Clinical Cases in Restorative and Reconstructive Dentistry

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