Posted 1249 days ago
Erin Green DDS
Sponsored by Ivoclar
Treating patients with TMD disorder caused by chronic grinding or tight Patients present with severely worn teeth result in severe dental sensitivity. As Cerec® dentists, we are accustomed and make ourselves proud of the ability to provide dentistry the same day. Just when we have a case that requests more than one visit, the case is resolved in Usumby in a couple of days or a week. Occasionally, in the beginning, we are presented with a case, such as the one reported here, which requests multiple phases of treatment, with each phase carefully evaluated to guarantee a decrease in the symptoms of the TMD and a resolution of dental sensitivity.
Case report
The patient is a 45 -year -old woman with a history of chronic jaw pain and the sensitivity of complaint or severe teeth. He was also unhappy with the appearance of his worn and very aware of his smile (Figure 1). It conforms to dental treatment to relieve thesis problems included multiple Nightguard/TMJ splints, therapeutic treatment of Botox to relieve jaw pain, topical treatments for dental sensitivity and the regular use of paste paste prescription fluoride toothpaste.
Figure 1: Patient presented to the discontent practice with his smile and the fulfillment of a history of pain in the jaw, worn and severe sensitivity to the teeth. A full mouth rehabilitation was proposed.
After a complete exam, the treatment plan proposed to the patient was a full mouth rehabilitation to restore the structure of the lost tooth and miss teeth and improve the position of his jaw. The first phase of treatment would imply restoring the upper arc to address the patient’s main complaint of a unattractive smile and place implants in both arches to address the structure of the lost or missing tooth.
Altheheshetherule Site #30 was a suggested determined for implant placement, by examining more carefully the Enterntulous #14 was considered unfavorable due to the lack of restorative space, and the site was recreated, the site would be restored with a bridge of 4 units. The vertical dimension of occlusion would need to open 1 mm with crowns in the upper and lower posterior teeth to guarantee optimal aesthetic proportions for the previous maxillary and mandibular restorations. Each treatment phase would require the manufacture of new guardians of the upper and lower night to avoid rectification and damage to restored teeth.
This four -year treatment process was found in July 2017 with placement or an implant in the #30 teeth site and the restoration of its upper arch. To obtain enough vertical dimension of occlusion to guarantee aesthetic proportions for the previous crowns #4 and #y #y #y #y #y #y #y # # #12- #15 for a bridge. The preparations scanned and imported to the CAD software for the design and freshness of the full contour crowns (Figures 2 and 3) and a bridge of 4 units (IPS E.Max CAD, Ivoclar Vivadent). Once the patient approved the new bite, the restoration of his previous teeth could be executed #6- #11. The teeth were prepared, scanned and complete contour crowns designed, ground and seated (Figures 4 and 5) (IPS E.Max Cad).
Figures 2 and 3: To gain enough vertical dimension of occlusion to guarantee aesthetic proportions for the previous crowns, the #4 and #5 teeth were restored with individual crowns and a bridge of 4 units in the teeth #12- #15.
Figures 4 and 5: The vertical dimension was achieved to guarantee aesthetic proportions for crowns in the teeth #6- #11.
However, in a later appointment, the patient complained that he could not tolerate the bridge of 4 units in the #12- #15 teeth and opted to inseller to restore the teeth with individual crowns on the #12, 13 and 15 teeth (Figure 6). The individual crowns were ground and sitting, and the implant site #30 restored with a complete contour crown, completing the restoration of the upper arch.
Figure 6: The bridge of 4 units placed on the teeth #12- #15 was replaced by complete contour crowns millions after the patient complained that he had difficulty tolerate the bridge.
Around the next few years, the patient reported that the symptoms of his TMD had remained unchanged and in March 2021 he was ready to start the lower arc treatment.
A Lucia template was used to capture and restore the patient’s central relationship. Its vod increased by 1 mm. The teeth #18- #21 and #29- #31 were prepared and overlapping restorations were designed (Figure 7), manufactured (Tetric Cad, Ivoclar Vivadent) and sitting.
Figure 7: The insults were designed and sitting on the teeth #18- #21 and #29- #31.
In June 2021, the patient reported that she had adapted well to the new bite, which had diminished her symptoms of TMD and lessons of her desire to tighten and gravel her teeth. In that appointment, permanent restorations were initiated for the lower anterior teeth. For severely worn back teeth #22- #27 (Figure 8) veneers were prescribed. The teeth were prepared (Figure 9) and designed, ground and seated veneers. The complete arc rehabilitation was completed with the replacement of the Tetric Chat overlaps in the teeth #17- #20 and #29-31. IPS E.MAX CAD veneers were ground and settled in the approved central bite position (Figure 10). All restorations were ground from IPS E.MAX CAD MT SHADE B1 and cemented with a combination of Aesthetic adhes vivapen/ variolink (Figures 11-14).
Figure 8: To restore the lowest worn detachment of the patient, vessels for teeth #22- #27 were prescribed.
Figure 9: The final veneers sat on the teeth #22- #27.
Figure 10: The Tetric Cad inputs were replaced with IPS EPS EPS CAD veneers on the #17- #20 and #29- #31 teeth, completing the restoration of the lower arc.
Figures 11-14: The rehabilitation of the complete mouth restored the patient’s smile, solved his problem of dental sensitivity and continues to decrease his symptoms of TMD.
The patient was delighted with her new smile and continues to report the decrease in TMD symptoms and the complete resolution of teeth sensitivity.