The patient, a 42-year old female, presented with a chief complaint of, "My teeth are too short and I do not like the way they look."
The challenge in restoring a patient's bite lies in not only achieving the desired esthetics, but also the function of a proper bite. The ultimate goal: get the plane of occlusion in the proper position from all perspectives--horizontal, vertical, anterior/posterior, pitch, yaw, and roll. The key is to think like a pilot landing an airplane. The patient experienced frequent headaches, and an indication grinding and clinching habits was present. A comprehensive examination was performed. After discussing multiple treatment options, the patient chose to restore her bite at the best physiological/anatomical position with the best possible esthetics. The treatment plan was presented with a utilization of Dentrix and intraoral photos.
I did an occlusal analysis using the K-7 Evaluation System and J-5 Monitor (Myotronics). Models were taken using Splash impression material (DenMat) and sent to William's Dental Laboratory who fabricated a fixed orthotic. This was placed on the existing mandibular teeth to begin the establishment of the final bite position. Over several months, the orthotic was managed and adjusted to achieve the most ideal physiological/anatomical position. Records were taken at this final (ideal) occlusal position and sent to William's Dental Laboratory. Models were mounted and a diagnostic wax-up fabricated. A Siltec stent was fabricated from the diagnostic wax-up, which was used for the patient?s temporaries.
The patient's teeth were prepared with conservative preparations and final impressions using Splash were taken. An NV Microlaser (Philips) was used at the prep appointment to sculpture the gingival height of contour and zenith. William's Dental Lab then fabricated the final veneers and crowns at this ideal occlusion. The final restorations were cemented with Excite F DSC Soft Touch (Ivoclar Vivadent) and Variolink Veneer cement (Ivoclar Vivadent) and Rely X Unicem 2 (3M ESPE) and cured with FlashLite Magna (DenMat). Only micro adjustments were necessary thanks to the accuracy of the lab.
The patient is extremely happy with her esthetics, elimination of headaches, and most importantly, her occlusion has been restored to the ideal physiological/anatomical position.