Occlusal Vertical Dimension Research Articles

Rehabilitation of a Severely Worn Dentition with Partial Lithium-disilicate Glass Ceramic Restorations: A Case Report

Rehabilitation of worn dentition is a challenging task because several predisposing factors may be included in the pathogenesis. The treatment options and process should be carefully considered based on the clinical condition and patients’ requirements. This case report represents the esthetic rehabilitation of a 68-year-old patient who exhibited severely worn teeth caused by attrition and erosion. After clinical evaluation, 3 mm increase in occlusal vertical dimension was planned with partial lithium-disilicate ceramic restorations as laminate veneers for anterior teeth and vonlays (onlays with veneer extentions) for posterior teeth in maxilla. The adaptation of the patient to the increased occlusal vertical dimension was tested for 1 month by provisional direct composite restorations. As the patient did not show any discomfort, definitive restorations were completed. The patient was satisfied with the esthetics and functionality of her new dentition.

Uso de implantes dentais em pacientes com bruxismo

Dentition with severe wear in patients stricken by bruxism is a challenge due to loss of dental structure and occlusal vertical dimension and the temporomandibular implications. Bruxism is presented as a contraindication in cases of dental implants. This systematic review was carried out by examining the electronic literature available at PubMed and Google Scholar from 2010 to 2020 in Portuguese, English and Spanish languages. The review details the relationship between bruxism and dental implant failure in contrast to temporomandibular disorders, presenting the following conclusions: a) bruxism is a contributing factor to the occurrence of technical / biological complications of the dental implant and plays an important role in the failure of the dental implant; b) the anamnesis must be detailed to confirm sleep or day bruxism; c) the control of bruxism through the use of occlusal stabilization device may provide relief in the implants region and it is highly recommended. The aim of this literature review was to summarize the influences of different potential risk factors on the incidence of late dental implant failure. The protocol for this systematic review was prepared and implemented based on PRISMA guideline – Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Validação de planejamento digital de restabelecimento de dimensão vertical através de dispositivos interoclusais em pacientes com desgaste dental severo

Restoring the vertical dimension is one of the most challenging procedures in dentistry. Patients who have suffered severe wear of the dental elements must have their occlusal condition restored to normal through oral rehabilitation and interocclusal devices. The objective of this work is to validate the rehabilitation planning through the construction of an interocclusal device cemented over tooth remnants, produced within the digital flow for patients with severe loss of vertical dimension of occlusion. Dental scanning of the upper and lower maxillary arches was performed. Afterwards, the muscle deprogramming with Leaf Gauge strips was produced with the purpose of obtaining the relation of dimension and taking the digital vertical dimension. In a planning software, the teeth were added in volume until the new occlusion was reestablished. An interocclusal device was obtained through a 3D printer and it was cemented in the mouth to validate the vertical increase strategy. In conclusion, virtual planning is an excellent tool to produce devices, bringing a predictable functional and aesthetic result, improving chewing capacity, speech, as well as reducing the patient’s pain complaint.

Centric relation and increasing the occlusal vertical dimension: concepts and clinical techniques - part one.

This article explores the theoretical aspects and clinical procedures involved in recording centric relation. Established clinical techniques to record centric relation are considered and described in part one. The second article considers more recent concepts of centric relation and clinical techniques to record it. The basis of centric relation to increase the occlusal vertical dimension and clinical aspects of increasing the occlusal vertical dimension are considered.

Centric relation and increasing the occlusal vertical dimension: concepts and clinical techniques - part two

This article explores the theoretical aspects and clinical procedures involved in recording centric relation. Established clinical techniques to record centric relation are considered and described in part one. The second article considers more recent concepts of centric relation and clinical techniques to record it. The basis of centric relation to increase the occlusal vertical dimension and clinical aspects of increasing the occlusal vertical dimension are considered.

A paradigm shift in increasing the occlusal vertical dimension: community dental health care

A paradigm shift in increasing the occlusal vertical dimension: community dental health care

Occlusal reconstruction in a patient with reduced occlusal vertical dimension using a removable occlusal overlay splint

Occlusal reconstruction in a patient with reduced occlusal vertical dimension using a removable occlusal overlay splint

Full-mouth reconstruction with Implant and Tooth-supported Zirconia Restorations in a Digital Workflow

Zirconia has become a popular restorative material regarding the mechanical and biocompatibility advantages. Monolithic and translucent forms of zirconia advanced the aesthetics of this material, making it the material of choice for both tooth- and implant- supported restorations. Also, digital fabrication of zirconia not only enables accurate restorations but also provides time efficiency. The present case report demonstrates the rehabilitation of a patient who has generalized tooth wear with implant- and tooth supported monolithic zirconia restorations with buccal veneers in a newly established occlusal vertical dimension. The treatment process was completed in a digital workflow as the impressions were taken with a powder-free intraoral scanner and the digital data were send to the dental laboratory to fabricate the restorations. Monolithic zirconia restorations with buccal feldspathic veneers were completed without any adjustments in only two appointments. The patient was satisfied and the restorations have been in service for two years.

Training Patient for Definite Treatment with the Pre-Definitive Treatment Prosthesis or the Rehabilitation Device - A Case Report

Severe morphological changes and the reduction of the residual ridge in old denture wearers can pose major challenges like providing optimum retention, stability, support and restoring the lost vertical dimensions in the new dentures. In addition, wearing such dentures with decreased or poor function can impair mastication and lead to harmful effects on the nutritional status of the patients. A rehabilitation device, often called a transitional denture or pre-definitive treatment prosthesis often provides a fine springboard from which to construct the second set of dentures. The present case report describes a method to restore the lost occlusal vertical dimension with a pre-definitive treatment prosthesis using the old complete dentures for a patient for him to adapt to the changes before the fabrication of the new complete dentures.

Rehabilitating simulated worn dentition by using a complete digital workflow and five anatomic guidelines

This report describes the rehabilitation of worn dentition by using a complete digital workflow on a nonhinged simulated patient. A dentiform was used to represent an individual with loss of occlusal vertical dimension. Interim restorations were designed following the simulated patient's midline, interpupillary line, and ala-tragus line and a defined central incisal edge position, posterior maxillary teeth central groove, and buccal cusp position of posterior maxillary teeth. The definitive restorations were then designed and fabricated by following the contour of the interim restorations.

Full mouth rehabilitation in anterior crossbite and posterior bite collapse patient – A case report

Background : Esthetically and functionally successful full mouth rehabilitation requires careful attention and me-ticulous treatment planning. Successful restoration in a patient with anterior crossbite and a partially edentulous situation can be challenging especially when bilateral posterior segment teeth is missing. Combination restora-tion using attachment retained removable partial denture (RPD) and removable partial overdenture (RPO) is such kind of treatment modality in prosthodontics. Purpose : This study was to provide an overview of a case about full mouth rehabilitation in anterior crossbite and posterior bite collapse patient. Case : A 64-year-old female pa-tient came to Prosthodontic Department of RSGMP Universitas Airlangga to have dentures replacing her missing teeth with aesthetic issue on her anterior teeth in order to eat well and be more confident. The patient wants to change her smile into new smile with acceptable aesthetic and function. Management : Diagnostic wax-up was made to capture the right occlusal vertical dimension (OVD) in centric relation (CR) that will be used in the first stage of full mouth rehabilitation, followed by management of the remaining teeth by endodontic and periodontal intervention by crown lengthening. Then, definitive restorations were made by maxillary attachment retained RPD with splint four anterior crowns and mandibular RPO with two single crowns on the lower teeth to correct anterior crossbite and posterior bite collapse. Conclusion : Patient had a satisfactoryly aesthetic and functional results with new occlusion using maxillary attachment retained RPD and mandibular RPO.

Considerations in occlusal vertical dimension rehabilitation

The vertical dimension is one of the important aspects that affect facial appearance, because it is related in facial height ratio. The vertical occlusal dimension is the height of the lower face measured from two points (infra-nasal and gnation points) when the maxillary and mandibular teeth were occlusion in the maximum intercuspal position. In complex cases, tooth wear can result in a decrease in facial height because the predominant wear on the anterior teeth encourages downward movement of the condyles when the intercuspal is maximum so that the vertical di-mension decreases. In addition, factors that cause a decrease in the vertical dimension are loss of posterior teeth accompanied by skeletal disharmony or accompanied by tooth abrasion and migration. The purpose of this paper is to explain how to restore the decreased occlusal vertical dimensions. Things that need to be considered are di-vided into two, extraorally and intraorally. Extraoral considerations are in the form of a large reduction in OVD, fa-cial esthetics and conditions of the temporomandibular joint. The parameters considered intraoral were the remain-ing tooth structure and occlusion. It was concluded that tooth wear due to functional and parafunctional activities can result in dimensional changes in facial morphology as well as a decrease in the occlusal vertical dimension. Correct OVD rehabilitation is an important factor in the success of rehabilitation treatment.

The computer-aided design and rapid prototyping fabrication of removable partial denture framework for occlusal rehabilitation: clinical report

The objective of this case report was to describe the clinical sequence for occlusal vertical dimension (OVD) recovering with the manufacture of removable partial dentures (RPD) produced by computer-aided design and rapid prototyping. The patient presented to the Dentistry Department of the Federal University of Rio Grande do Norte reporting dissatisfaction with the superior RPD. At clinical investigation, a fracture in the minor connector and support at the region of tooth 15 was observed, in addition to severe OVD loss. In this case, after obtaining correct OVD, four more sessions were necessary for RPD fabrication. In the first appointment, intraoral scanning was performed to generate STL files used for path of insertion determination in the CAD software. The need for a guide plane on tooth 15 was observed, thus a preparation guide was designed and 3Dprinted to aid axial tooth reduction. At the second visit, after mouth preparation, another intraoral scanning was performed to acquire virtual working models. The RPD framework was designed and 3D printed in a castable resin pattern and invested for cobalt-chromium alloy melting. In the third visit, clinical evaluation of the framework and teeth and artificial gingiva colors selection were performed. The articulated models were then 3D printed, enabling pre-fabricated teeth to be assembled and acrylized. On the fourth appointment, RPD was installed and the patient received routine instructions. In this sense, the use of CAD/CAM technologies presented as a valuable tool to enhance restoration of OVD by the manufacturing of RPD.

Interdisciplinary management of nonsyndromic tooth agenesis in the digital age

Background and OverviewTooth agenesis is the most common congenital condition affecting the oral cavity. This condition can involve single or multiple missing teeth. Severe forms of tooth agenesis are best managed by a team of specialists, as they can be daunting for a single provider. Case DescriptionAs the goal of most patients is to replace missing teeth to improve cosmesis and function, a prosthodontist or restorative dentist plays a major role in the team’s effort. Although diagnostic skills and careful planning are still the mainstay of this treatment, digital technology and modern materials can greatly facilitate implementation of the treatment plan. The authors present a case of a patient with nonsyndromic oligodontia who had a deficient occlusal vertical dimension that was treated by means of an interdisciplinary approach. The management included a combination of orthodontics, fixed and removable prosthodontics, and oral surgery. Conclusions and Practical ImplicationsWhen treating patients with complex congenital tooth anomalies, the prosthodontist or restoring dentist is well positioned to take the lead and orchestrate treatment of the patient.

Correlation Between Length of Digitus Minimus, Thumb, Length of Ear, Eye, and The Vertical Dimension of Occlusion

Correlation Between Length of Digitus Minimus, Thumb, Length of Ear, Eye, and The Vertical Dimension of Occlusion

Occlusal re-establishment and clinical complications of resin-bonded fixed partial dental prostheses cemented at an increased occlusal vertical dimension: A retrospective study

Statement of problemResin-bonded fixed partial dental prostheses (RBFPDPs) cemented at an increased occlusal vertical dimension (OVD) (the Dahl concept) to create space for a metal retainer remain controversial because of the lack of reported clinical studies. This study evaluated RBFPDPs by applying the Dahl concept. PurposeThe purpose of this retrospective study was to investigate the clinical factors affecting the occlusal re-establishment and short-term complications of RBFPDPs cemented at an increased OVD. Material and methodsOcclusal re-establishment and clinical complications were reviewed in 109 participants (155 RBFPDPs) treated at the Faculty of Dentistry, Universiti Teknologi MARA from January 2013 to May 2018. Types of complications and risk factors were assessed from clinical data. Demographic factors, clinical factors, and prosthesis factors were distinguished and their association with occlusal re-establishment analyzed by using multiple regression analysis. ResultsA total of 155 RBFPDPs (42 anterior, 113 posterior) were placed in 109 participants. All achieved occlusal re-establishment, 89.9% complete occlusal re-establishment and 10.1% partial occlusal re-establishment, a minimum of 4 months after the RBFPDPs had been placed at an increased OVD. The design of the metal retainer coverage was found to be a significant factor affecting occlusal re-establishment and decementation (P<.05). Widening of the periodontal ligament space was the most common complication (29.2%). ConclusionsRBFPDPs cemented at an increased OVD can be clinically recommended. The design of the retainer coverage was a significant factor influencing occlusal re-establishment and clinical complications.

Correction of a Class III Malocclusion with All-on-4 Concept Implant Supported Full Mouth Rehabilitation.

This case report describes the correction of a skeletal Class III malocclusion by performing alveoloplasty and All-on-four styletitanium/acrylic (hybrid) fixed/detachable implant supported prosthesis.A 76-year-old Hispanic,femalepatient with a noncontributory medical history presented to the clinic witha chief complaint of "I cannot wear my upper partial denture, it keeps on breaking".Intraoral examination revealed significant inter-arch Class III relation, supra-erupted mandibular dentition, and significant loss of the vertical dimension of occlusion. Surgical treatment included edentulation of the patient in addition to a significant mandibular alveoloplasty in order to correct the patient's malocclusion prosthetically. Through proper planning and execution, a skeletal Class III relationship was corrected with an implant supported All-on-four maxillary/mandibular prostheses. An edge-to-edge incisal relationship was achieved along with an appropriate vertical dimension of occlusion. The preplanning protocol allowed determination of the required alveoloplasty in order to obtain sufficient restorative space to allow for the correction of the skeletal malocclusion prosthetically.

Reabilitação estética funcional com resina composta: relato de caso

Objetivo: Descrever reabilitação estética anterossuperior através de facetas diretas em resina composta. Relato de Caso: Paciente procurou a clínica odontológica, pois estava insatisfeita com seu sorriso. Ao exame clínico foi constatada perda de dimensão vertical, hábitos parafuncionais de bruxismo de vigília e restaurações infiltradas, dentre outros achados. Inicialmente, foi realizada uma profilaxia com pasta à base de pedra-pomes e água, em escova de Robinson, de todas as superfícies dentais; em seguida, após a confecção de uma placa miorrelaxante de acetato, visando controlar o bruxismo, foram realizadas restaurações adesivas nos dentes posteriores com o intuito de aumentar a dimensão vertical de oclusão. Sendo assim, os elementos fraturados que apresentavam férula compatível, optou-se por realizar a reconstrução com pino de fibra de vidro em virtude de eliminar a etapa laboratorial. Posterior a isso foi realizada uma sessão de clareamento de consultório e pôr fim a reabilitação através de facetas diretas em resina composta. Considerações finais: No tratamento reabilitador estético se fazem de extrema importância a destreza e competência do cirurgião-dentista quanto às técnicas e conhecimentos empregados no caso, visando à satisfação e segurança do paciente e êxito do tratamento realizado.

Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting

BackgroundAtraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months.MethodsChildren (5–10 yo) who had a primary molar with a dentinal occluso-proximal, cavitated carious lesion were allocated to the ART (selective removal) or HT arms. Primary outcome: restoration survival over 36-months (using Kaplan–Meier survival analysis, log rank test, and Cox regression). Secondary outcomes: (1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and (2) child self-reported discomfort; (3) treatment acceptability (immediately following interventions); (4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and (5) a post hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months).ResultsOne-hundred and thirty-one children (ART = 65; HT = 66) were included (mean age = 8.1 ± 1.2). At 36 months, 112 (85.5%) children were followed-up. Primary outcome: restoration survival rates ART = 32.7% (SE = 0.08; 95% CI 0.17–0.47); HT = 93.4% (0.05; 0.72–0.99), p < 0.001; Secondary outcomes: (1) OVD returned to pre-treatment state within 4 weeks; (2) treatment discomfort was higher for the HT (p = 0.018); (3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; (4) Child OHRQoL improved after 6 months; and (5) teeth treated with the HT exfoliated earlier than those in the ART group (p = 0.007).ConclusionsBoth ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child’s tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%).Trial registrationThis trial was registered in ClinicalTrials.gov (NCT02569047), 5th October 2015. https://clinicaltrials.gov/ct2/show/study/NCT02569047?cond=Hall+Technique+Atraumatic+Rest orative+Treatment&draw=2&rank=2.

Predictive Model for Occlusal Vertical Dimension Determination and Digital Preservation with Three-Dimensional Facial Scanning

(1) Background: Occlusal vertical dimension (OVD) in the optimal maxillo–mandibular relationship is an important parameter to establish when complex dental rehabilitation has to be done. The optimal method to measure OVD is still a challenge in everyday practice. The aim of the present study was to test the reliability of the correlation between OVD and some anthropometric and cephalometric methods described in the literature. The validity of OVD registration using a facial scanner was also assessed. (2) Materials and Methods: 150 dentate participants, aged 20–25 years, were randomly selected using sealed envelopes. Anthropometric measurements between specific standard points were performed: Subnasion–Prementon (Sn–PM) and Subnasion–Gnation (Sn–Gn) in maximum intercuspation and in the rest mandibular position, right and left pupil to the corresponding chelion. The cephalometric measurements registered were the lower facial angle and the angle between mandibular and Frankfurt planes. The distance Sn–Gn in maximum intercuspation was compared to all other parameters. Facial scanning, with a mobile phone and installed dedicated application, was performed on ten subjects, randomly selected using the same method among the participants, and the obtained 3D files were analyzed. The digital measurements were compared, for validity, to the clinical measurements. Pearson’s correlation coefficient was used, for comparing clinical Sn–Gn in maximum intercuspation position to the other parameters. (3) Results: A strong agreement between all measured anthropometric parameters of the facial scan and clinical contact measurement method was registered. None of the measured parameters could predict the exact OVD. (4) Conclusions: In the limits of our study, the facial scanning could be used for predictable registration of OVD and the stored digital information could be preserved through life and use for oral rehabilitation. However, if OVD needs to be determined, several measurement methods, including cephalometric measurements, need to be used simultaneously to reach a final decision.