Collapsed Bite Reconstruction
This patient was investigating treatment alternatives that were different from his current dentist.
He explained that with his previous dentist too many teeth were being taken out and the treatment was painful.
He was concerned because he was developing a severe bruxism problem and his teeth were showing serious signs of wear.
The patient had ground his teeth so much that his bite lost 4 to 5 mm of vertical facial height. The adjacent photo readily shows the damage.
This collapsed bite caused him to over close which also collapsed his smile, and quite frankly made him look older than his years.
Because the patient had lost so many teeth and had worn down all the others so severely, he wasn't able to wear partial dentures to replace his lower back teeth.
Without the support of his back teeth, even more stress was placed on his already worn front teeth.
Once bite occlusion issues become significant... the failure to obtain proper treatment can lead to a rapid progression of accelerated wear and tear.
What the patient wanted to know was what could anything be done to restore the collapsed bite, give him his youthful smile back, and simulataneously provide him with essentially maintenance-free dentistry for the rest of his life.
Because of the Bruxism issue, the patient understood that we would be fabricating a custom nighttime anti-bruxism guard that would promote oral health and protect his new teeth and restorations, making the investment last the rest of his life.
In terms of proper Dental Function, the doctor outlined a treatment plan that would re-establish what was once a normal bite. The goal was to open the collapsed bite with correctly sized teeth, thereby overcoming the 4 to 5 mm loss he had endured.
The physical forces caused by Bruxism operated for several years. By implementing special orthodontic appliances, his bite was reopened. A progression of different sized appliances were used and within several months the patient would become comfortable again with a normal vertical relationship and bite (centric occlusion).
Since the patient had no desire to have teeth that he would have to take out nightly, dentures were eliminated as a treatment option.
Six (6) Branemark (Nobel Biocare) titanium implants were placed in his lower right and left back jaw (molar) areas. These high grade implants would then be implemented to accommodate two 3 unit fixed or permanent porcelain to noble metal bridge units.
These types of implant bridges do not come out, feel and function like natural teeth, and because of the natural bone stimulation properties of implants, help keep the bone from being resorbed away over time.
As shown in the adjacent treatment photos, we created fixed bridgework for the bottom (mandibular) jaw to restore the worn bottom teeth, and to stabilize his newly recreated, normal vertical dimension.
To assure accuracy in assessments, measurements and final fabrication processes of all the reconstructive and restorative components, we relied on specialized articulator devices and the patient's centric bite records.
During the oral surgery/implant phase of treatment, extractions were carefully performed with implant devices being placed in critical areas of the jawbone material that would optimize the recreation of a stabile and normal occlusal relationship.
For the upper (maxilla) jaw, treatment included three dental extractions, two root canals due to grinding several teeth down to the nerve and a complete upper arch restoration for his worn front teeth and replacement of old defective bridges.
The next photo in our treatment series shows the lower arch implant devices and completed preparation to the lower front teeth, immediately prior to completion of restorations to the lower jaw.
As in other complex treatment programs we employed the use of cast metal T impression copings to take make sure critical impression data was accurate for the laboratory technician. These T copings are pulled in the impression which enables the lab technician to create the best working model possible.
While the patient wore temporaries, adjustments were made as necessary to address his ability to maintain correct speech patterns. Vertical dimension properties were closely monitored throughout treatment.
This adjacent photo provides a view of the lower mandibular jaw with implant copings and T copings (a coping is a thimble-like cap that fits over the prepared tooth and becomes part of the final impression used by lab technician) in place.
After assuring proper fit of metal bridge framework, a segmented bridge with interlocking male/female adapters on the backside of the canine teeth was created and placed.
This last photo in the treatment series shows the final completion of the upper arch restoration. The functional rehabilitation of the patient's upper and lower jaws was a resounding success.
Premium porcelain dental restoration components were used throughout the full mouth rehabiliation. The extensive use of articulation devices assured a proper match between individual and all biting surfaces. This extra attention to detail prevents lateral forces from developing which can potentially compromise the integrity of the new porcelain materials.
Bite and occlusal relationships were corrected, providing the patient with dental function he hadn't had for many many years. Speech patterns were properly maintained.
As evidenced by the patient's smile in this last post treatment photograph, he looks 10 years younger. When he smiles, the upper lip now rides up underlying maxillary structures normally, showing off teeth that look and feel natural.
Both the patient and his wife were thrilled with the results. He began wearing the custom anti-bruxism night guard to protect his newly placed dental restorations and implants, thereby assuring years and years of endurance.
The restorations are expected to last a lifetime with proper brushing, flossing and fluoride rinsing at nighttime. Also included in the maintenance process are regular dental checkups and cleanings.
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