the final year dental students in completing occlusal and oral rehabilitation of patients, with complexities beyond their scope, based on full analysis of the biomechanical and esthetic considerations of each case.Material & methodsTwo comprehensive patient situations presenting with special difficulties including extensive, reduced vertical dimension of occlusion, limited interocclusal space and maxillary alveolar bone for implant insertion necessitating bone augmentation and a sinus lift surgery was managed by two students at our institute. Procedures like surgical crown lengthening, sinus lifting, and bone augmentation were performed by senior faculty with the respective two students’ assisting as well as following up at the healing phase and reporting progress of healing and any possible complications to the supervisor. Students’ reported significant improvement in decision making skills; time management; interpersonal skills, management of cases in an evidence –based interdisciplinary approach as well as increase in their confidence in managing complex cases independently. Follow up with both cases showed optimum outcome and patients’ satisfaction.ResultsStudents’ reported significant improvement in decision making skills; time management; interpersonal skills, management of cases in an evidence –based interdisciplinary approach as well as increase in their confidence in managing complex cases independently. Follow up with both cases showed optimum outcome and patients’ satisfaction.ConclusionsExposing students to manage complex oral rehabilitation including procedures like sinus lifting and bone augmentation, through an evidence-based interdisciplinary approach during the undergraduate comprehensive clinical dentistry course enhances their confidence and clinical acumen as an independent practitioner.

Influence of surface treatment on the wear of solid zirconia

Objective. Recently there has been talk of the use of full-contour solid zirconia crowns or bridge restorations with no porcelain overlay. This could be a useful solution for patients with bruxism or limited interocclusal space. However, the hardness of zirconia could affect the opposite natural dentition. The aim of this in-vitro study was to investigate the role of surface treatments on the wear of a zirconia material and its antagonist. Materials and methods. Fifty plates (10 × 10 × 1 mm) made of zirconia (LavaMulti™ ZrO2, 3M ESPE), divided into five equal groups, were sandblasted and ground under standardized conditions with a fine-grit diamond bur (Komet Brasseler, Germany) to simulate clinical conditions. Group (a) was only fired, (b) was fired and sandblasted, (c) only ground, (d) was ground and additionally polished (EVE Ceramic Polishing-Set, Pforzheim) and (e) was ground and glazed. Wear behavior was measured with a pin-on-disk apparatus ABREX against 6 mm steatite balls as antagonists (45°, 5 N load, 5000 cycles, water). The amount of wear was determined topographically using a 3-D profilometer (Concept 3D, Mahr, Germany) by measuring the height loss of the antagonist and the depth of wear Pt of the zirconia. Results. In groups (a), (b), (c) and (d) the wear value Pt could not be determined (<1 μm). Wear values of the antagonists (steatite balls) revealed a similar outcome in contact with (b), (c) and (e) in the range of 81–85 μm, whereas (e) was more abrasive but not significantly. A noticeable difference in the wear of the antagonist showed group (d) to have the smallest value. Conclusion. Polished zirconia seems to have the lowest wear on the antagonists, in contrast with the other kinds of surface treatment.

Multidisciplinary Management of Limited Interocclusal Space: A Clinical Report

Prosthetic management of partial edentulism can be challenging with the presence of limited interocclusal space. The extrusion of opposing teeth combined with the alveolar extrusion of the edentulous areas reduces the space needed for fabricating a removable or fixed prosthesis when edentulous areas are present in the maxilla. This clinical report describes the treatment provided to a patient who presented with a limited interocclusal space on the posterior right quadrant. Before prosthetic rehabilitation, mandibular right posterior teeth were intruded, and the maxillary right posterior alveolar crest was reduced by alveoloplasty. After gaining adequate space, prosthetic rehabilitation was completed with a maxillary removable partial denture. During the 2-year follow-up period, the patient's chewing functions and physical appearance improved, and no complications occurred.

Fabrication of a custom abutment for a wide-diameter implant in a situation with limited interocclusal space

This article illustrates a technique to solve the esthetic and functional challenges of restoring implants in situations with limited interocclusal clearance. As manufactured, some wide implants lack a gold cylinder abutment that attaches directly to the implant. Instead, an intermediate abutment is provided with the system. However, with limited interocclusal space, it is not feasible to restore an intermediate abutment due to the increased restorative space required. This article describes a technique to fabricate a customized abutment that directly connects to a wide-diameter implant, resulting in a functional and esthetic restoration.

Resistance to dislodgement of zirconia copings cemented onto titanium abutments of different heights

For patients with limited interocclusal space, standard height implant abutments may not be usable. Shorter abutments may be desirable. The purpose of this study was to determine the effect of the height of titanium abutments on the tensile strength required to dislodge zirconia copings. Two experimental groups of abutments were prepared: (1) 4.3-mm platform width implant abutment with a 6.5-mm height (control), and (2) a 4.3-mm platform width implant abutment with a 5.5-mm height (shorter). Each abutment had 5 zirconia copings (custom designed) fabricated through a 3-dimensional computer-assisted design (3-D CAD) process by scanning an identical wax pattern. The zirconia copings were designed to have a 6-mm projection above the titanium abutment to accommodate a 2-mm hole. A wire was inserted through this hole to attach the zirconia coping to a universal testing machine. Each abutment was placed onto an implant embedded in a brass base designed to fit onto the universal testing machine. The zirconia copings were cemented onto the abutments with a provisional luting agent (Improv), and a tensile force was applied at a crosshead speed of 0.5 mm/min. The removal force was recorded for each specimen. An unpaired t test was used for the statistical analysis (alpha =.05). The mean force (SD) necessary to remove the zirconia copings (Newtons) from the 6.5-mm titanium abutment (198.09 (28.83)) was higher (P=.0078) than for the 5.5-mm abutment (124.89 (36.388)). By increasing the height of the abutment 1 mm and maintaining the diameter of the abutment, the resistance to tensile forces increased significantly between the 2 abutment dimensions evaluated.

Intentional replantation of a mandibular molar: case report and 14-year follow-up

This case report describes the nonsurgical endodontic treatment and intentional replantation of a mandibular molar and its nearly 14-year follow-up. A 56-year-old woman sought treatment with complaint of discomfort and sensitivity in the mandibular left area. The radiographic examination showed that the mandibular left first molar was endodontically treated, with over-instrumentation of the distal root and unsatisfactory obturation on the mesial root. A large periapical lesion was observed surrounding the roots. In view of the patient's limited interocclusal space and objection to undergo an apical surgery, intentional replantation was suggested as an alternative. The patient returned for clinical and radiographic follow-up at 15 days, 40 days, 6 months, 12 months, and once yearly thereafter. At the last visit, after 14 years, no painful symptomatology was reported, probing depth was no greater than 3 mm, the periradicular area had normal appearance and no evidence of root resorption or periapical lesion.

Advantageous uses of new computerized custom milled abutments in restoring endosseous implants

Golden criteria of an implant abutment system would be that it is a machined milled, custom made, made of titanium, it accounts for poor angulation and limited interocclusal space. It also should provide ease of orientation during transfer in and out the patient's mouth, and it should have individualized resemblance of the prepared tooth form for the replaced tooth to provide optimal esthetics, healing, and emergence profile. Only one abutment system that has been introduced recently provides all of these criteria. This abutment system would be the computerized custom milled titanium abutment.

Management of worn dentition with resin-bonded cast metal lingual veneering

The treatment of excessive tooth wear with limited interocclusal space is complicated. Nonprecious alloys may be cast into thin sections and bonded to the tooth surface with an adhesive cement. The technique may be applied to the provision of veneers to restore and protect worn tooth surfaces. This article describes the conservative management of excessively worn maxillary anterior teeth by use of this technique.