Malkoc Meral Arslan, Sevimay Mujde, Yaprak Emre
Research Assistant, Selcuk University, Faculty of Dentistry, Department of Prosthodontics, Konya, Turkey.
Eur J Dent. 2009 Jan;3(1):75-80.
The management of the interim phase of a complete oral rehabilitation in patients with severely worn dentition is often challenging due to the loss of occlusal vertical dimension, loss of tooth structure, uneven wear of teeth creating an uneven plane of occlusion, and parafunctional habits. This case report describes the management of excessive tooth tissue loss in a 45 year old woman with a history of bruxism, esthetical complaints in anterior teeth, and impaired dental function due to reduced tooth height. The patient used occlusal splint for a month and than resection of the alveolar bone was performed on the vestibular sides of the maxillary anterior teeth, except the interdental alveolar crest. Maxillary anterior teeth were restored with zirconia porcelain. Feldspathic porcelain was chosen to restore remaining teeth in both jaws; the patient also was given an occlusion guard to protect the restoration against future bruxism. Regardless of the cause of occlusal instability, it is important that the restorative dentist should be able to recognize its signs such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement, and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.
对于牙列严重磨损患者的全口义齿修复过渡阶段的管理往往具有挑战性,这是由于咬合垂直距离丧失、牙体组织丧失、牙齿不均匀磨损导致咬合平面不平以及存在副功能习惯。本病例报告描述了一名45岁女性患者牙齿组织过度丧失的治疗情况,该患者有磨牙症病史,前牙存在美观问题,且由于牙高度降低导致牙齿功能受损。患者佩戴咬合板一个月,然后对上颌前牙前庭侧(除牙槽嵴间)进行牙槽骨切除术。上颌前牙用氧化锆瓷修复。选择长石质瓷修复上下颌其余牙齿;还给患者佩戴了咬合保护装置,以保护修复体免受未来磨牙症的影响。无论咬合不稳定的原因是什么,修复牙医能够识别其体征很重要,如牙齿松动、牙齿磨损、牙周破坏、咬合面凹陷、应力性骨折、骨赘、肌肉增大以及后牙无咬合接触。在修复磨损的牙列时,临床医生应牢记五个“P”原则:合理规划可避免糟糕表现。