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Clinical Cases in Restorative and Reconstructive Dentistry



Clinical Cases in Restorative and Reconstructive Dentistry

Gregory J. Tarantola DDS

ISBN: 978-0-813-81564-0 September 2010 Wiley-Blackwell 488 Pages

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Wiley-Blackwell's “Clinical Cases” series is designed to recognize the centrality of clinical cases to the profession by providing actual cases with an academic backbone. Clinical Cases in Restorative and Reconstructive Dentistry describes the principles and demonstrates their practical, every-day application through a range of representative cases building from the simple to the complex and from the common to the rare. This unique approach supports the new trend in case-based and problem-based learning, thoroughly covering topics ranging from infant oral health to complex pulp therapy. Highly illustrated in full color, Clinical Cases in Restorative and Reconstructive Dentistry’s format fosters independent learning and prepares the reader for case-based examinations.

The book presents actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in restorative and reconstructive dentistry. The book begins by laying the groundwork of the fundamental principles that apply to all cases and outlining the ten decisions to be made with all cases. The main sections of the book cover the cases themselves, examining them both by type of restoration / solution, and by type of problem. This unique approach enables the reader to build their skills, aiding the ability to think critically and independently.

Clinical Cases in Restorative and Reconstructive Dentistry’s case-based format is particularly useful for pre-doctoral dental students, post-graduate residents and practitioners, both as a textbook from which to learn about the challenging and absorbing nature of restorative and reconstructive dentistry, and also as a reference tool to help with treatment planning when perplexing cases arise in the dental office.

Author xi

Contributors to Appendices xi

Acknowledgments xiii

Introduction xv

Part 1 Didactics 3

Chapter 1 Fundamental Principles of the Comprehensive Approach 5

The Case for the Four-Part Comprehensive Evaluation 5

The Details of the Four-Part Comprehensive Evaluation 5

The Initial Conversation 6

The Clinical System–Based Masticatory System Examination 8

Imaging 22

Articulated Diagnostic Casts 25

Chapter 2 The People Side of Dentistry 27

The Importance of Behavioral and Communication Skills 27

The All-Important 5 Questions 27

The Codiscovery Process 29

Which Approach Is Best—The 4 Quadrants 33

Dentistry: A Blend of Technical, Emotional, and Intellectual Skills 33

Chapter 3 The 4 Essential Skills of the Comprehensive Dentist 37

Section A Bite Splint Therapy 38

Section B Definitive Occlusal Therapy: Equilibration 45

Section C The Diagnostic Blueprint—Wax-Up 50

Section D Provisionalization55

Chapter 4 The 10 Decisions 63

Section A TMJ Diagnosis and Condylar Position 64

Section B Vertical Dimension 66

Section C Lower Incisal Edge Position 74

Section D Upper Incisal Edge Position 77

Section E Centric Stop Design 86

Section F Anterior Guidance 91

Section G Curve of Spee 98

Section H Curve of Wilson 101

Section I Cusp to Fossa Angle 102

Section J The Aesthetic Occlusal Plane 105

Part 2 Case Studies 109

Chapter 5 Nonremovable Implant Restoration with Natural Teeth 111

Case 1 Nonremovable maxillary implant restorations with natural teeth restorations including crowns, veneers, and fixed partial dentures 112

Case 2 Transitioning a maxillary tooth-supported fixed partial denture to an implant-supported fixed partial denture along with other single crowns and tooth-supported fixed partial dentures 121

Case 3 Lower reconstruction with lower left being implant-supported, important neutral zone consideration affecting design; upper reconstruction landmarks acceptable; temporomandibular disorder managed 129

Case 4 Maxillary fixed partial denture supported by both teeth and implants along with other maxillary and mandibular implant-supported crowns and tooth-supported crowns and fixed partial dentures 133

Case 5 Maxillary extractions, periodontal surgery, orthodontics, veneers, and fixed partial dentures on teeth; mandibular extractions, implants, fixed partial dentures on teeth and implants 139

Case 6 Multiple congenitally missing teeth, past orthognathics/orthodontics, tooth position inconsistencies handled restoratively, multiple implants, tooth-supported crowns and fixed partial dentures, implant-supported crowns and fixed partial dentures 143

See also: Chapter 6 Case 1 148

Chapter 7 Case 7 216

Chapter 14 Case 4 342

Chapter 6 TM Disorders Followed by Reconstruction 147

Case 1 Osteoarthritis of the left TMJ managed with bite splint therapy followed by implant-supported restorations and tooth-supported restorations 148

Case 2 Intracapsular and muscular components of a temporomandibular disorder managed with bite splint therapy followed by occlusal therapy and a full reconstruction 152

Case 3 Intracapsular and muscle disorder resolved with bite splint therapy followed by occlusal reconstruction with maxillary lingual porcelain veneers 157

Case 4 Intracapsular and muscle disorder with resultant occlusal plane asymmetry resolved with bite splint therapy and followed by occlusal therapy with restoration only on the lower left 162

Case 5 Past condylar replacement due to avascular necrosis followed by posterior occlusal reconstruction 166

Case 6 Temporomandibular disorder resolved with bite splint therapy followed by definitive occlusal therapy including a maxillary reconstruction and mandibular functional changes with composite 171

Case 7 Past mandibular orthognathic surgery to correct maxillary to mandibular malrelationship caused by condylar degeneration; intracapsular and muscle pain resolved with bite splint therapy followed by definitive occlusal therapy with posterior reconstruction and anterior composites 178

See also: Chapter 15 case 1 350

Chapter 16 case 1 360

Chapter 7 Restorations to Achieve Aesthetic and Functional Changes 183

Case 1 Restoration of anterior aesthetics and anterior guidance in a deep overbite damaged by bruxism with upper and lower anterior reconstruction 184

Case 2 Posterior reconstruction with severe interferences to the centric arc of closure 189

Case 3 Restoration of aesthetics and anterior guidance damaged by wear by increasing overbite with upper and lower anterior crowns 195

Case 4 Maxillary reconstruction at open vertical dimension to improve aesthetics, length, buccal profiles, and functional landmarks; mandibular restorations only recontoured 199

Case 5 Maxillary and mandibular aesthetic and functional reconstruction with lab-processed composite restorations to treat amelogenesis imperfecta 204

Case 6 Restorations maxillary bicuspid-to-bicuspid done first as part of a comprehensive plan; maxillary left central incisor implant and other functional discrepancies corrected with reshaping and equilibration 210

Case 7 Maxillary and mandibular dental reconstruction including 4 dental implants replacing unrestorable teeth; impaired aesthetics due to recession handled with grafts and all porcelain restorations 216

See also: Chapter 16 case 1 360

Chapter 8 Complete Implant-Supported Restorations 221

Case 1 Complete implant-supported maxillary reconstruction— transitioning the anterior teeth from tooth-supported to implant-supported 222

Case 2 Complete maxillary nonremovable restoration supported by 6 implants converted from a completed removable restoration on 4 implants 226

Case 3 Complete implant-supported nonremovable maxillary and mmandibular reconstructions; transitioning from natural teeth that were not predictably restorable 231

Case 4 Maxillary extractions, immediate implant placement, immediate loading, and complete nonremovable zirconia restoration with pink porcelain 237

Case 5 Mandibular implant bar–supported full removable denture converted to a nonremovable restoration to improve comfort of the neutral zone and phonetics 240

Chapter 9 Orthognathics 245

Case 1 Severe anterior open bite corrected with maxillary-only orthognathics and occlusal therapy with upper incisor restorations 246

Case 2 Mandibular orthognathic surgery and chin implant; managing a temporomandibular disorder during treatment; posterior restorative dentistry including implants 250

Case 3 Maxillary and mandibular orthognathic surgery with chin advancement; prerestorative occlusal therapy with equilibration and composite additions 256

See also: Chapter 16 Case 1 360

Chapter 10 Bruxism and Wear Reconstruction 261

Case 1 Restoration of worn lower anterior teeth in a deep bite without changing other restorations 262

Case 2 Severe wear from parafunctional habits restored with a complete reconstruction at an increased vertical dimension of occlusion 266

See also: Chapter 16 Case 2 366

Chapter 11 Perioprosthesis 275

Case 1 Full maxillary periodontal-restorative reconstruction improving aesthetics and function; lower posterior reconstruction following conventional surgery, bone and soft tissue grafts, covering recession 276

Case 2 Posterior reconstruction in conjunction with conventional periodontal surgery; root resection, pocket elimination 282

Chapter 12 Implants in the Aesthetic Zone 289

Case 1 Hopeless maxillary central incisor transitioned to an implant-supported restoration (delayed placement and delayed loading) with crowns on the remaining incisors along with occlusal therapy 290

Case 2 Extraction and immediate implant placement, delayed loading, and restoration maxillary central incisors; pink porcelain to simulate papilla 296

Case 3 Congenitally missing maxillary lateral incisors, orthodontics to open lateral incisor space, dental implants, and other aesthetic improvements 302

Case 4 Congenitally missing upper right cuspid; upper right lateral incisor lost in an accident; implant placed in cuspid position with 2-unit cantilever restoration, pink porcelain to simulate gingival 307

Case 5 Maxillary central incisor extracted and replaced with a dental implant, delayed placement, and delayed loading 311

See also Chapter 7 case 6 210

Chapter 13 Removable Implant-Supported Restoration with Natural Teeth 313

Case 1 Maxillary implant-supported bar-retained removable partial denture along with tooth-supported restorations to reconstruct occlusion and vertical dimension 314

Case 2 Combination mandibular fixed anterior–removable posterior reconstruction with Locator attachments 319

See also: Chapter 14 Case 4 342

Chapter 14 Combination Fixed-Removable Restoration on Natural Teeth 323

Case 1 Maxillary bar–supported removable partial denture; lower crowns with semiprecision removable partial denture 324

Case 2 Maxillary fixed partial dentures with precision removable partial denture; mandibular bar–supported complete denture 331

Case 3 Maxillary telescope case: alumina copings on natural teeth and removable overstructure; mandibular telescope case: Galvano copings on natural teeth and nonremovable overstructures 337

Case 4 Mandibular anterior fixed partial denture and posterior removable partial denture with implants and Locator attachments for added support and retention; maxillary reconstruction, telescope case with 1 dental implant included along with 6 teeth 342

Chapter 15 Implant-Supported Complete Dentures 349

Case 1 Maxillary extensive bone graft followed by implant-supported bars and bar-supported overdenture after managing a temporomandibular disorder; flange needed for lip support necessitating a removable rather than a nonremovable approach 350

Case 2 Severe maxillary and mandibular resorption; maxillary bone grafting; maxillary and mandibular implant-supported bar and bar-supported dentures; flange needed for lip and cheek support necessitating a removable rather than a nonremovable approach 355

Chapter 16 Reconstructions on All Natural Teeth 359

Case 1 Severe anterior overjet handled with occlusal/restorative treatment in lieu of orthognathics; muscular component of a temporomandibular disorder also managed 360

Case 2 Failed multiple reconstructions; original deep overbite with current condition in provisionals with an opened vertical dimension and anterior overjet; managed with a new reconstruction harmonizing a physiologic deep overbite 366

Case 3 Maxillary reconstruction combined with extractions and periodontal surgery to improve periodontal architecture; landmarks of lower acceptable with minor modification 373

Case 4 Full mouth reconstruction utilizing crown-lengthening surgery, extractions, single crowns, veneers, and a fixed partial denture sequenced over 2 years 379

Case 5 Maxillary complete fixed partial denture on 9 Galvano telescopic copings; mandibular anterior fixed partial denture on 4 Galvano copings 385

See also: Chapter 6 Case 6 171

Chapter 14 Case 3 337

Chapter 14 Case 4 342

Appendix 1 Definitive Occlusal Therapy Using the T-Scan III, by Robert BKerstein, D.M.D391

Appendix 2 What Your Laboratory Technician Needs to Provide Excellence, by Jerry Ulaszek, C.D.T433

Index 449

  • Unique case-based format supports problem-based learning
  • Promotes independent learning through self-assessment and critical thinking
  • Highly illustrated with full-color clinical cases
  • Covers all essential topics within reconstructive and restorative dentistry