The Award contest 2017/ 13 February 2017/

Case 31 | The Award 2017 | India

Dr. Jitendra Anaghan

Presenting Case of Full Mouth Rehabilitation

38 yrs old male patient came with complaint of sensitivity in almost all teeth, pain wrt to 47 , 36 and he is also worried about his worn lower front teeth
On Examination their is severe attrition of all teeth
Grade 1 mobile tooth no 47 36 chronic periodontitis in lower molar region

Treatment plan
1 Oral prophylaxis and open flap debridement in both side mandibular molar region
2 Rct wrt 46 47 36 37(these teeth are periodontally compromised and Associated with endo perio lesions)
Also rct wrt 26 27 (their is persistent sensitivity after preparation and during temporary period so did intentional rct )
3 Direct composite build up wrt 31,32,41,42
4 FMR with monolithic zirconium crown in all posteriors and layered zirconium crown in all anteriors

STEPS I FOLLOWED IN THIS CASE
1. Diagnostic impression
2. Facebow transfer
3. Most important step how much VD should I increase decided by free way space and vertical dimension at jaw rest position with coordination of vertical dimension at initial point of contact
4. Centric jaw relation record( explained in below photo)
5. Bite registration at decided VD and Centric jaw position
6. Mock up in lab
7. Mock up transfer in mouth by putty index technique
8. Tooth Preparation through mock up
9. Temporary crowns (made in clinic by using protemp and putty index technique)
10. Waiting period (2months )let pt adjust to new occlusion scheme
11. Finishing of tooth preparation
12. Final impression
13. Face bow transfer
14. Bite registration with raised VD and jaws are in centric relation
15. Trial
16. Final cementation

Pre op frontal view

Pre op upper arch

Pre op lower arch

Right side occlusion

Left side occlusion

Using a bunch of trimmed mixing pad (Here in Indian leaf gauze is not available so i choose this) to guide patients jaw in centric relation

Here i got initial point of contact on 17 and 47 by using mixing pad as leaf gauge and guiding pt into centric as well as point in mind how much to increase VD and once i got it must be transfer properly to semi adjustable articulator by using proper bite to simulate pts jaw relations

Increased height on left side

Frontal view

Bite with increased height and jaws are in centric relation

Pre op lower anteriors

Ready for final impression

Final impression

Lower arch with preparation

Final lower arch impression need one more

All set of impression

Final bite with prepared teeth

Trial need some corrections premolar are in negative occlusion

Lower arch trial

Frontal view trial

Trial right side occlusion

Trial left side occlusion

Final upper arch with occlusal contact point

Final lower arch

Final right side occlusion

Final left side occlusion (here First molar kept slight negative on lateral movement because of periodontally poor condition and my patient is not ready for extraction)