Reconstruction Of Defect Dentition Accompany With Remaining Teeth Severe Attrition

ObjectiveReconstruction of defect dentition accompany with remaining teeth severe attrition, could alleviate some symptoms, for example sensitivity tooth, the weak chewing, the discomfort of temporomandibular joint and masticatory muscles, the old face, to restore the function of the stomatognathic system. MethodsThe seven patients(male 3, female 4, age from 45 to 81,average age 66.6)with defect dentition accompany with remaining teeth severe attrition are obtained from Dalian Stomatological Hospital affiliated to Dalian Medical University, from October 2014 to October 2015. Case selection conditions :(1) teeth wear up to 2 degrees(according to the tooth wear index put forward by Smith and Knight);(2) with weak chewing or OVD(occlusal vertical dimension) decreased,but temporomandibular joint without organic lesions;(3)the abutment with no progressive periodontal disease and with healthy pulp or had root canal therapy;(4) patients had higher appearance and comfort requirements, with good economic condition;(5) coordinate the treatment with good oral hygiene habits, can according to the prescribed regular reexamination. 2 case with discomfort in temporomandibular joint and masticatory muscles, the others without discomfort.Before the treatment, we have checked on the patients oral system and the old denture carefully, we also photographed the patients as the original date, told patients the cost and the complex process of reconstruction, they need come to hospital many times and will take a long time, we also explained the effect and the possible problems, all patients signed the informed consent.Determine the restorative design,prepared tooth,alginate impression,plaster model. According to ICP transfer the jaw relation by using a face-bow, the distance between the bottom of the nose to chin minus 2-3mm when the patients’ mandible at MPP combined with facial three division method to determine the OVD. In case 1 and case 2 the tooth wear up to 4 degrees, patients feel discomfort in temporomandibular joint and masticatory muscles, so provisional restoration used first to increasing the OVD, after 3 months the discomfort symptoms disappeared and OVD maintain stability, the final prosthesis produced. In case 3 to case 6 the tooth wear up to 4 degrees, and the case 7 up to 2 degree, these patients’ OVD decreased less than the others and without discomfort in temporomandibular joint and masticatory muscles, so using final prosthesis to restore the right jaw relation directly. During the treatment, oral health education on each patient, tell them the causes and harm of severe attrition, help them to correct bad bite habit. After wear the prosthesis, the patients were told the use of restoration and the matters needing attention to ensure the service life. ResultsAfter 3-6 months, the patients were asked for a return visit to observe the effect of the treatment, acquire the using situation of restoration and the satisfaction of patients.None of the seven patients appear the discomfort in temporomandibular joint and masticatory muscles, abutment also have no pain or sensitive.What feedback from patients are that the denture retention is well, chewing efficiency, look younger than before. ConclusionThe masticatory system can adaptive remodeling according to occlusion, The biggest difficulty of treating severe attrition teeth accompany with the decreased vertical dimension of occlusal is the remaining tooth structure is too small and lack of space for restore, these patients need increase the occlusal vertical dimension and reconstruct the jaw relation, to achieve the purpose of prevent tooth sensitive and recover masticatory function and improve the face.