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Clinical Cases in Restorative and Reconstructive Dentistry (Clinical Cases

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Table of Contents

Author. Contributors to Appendices. Acknowledgments. Introduction. Part 1 Didactics. Chapter 1 Fundamental Principles of the Comprehensive Approach. The Case for the Four-Part Comprehensive Evaluation. The Details of the Four-Part Comprehensive Evaluation. The Initial Conversation. The Clinical System Based Masticatory System Examination. Imaging. Articulated Diagnostic Casts. Chapter 2 The People Side of Dentistry. The Importance of Behavioral and Communication Skills. The All-Important 5 Questions. The Codiscovery Process. Which Approach Is Best The 4 Quadrants. Dentistry: A Blend of Technical, Emotional, and Intellectual Skills. Chapter 3 The 4 Essential Skills of the Comprehensive Dentist. Section A Bite Splint Therapy. Section B Definitive Occlusal Therapy: Equilibration. Section C The Diagnostic Blueprint Wax-Up. Section D Provisionalization. Chapter 4 The 10 Decisions. Section A TMJ Diagnosis and Condylar Position. Section B Vertical Dimension. Section C Lower Incisal Edge Position. Section D Upper Incisal Edge Position. Section E Centric Stop Design. Section F Anterior Guidance. Section G Curve of Spee. Section H Curve of Wilson. Section I Cusp to Fossa Angle. Section J The Aesthetic Occlusal Plane. Part 2 Case Studies. Chapter 5 Nonremovable Implant Restoration with Natural Teeth. Case 1 Nonremovable maxillary implant restorations with natural teeth restorations including crowns, veneers, and fixed partial dentures. 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. Case 3 Lower reconstruction with lower left being implant-supported, important neutral zone consideration affecting design; upper reconstruction landmarks acceptable; temporomandibular disorder managed. 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. 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. 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. See also: Chapter 6 Case 1. Chapter 7 Case 7. Chapter 14 Case 4. Chapter 6 TM Disorders Followed by Reconstruction. Case 1 Osteoarthritis of the left TMJ managed with bite splint therapy followed by implant-supported restorations and tooth-supported restorations. Case 2 Intracapsular and muscular components of a temporomandibular disorder managed with bite splint therapy followed by occlusal therapy and a full reconstruction. Case 3 Intracapsular and muscle disorder resolved with bite splint therapy followed by occlusal reconstruction with maxillary lingual porcelain veneers. 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. Case 5 Past condylar replacement due to avascular necrosis followed by posterior occlusal reconstruction. 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. 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. See also: Chapter 15 case 1. Chapter 16 case 1. Chapter 7 Restorations to Achieve Aesthetic and Functional Changes. Case 1 Restoration of anterior aesthetics and anterior guidance in a deep overbite damaged by bruxism with upper and lower anterior reconstruction. Case 2 Posterior reconstruction with severe interferences to the centric arc of closure. Case 3 Restoration of aesthetics and anterior guidance damaged by wear by increasing overbite with upper and lower anterior crowns. Case 4 Maxillary reconstruction at open vertical dimension to improve aesthetics, length, buccal profi les, and functional landmarks; mandibular restorations only recontoured. Case 5 Maxillary and mandibular aesthetic and functional reconstruction with lab-processed composite restorations to treat amelogenesis imperfecta. 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. 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. See also: Chapter 16 case 1. Chapter 8 Complete Implant-Supported Restorations. Case 1 Complete implant-supported maxillary reconstruction transitioning the anterior teeth from tooth-supported to implant-supported. Case 2 Complete maxillary nonremovable restoration supported by 6 implants converted from a completed removable restoration on 4 implants. Case 3 Complete implant-supported nonremovable maxillary and mandibular reconstructions; transitioning from natural teeth that were not predictably restorable. Case 4 Maxillary extractions, immediate implant placement, immediate loading, and complete nonremovable zirconia restoration with pink porcelain. Case 5 Mandibular implant bar supported full removable denture converted to a nonremovable restoration to improve comfort of the neutral zone and phonetics. Chapter 9 Orthognathics. Case 1 Severe anterior open bite corrected with maxillary-only orthognathics and occlusal therapy with upper incisor restorations. Case 2 Mandibular orthognathic surgery and chin implant; managing a temporomandibular disorder during treatment; posterior restorative dentistry including implants. Case 3 Maxillary and mandibular orthognathic surgery with chin advancement; prerestorative occlusal therapy with equilibration and composite additions. See also: Chapter 16 Case 1. Chapter 10 Bruxism and Wear Reconstruction. Case 1 Restoration of worn lower anterior teeth in a deep bite without changing other restorations. Case 2 Severe wear from parafunctional habits restored with a complete reconstruction at an increased vertical dimension of occlusion. See also: Chapter 16 Case 2. Chapter 11 Perioprosthesis. Case 1 Full maxillary periodontal-restorative reconstruction improving aesthetics and function; lower posterior reconstruction following conventional surgery, bone and soft tissue grafts, covering recession. Case 2 Posterior reconstruction in conjunction with conventional periodontal surgery; root resection, pocket elimination. Chapter 12 Implants in the Aesthetic Zone. 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. Case 2 Extraction and immediate implant placement, delayed loading, and restoration maxillary central incisors; pink porcelain to simulate papilla. Case 3 Congenitally missing maxillary lateral incisors, orthodontics to open lateral incisor space, dental implants, and other aesthetic improvements. 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. Case 5 Maxillary central incisor extracted and replaced with a dental implant, delayed placement, and delayed loading. See also Chapter 7 case 6. Chapter 13 Removable Implant-Supported Restoration with Natural Teeth. Case 1 Maxillary implant-supported bar-retained removable partial denture along with tooth-supported restorations to reconstruct occlusion and vertical dimension. Case 2 Combination mandibular fi xed anterior removable posterior reconstruction with Locator attachments. See also: Chapter 14 Case 4. Chapter 14 Combination Fixed-Removable Restoration on Natural Teeth. Case 1 Maxillary bar supported removable partial denture; lower crowns with semiprecision removable partial denture. Case 2 Maxillary fi xed partial dentures with precision removable partial denture; mandibular bar supported complete denture. Case 3 Maxillary telescope case: alumina copings on natural teeth and removable overstructure; mandibular telescope case: Galvano copings on natural teeth and nonremovable overstructures. Case 4 Mandibular anterior fi xed 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. Chapter 15 Implant-Supported Complete Dentures. 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. Case 2 Severe maxillary and mandibular resorption; maxillary bone grafting; maxillary and mandibular implant-supported bar and bar-supported dentures; fl ange needed for lip and cheek support necessitating a removable rather than a nonremovable approach. Chapter 16 Reconstructions on All Natural Teeth. Case 1 Severe anterior overjet handled with occlusal/restorative treatment in lieu of orthognathics; muscular component of a temporomandibular disorder also managed. 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. Case 3 Maxillary reconstruction combined with extractions and periodontal surgery to improve periodontal architecture; landmarks of lower acceptable with minor modifi cation. Case 4 Full mouth reconstruction utilizing crown-lengthening surgery, extractions, single crowns, veneers, and a fixed partial denture sequenced over 2 years. Case 5 Maxillary complete fi xed partial denture on 9 Galvano telescopic copings; mandibular anterior fixed partial denture on 4 Galvano copings. See also: Chapter 6 Case 6. Chapter 14 Case 3. Chapter 14 Case 4. Appendix 1 Defi nitive Occlusal Therapy Using the T-Scan III, by Robert B. Kerstein, D.M.D. Appendix 2 What Your Laboratory Technician Needs to Provide Excellence, by Jerry Ulaszek, C.D.T. Index.

About the Author

Gregory J. Tarantola, D.D.S. is former Clinical Director of the Department of Education at The Pankey Institute for Advanced Dental Education in Key Biscayne, Florida. In January of 2002, he opened a full time restorative practice and now lives and practices in Jacksonville, Florida. He also continues to lecture around the country and around the world on comprehensive, masticatory system dentistry in a relationship based setting.

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