Dr.Yoshinori Kamae D.D.S
(Prosthodontic,Periodontic,Orthodontic,Endodontic)
Dt.Ken Takahashi R.D.T
Case:
She is 52years old.
Her chief complain is esthetic demand.
Diagnostic findings
1. Extraoral and facial findings
Convex facial profile
decrace lower facial height
Slight prognathic and mandible
2. TMJ and mandibular range of motion
Not particular
3. Intraoral findings
Dental
Many defective restorations
Disorder of occlusal plane
Slight anterior open bite
Class3 tend
Periodontal
Generalized mild to moderate gingival inflammations
Bleeding on probing
Disproportionate levels of marginal gingiva
4. Occlusal notes
Class3 relationship
Horizontal overlap (overjet): 1mm
Anterior open occlusal relationship; no anterior guidance
Centric relation is not coincide MIP
5. Radiographic findings
Need root canal treatment:#21.#27,#35,#36,#37,#44,#47
Caries; #12,#11,#24
Root fracture; #15
Diagnosis
Class3 malocclusion with open bite
Goal/objectives of treatment
Face
Improve facial balance/profile
Increase lower facial height
Reduce prominence of chin
Smile
Improve appearance of teeth with respect to shape, size, color, and position
Balance levels of maxillary marginal gingiva
Improve alignment of the teeth
Dentition
Balance levels of maxillary and mandibular marginal gingiva
Establish normal morphology of clinical crowns with appropriate dimensions
Establish adequate tooth length to facilitate retention of restorations and resistance to displacement
Eliminate caries lesions
Correct malocclusion of teeth and associated dental and skeletal findings
Align teeth
Establish Class1 relationship, at least anteriorly
Establish optimal horizontal and vertical overlap of teeth-eliminate anterior open bite relationship
Level occlusal and incisal planes
Establish symmetric dental arch
Eliminate arch length deficiencies and associated crowding of teeth
Establish appropriate spacing for optimal restoration of teeth
Coordinate dental Arches
Restore affected teeth to improve occlusion, function, appearance, stability of tooth position and ability of patient to maintain health and supporting structures
Active Clinical Treatment
Phase Ⅰ: Initial treatment
Phase Ⅱ: Implant placement
Phase Ⅲ:Orthodontic treatment
Phase Ⅳ:Definitive restorative treatment
Phase Ⅴ:Maintenance
Acknowledgements
I want to thank the Dr.Masao Yamazaki and Kenji Tsuchiya who advise me the management of these patient’s complex dental needs
And thanks to Mr. Ken Takahashi who always fabricate beautiful restorations.
Finally, I thank Dr.Ward Smalley, a mentor of mine and always teach me the “answer” against my questions.
