Occlusal Reconstruction Of Severe Teeth Attrition With Dentition Defect

Objective: This paper analyzed the treatment process and postoperative effect of six patients with severe teeth attrition accompanied by dentition defect,summarized the treatment process of occlusal reconstruction,and provided reference for the selection and formulation of treatment plan in the future.Methods: Six patients(3 males and 3 females,aged 45 to 83 years)with severe tooth attrition and dentition defect were selected from Dalian Stomatological Hospital from October 2017 to December 2018.Inclusion criteria :(1)no systemic disease,no history of drug allergy;(2)dentition defect accompanied by severe attrition of the remaining teeth;(3)lower occlusal vertical distance,and shorter 1/3 of the lower face;(4)neutral original occlusal relationship;(5)no organic diseases of temporomandibular joint;(6)patients have good communication ability and economic conditions,can well comply with doctor’s advice and timely follow-up.Methods: According to the patients’ complaint,current and past medical history,the patient’s condition was preliminarily understood.Intraoral examination of patients,including dental examination,periodontal examination,dentition examination,old denture and occlusal relationship examination,soft tissue examination,etc.Extraoral examination included temporomandibular joint area,opening degree and opening type,masticatory muscle examination,etc.At the same time,assistant imaging examination including RVG,curved surface tomography,CBCT and so on.The main complaints and clinical examinations of the patients were combined to clarify the causes of attrition.After fully communicating the condition with the patients,the physician formulated the treatment plan for the patients according to their individual requirements and wishes,and informed the patients of the treatment plan,steps,approximate cost,visiting times and possible discomforts.Patients can be formally treated with informed consent.What’s more,preoperative intraoral and extraoral photographs were taken to make the research model.The vertical distance was reduced by 2~3mm when resting the jaw position,and the new vertical distance was determined by referring to the facial trisection method.Increase the vertical distance to the desired height through a stable occlusal plate or transition prosthesis.Transitional dentures should be re-examined once in a week at the beginning of wearing,and then the time of re-examination can be appropriately extended according to the patient’s situation,and re-examined once in a week to two weeks.Re-examination was conducted in combination with clinical symptoms and patients’ subjective feelings.It should be worn for at least 3 months until the patient was comfortable,chewing forcefully and bilateral temporomandibular joints were not uncomfortable.At this time,the teeth were prepared,the impression was taken,the plaster model was reproduced and handed over to the technician’s room to complete the final restorations.Wore the final restorations for patients.If there is any problem or discomfort,please return to the doctor at any time,and the effect of treatment will be evaluated three months later.In the course of treatment,patients were informed of the causes of severe teeth attrition,oral hygiene education was carried out,bad habits such as biting hard objects were abandoned,and the use methods and precautions after wearing new dentures were given to ensure the health of the remaining teeth and the maintenance of new dentures.Results: After permanent restoration was completed,the patient should be informed of any problem for follow-up visit and adjustment at any time.The denture should be re-examined every 3~6 months and adjusted if necessary.At the same time,the patient’s subjective feelings,mastication condition,temporomandibular joint and masticatory muscle status were understood and examined.None of the six patients presented discomfort of TMJ and masticatory muscles.The patients consciously improved their masticatory efficiency,the prosthesis was beautiful and comfortable,and there was no discomfort such as pain and sensitivity of the abutment teeth.The facial appearance was also improved.Conclusion: Severe teeth attrition and dentition defect can cause changes in the jaw position relationship,such as teeth sensitivity,chewing efficiency decline,1/3 lower facial height decline and other symptoms.At the same time,the treatment of inadequate space for restoration,too little residual healthy tooth tissue is the difficulty of treatment.Doctors should clearly diagnose the cause of attrition,choose the best restoration plan according to the patient’s own conditions and wishes,restore the patient’s jaw position relationship,protect the remaining dental tissue,improve sensitive symptoms,improve mastication efficiency and improve facial appearance.