Form Follows Function: Continuing to the Final Restorations, Part 2

By Dr. Rhys Spoor, DDS, FAGD, Accredited Member of the American Academy of Cosmetic Dentistry

To read part 1, click here.

In Part 1, I discussed a technique of test driving the proposed occlusal position before committing to a final restorative phase. The advantage is that you can assure yourself and the patient of the proper physiologic envelope of function. With the flexural strength of many of the current generation of bis-acryl composites (eg,. DMG Luxatemp®), one can be reasonably sure that, if during the testing phase the provisionals do not chip or break, the patient does not develop any muscle or tooth pain, and the phonetics is normal, then the patient is in the correct occlusal position. If the position is incorrect, the opportunity to make changes is much easier during this phase.

In this case, the bite was opened slightly to allow better clearance in the anterior dentition that had significantly worn (Figure 1). The patient also had fairly chronic headaches and muscle tenderness. During the test drive of approximately three months, there were some minor adjustments made, but the patient confirmed the final restorative position early on.

The key to converting this occlusal position to the final restorations was to prepare and complete the maxillary arch first and maintain an interarch tripod of stops during the preparation, provisionalization and cementation. All adjusting of the occlusion was done on the mandibular Luxatemp® overlay. A week later, the patient returned for the preparation of the mandibular arch, again maintaining a tripod of interarch stops.

The final restorations (Ivoclar  IPS eMax®) exhibited the proper portions of natural teeth even though the bite was opened (Figures 2, 3 and 4). By opening the bite, the Class III mandibular cuspids did not negatively impinge on the distoincisal corners of the maxillary laterals that had been a problem in the original dentition (Figures 5 and 6). Most of the gingival embrasures were closed without creating an excessively square tooth form (Figure 7). Because of the position of the original occlusal plane and the quality of the natural dentition, the maxillary arch was fairly conservatively prepared with four teeth left untouched except for minor recontouring (Figure 8). An implant and crown will later be placed in #3. The mandibular arch was also restored fairly conservatively with posterior onlays, anterior veneers and crowns (Figure 9). Having the bite opened allowed room for the restorative materials and made tooth reduction minimal.

Even though this case was originally driven by wear and pain, the final restorative design was created with the concept of form following function and this patient can expect years of a comfortable and attractive smile (Figures 10 and 11).

Click here to see the original article.

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