Dr. Effie Habsha
A Multidisciplinary Approach to Full Mouth Rehabilitation
ALL CLINICAL CASES
A 47-year-old male presented with the desire to enhance the aesthetic appearance of his smile and improve his overall masticatory function. The comprehensive prosthodontic analysis revealed a non-physiologic occlusion characterized by loss of occlusal vertical dimension (OVD) as a result of tooth loss, tooth wear, and a skeletal discrepancy characterized by a retrognathic mandible and a deep bite. The treatment objectives for this patient included correction of his skeletal discrepancy, recovery of OVD, replacement of missing teeth, replacement of tooth volume , and enhancement of aesthetics and function.
In order to achieve these treatment objectives, both arches were decompensated orthodontically and a bilateral saggital split osteotomy advancement of 11mm was performed. The maxillary posterior left quadrant and mandibular posterior right and left quadrants were grafted to improve the bone volume. A direct sinus lift was completed in the second quadrant. Following the desired healing period and upon completion of orthodontic alignment, a total of four maxillary and three mandibular implants were placed.
The appropriate OVD was then established along with alignment of the maxillary and mandibular occlusal planes. The patient was provided with maxillary and mandibular full arch PMMA provisionals. His tolerance to the new OVD and acceptance of aesthetics was confirmed during the provisional phase of care. Transfer of the newly established OVD from the provisionals to the definitive restorations was accomplished using a facebow record and successive interocclusal registrations with sectioned provisionals. Full coverage Procera crowns and porcelain fused to metal based implant-supported prostheses were provided.
This case presentation demonstrates the synergy required in a multidisciplinary approach to full mouth rehabilitation. Close communication and treatment planning between the prosthodontist, orthodontist and oral surgeon is critical in achieving predictable and functional long-term outcomes.
Prosthodontist: Dr. Effie Habsha
Orthodontist: Dr. Bruce V. Freeman
Oral and Maxillofacial Surgeon: Dr. Marco Caminiti
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ALL CLINICAL CASES
