Restorative
Fig 4 – Luxatemp prototypes fitted
Fig 5 – Final restoration with class 1 occlusion and ideal anterior guidance
Fig 6 – Post-restorative occlusal splint
Fig 7 – Final close-up
Fig 8 – Initial presentation showing worn upper dentition
Fig 9 – Hopeless teeth removed
tion on both anterior and posterior teeth with only part of the gingival margin area prepared for porcelain (labial) and the rest a conservative 0.5mm light chamfer for metal (Fig 3). There is also the added longevity in both of these areas of the mouth (the reader is referred to the work of Shillingburg for a full descrip- tion of PFM crown preparation). In this instance, the classic PFM crown was used to restore the upper ı0 anterior teeth. Tooth preparation should be done
in stages so as to maintain control of the condylar position and vertical dimension. Providing the patient has adequate posterior stability (from amalgams, cores, prototype crown etc) then the initial tooth preparation should be the upper and lower anterior canine -to-canine teeth. When completing a full-mouth
reconstruction, upper and lower preparations should done together so as to be able to establish ideal anterior guidance in both protrusive and lateral movements. Once prepared, the dentine is sealed and prototypes are relined with ‘Luxatemp’ (DMG), trimmed and fitted (Fig 4). No impressions or jaw registrations are taken at this time. The aim of the tooth preparation
stage is, over three long visits, to place prototypes on all the teeth and then to spend time reassessing occlusal planes, aesthetic concerns and, of course, occlusal scheme and comfort of the patient. The long-term success of the final
restoration is directly proportional to the skill and time in preparing and planning
prototypes and their adjustments. It is easy to lose vertical dimension, occlusal stability and ideal sealing of the condyle in the fossa if this stage is hurried. If increasing vertical dimension
then either the timing of the preparation and prototypes is changed to accommodate all initial procedures in one week or full occlusal contacts need to be re-established on posterior teeth during the interval between fitting of the anterior prototypes and the final segments of the posteriors.
Impressions/jaw registrations Once the patient has confirmed that they are happy with the aesthetic appearance, is symptom free, having an ideal occlusal scheme with multiple contacts on all teeth and the condyles in RAP with smooth shallow anterior guidance, the next stage of treatment is to take impressions and jaw registrations. This can be done in several ways. A similar sequencing of events
can occur as anterior prototypes are removed, retraction cords placed, teeth re-prepared, sealed and impressions, jaw registrations and facebow record- ings made with the posterior prototypes maintaining occlusal contacts, vertical dimension and a stable RAP position. Alternately, there are times when the
full arch needs to be delivered to the patient at one go. This may be the case when anterior and posterior teeth are linked together in bridgework; there are limited number of appointments; patients are travelling long distances or vertical dimension is being increased on the fully
adjustable articulator. This then requires the use of duralay bonnets or copings on all teeth and the use of a pick-up impression. Once anterior impressions, jaw
registrations and facebow recordings are taken again, the prototypes are relined, trimmed, cemented and are adjusted once more.
Try-in stage The anterior restorations are now produced by the technician to the biscuit bake or ‘try-in’ stage and are tried in the mouth and the occlusion is adjusted using the mouth as the ultimate articulator.
Cementation As described earlier, all articulators have limitations as do the materials and techniques we use. Once upper and lower have been checked and adjusted they are sent back to the technician for glazing and then to the dentist for cementation (Fig 5). This same sequence is then performed on one side of the mouth with upper and lower posteriors and then finally the other side of the mouth.
Conclusions Patients requiring full mouth or partial reconstruction usually are, or have been, bruxists. As such they may often brux again, which is one of the limiting factors to the longevity of our restorations. Careful post-restoration occlusal adjustment and refinement are essential, followed by the post-restorative occlusal splint for night
Continued » Scottish Dental magazine 49
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