Vertical dimension of occlusion reestablishment with 3-D pri
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A 65-year-old African American female had a complaint of difficulty breathing, pain in the jaw joints and she wanted to replace missing teeth.

During clinical examination, findings were:
1.-lower anterior teeth occlude in the palatal mucosa.
2.- total loss of interocclusal space on right posterior mandibular edetulus region due to supra eruption of maxillary premolars and molars.
3. Loss of vertical dimension of occlusion.

Treatment options for such a case can be very complicated and expensive. Like Orthognathic surgery with maxillary advancement and mandibular setback, dental implants to replace missing teeth after orthognathic surgery, orthodontic treatment to achieve a more harmonious occlusion with dental implants, or fixed bridges. However, patient’s limited resources did not allow any of these options. Therefore, an overlay RPD would be an exceptionally good option for this patient because it could fix the patient’s dental deficiencies from professional point of view. Patient agreed and the treatment started.

Treatment started by alveoloplasty of the lower right edentulous ridge to create enough space for the RPD. Alginate impressions were taken after healing. Special trays were fabricated for second impressions. Face bow bite was transferred to a semi-adjustable articulator. Scan of the cast was done with a 3shape D2000 scanner system by the lab and a 5 mm increase of the VDO was achieved. Digital articulation was completed with 3shape Dental system. This facilitated an accurate measurement for the VDO. The dental laboratory fabricated a digital RPD for trial appliance.

The patient tried the appliance and the occlusion was adjusted as needed. In this try-in visit several steps were accomplished. The first, bilateral occlusal adjustments until all posterior teeth were in occlusion. Second, the freeway space was changed from 8 mm to 4 mm. Third, lower anterior overlay was trimmed so as to not occlude with palatal mucosa. Fourth, canine guidance was considered and checked inside the patient’s mouth. Lastly, a vinyl polysiloxane bite was taken for registration. All the recorded information was sent to the dental laboratory for the fabrication of the final RPD. This step was completed with Dental CAD/CAM. The overlay RPD was delivered and seated.

Patient experienced an increase in VDO and better facial profile. Also, the experience of masticatory overload distributed evenly, with this ability to chew and grind foods more efficiently. The result was better esthetics as lower teeth come to the smile and improvement in the patient’s dental health.

Source: http://ispub.com/IJDS/16/1/54392
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