Clinical Cases in Restorative and Reconstructive Dentistry

492 Pages·2010·21.28 MB·English

by  Gregory Tarantola

Clinical Cases in
Restorative &
Reconstructive Dentistry

Clinical Cases in
Restorative &
Reconstructive Dentistry
Gregory J. Tarantola, D.D.S
A John Wiley & Sons, Inc., Publication
Edition fi rst published 2010
© 2010 Blackwell Publishing Ltd.
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Library of Congress Cataloging-in-Publication Data
Tarantola, Gregory J.
Clinical cases in restorative & reconstructive dentistry / Gregory J. Tarantola.
p. ; cm. – (Clinical cases)
Other title: Clinical cases in restorative and reconstructive dentistry
Includes bibliographical references and index.
ISBN 978-0-8138-1564-0 (pbk. : alk. paper)
1. Dentistry, Operative–Case studies. 2. Dental implants–Case studies. I. Title. II. Title:
Clinical cases in restorative and reconstructive dentistry. III. Series: Clinical cases (Ames, Iowa)
[DNLM: 1. Dental Prosthesis–methods–Case Reports. 2. Oral Surgical Procedures–methods–Case
Reports. 3. Reconstructive Surgical Procedures–methods–Case Reports. 4. Stomatognathic
System–Case Reports. WU 500 T176c 2010]
RK501.5.T37 2010
617.6′05–dc22
2010013916
A catalog record for this book is available from the U.S. Library of Congress.
Set in 10/13pt Univers Light by Toppan Best-set Premedia Limited
Printed in Singapore
1 2010
CCOONNTTEENNTTSS
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 Defi nitive Occlusal Therapy: Equilibration. . . . . . . . . . . . . . . .45
Section C The Diagnostic Blueprint—Wax-Up . . . . . . . . . . . . . . . . . . .50
Section D Provisionalization. . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
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
Clinical Cases in Restorative & Reconstructive Dentistry v
CONTENTS
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 fi xed
partial dentures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Case 2 Transitioning a maxillary tooth-supported fi xed partial denture
to an implant-supported fi xed partial denture along with
other single crowns and tooth-supported fi xed 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 fi xed partial denture supported by both teeth and
implants along with other maxillary and mandibular
implant-supported crowns and tooth-supported crowns
and fi xed partial dentures . . . . . . . . . . . . . . . . . . . . . . . 133
Case 5 Maxillary extractions, periodontal surgery, orthodontics,
veneers, and fi xed partial dentures on teeth; mandibular
extractions, implants, fi xed 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 fi xed partial dentures, implant-supported crowns and
fi xed 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
vi Clinical Cases in Restorative & Reconstructive Dentistry
CO NTENTS
Case 6 Temporomandibular disorder resolved with bite splint
therapy followed by defi nitive 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 defi nitive 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 profi les, 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 fi rst 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
mandibular reconstructions; transitioning from natural teeth
that were not predictably restorable . . . . . . . . . . . . . . . . . 231
Clinical Cases in Restorative & Reconstructive Dentistry vii
CONTENTS
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
viii Clinical Cases in Restorative & Reconstructive Dentistry