Naina Swarup
Full Mouth Rehabilitation using Vonlays following HOBO’s philosophy
Patient
reported with the chief complain of worn down teeth and difficulty in
mastication. On Examination, there was marked attrition of the mandibular teeth
and slight attrition of the maxillary teeth. (Fig 1-5) The patient fell under
Category 1 of the Turner Missirlian
Classification.
Orthopantomogram
was checked (Fig 6) and Root Canal treatment was done of the mandibular teeth.
A loss of Vertical Dimension was Evaluated to be 4mm and its restoration was
planned.
Face
bow records were made using a Springbow to record the orientation relation. A
deprogrammer in form of a Lucia Jig was used and the planned Vertical dimension
was recorded (Fig 7). This was mounted on a Semi Adjustable Articulator (Hanau
183 Wide Vue).
A non
permissive splint was made for the patient at the desired restored vertical
dimension (Fig 8). This splint was then kept on the articulator and the
occlusal plane was marked using BOPA (Broadrick’s Occlusal Plane Analysis) (Fig
9,10).
At
this decided plane, the wax up was done following HOBO’s Philosophy. Condition
1 wax up was done without the anterior segment at the set values (Table 1).
Care was to be taken that the cuspal heights were in harmony with the values
(Fig 11). The anterior segments were then kept and the wax up was done to
Condition 2 (Fig 12).
The
Posterior wax up was transferred to the mouth using the direct technique using
a putty index and a composite based provisional material (CoolTemp)
(Fig 13-15). Gurel’s technique was followed for the Preparations (Fig 16).
Similarly, for the maxillary anteriors (Fig 17).
A
crown Lengthening Procedure was done using a soft tissue laser in the
mandibular anterior region (Fig 18-20)
and the gingiva was prepared to receive an ovate pontic. Heat cure
provisionals were given to the patient and the posterior disocclusion was
verified (Fig 21-24).
After
2 months, the patient comfort was assessed and a final digital scan was made
(Fig 25- 27). The prosthesis was digitally designed and milled in Emax for
maxillary and Zirconia for the mandibular (Fig 28, 29). The fit was verified on
a final cast (Fig 30,31).
The Prosthesis were then bonded and cemented to the teeth (Fig 32,33) and occlusion was checked (Fig 34,35). The soft tissue healing around the mandibular anterior teeth was verified and gave optimal esthetics (Fig 36, 37). Final Prosthesis was checked with the before pictures (Fig 38,39). A 6 month follow up also showed healthy gingiva and prosthesis.
