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Maxillary and mandibular overlay removable partial dentures for the treatment of posterior open-occlusal relationship : A clinical report. Rafael Del Castillo, JPD 2002;87:587-92. 길병원 보철과 김세웅. 1. This clinical report ……. Class III skeletal malocclusion

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Maxillary and mandibular overlay removable partial dentures for the treatment of posterior open-occlusal relationship : A clinical report

Rafael Del Castillo, JPD 2002;87:587-92

길병원 보철과 김세웅

1

this clinical report
This clinical report……
  • Class III skeletal malocclusion

& posterior open-occlusal relationship

 Overlay removable partial dentures(ORPD)

slide3
ORPD
  • Advantages
    • 교정 및 구강 외과 술식이 병합된 경우에 다른 치료의 대체 치료로 이용
    • 환자의 심미적 및 기능적 요구를 만족
    • 치료 전에 비하여 안정된 교합을 제공
    • 가역적
    • 선천적 또는 후천적 기형을 보이는 환자에게 상대적으로 비싸지 않은 치료
  • Disadvantages
    • 의치를 제거했을 때의 비심미성
    • 좋지 못한 구강 위생의 결과로써 치아 우식 및 치주 질환 발생 가능
    • Venner material의 파절
    • Debonding, 변색, 마모……
posterior open occlusal relationship
Posterior open-occlusal relationship
  • Definition
    • “The lack of posterior tooth contact in any occluding position of the anterior teeth”
  • Occur bilaterlly, unilateral presentations are more frequently.
posterior open occlusal relationship1
Posterior open-occlusal relationship
  • Etiology
    • Is not well understood.
    • A number of factors have been associated with…
      • Mechanical obstruction by the fingers, tongue, or cheek
      • Primary failure of eruption
      • Abnormal tongue function
      • Ankylosis of teeth
      • Condylar trauma or pathology
      • Cleidocranial dysplasia
      • Neurological disturbance
      • Iatrogenic factors
      • Endocrine alterations
        • Hypothyroidism
        • hypopituitarism
posterior open occlusal relationship2
Posterior open-occlusal relationship
  • Etiology(by Proffit and Vig)
    • 2 possible causes for posterior open-occlusal relationships

(1) Mechanical interferences with eruption,

either before of after the tooth emerges

from the alveolar bone.

(2) Failure of the eruptive mechanism of the tooth

so that the expected amount of eruption

does not occur.

“ Primary failure of eruption”

    • Non-ankylosed teeth fail to fully or partially erupt

due to malfunction of the eruption mechanism.

posterior open occlusal relationship3
Posterior open-occlusal relationship
  • Incidence
    • Ballard first described open-occlusal relationships
      • To be rare
      • Only 9 such relationships in 16,000 referrals.
      • The maxilla that was responsible.
    • Kaban et al
      • Reported 5 patients in whom the permanent molars had failed to erupt without a known cause.
posterior open occlusal relationship4
Posterior open-occlusal relationship
  • Managements
    • Can be managed in several ways depending on their severity and the diagnosis.
    • Orthodontic treatment
      • May be effective when the condition is caused by mechanical interferences.

Primary failure of eruption(main etiologic factor)

The involved teeth may tend to ankylose

when orthodontic force is applied.

Intrusion of the normal teeth

Combination of

surgical procedures and orthodontics

Be considered for

prosthetic rehabilitation

clinical report
Clinical report
  • 53 / F
  • PMH; pharmacologically controlled hypertension
  • PDH
    • Received orthodontic treatment as a child
    • Had not sought regular dental care
    • Denied any oral habits such as tongue thrust
  • Chief complaint
    • Instability to chew
    • Dissatisfied with

the esthetics of her teeth

    • Maintaining as many teeth

as possible was a priority for the patient

clinical report1
Clinical report
  • X-ray examination
    • Cephalometric, panoramic, periapical
    • Ricketts’ cephalometric analysis
  • Intraoral examination
  • Periodontal examination
  • Present illness
    • Mixed dental/skeletal malocclusion(class III)
    • Dental caries ; #37 facial aspect
    • Amalgam restoration ; #16, #46
    • Severe missing teeth ; #23, #34, 35, 36, #47
    • Partial eruption(palate) ; #13
    • Presence of plaque, calculus, and gingival inflammation
    • With bleeding on probing
    • 상악 중절치 협측 치간 유두에 papule 존재
    • 대부분의 pocket depth는 정상이었으나 상,하악 절치는 7~9mm의 probing depth를 보임…..MO(++ or +++)
    • Angular defect ; mandibular central incisors
treatment procedures
Treatment Procedures
  • Diagnostic casts; irreversible hydrocolloid impressions
  • Face-bow transfer(Mx.)
  • Occlusal record; silicone-based interocclusal record material
  • Articulationon the semi-adjustable articulator
    • CR record ; bilateral manipulation
  • Evaluation of theVDR, VDO
    • 2 reference point ; nose & chin
    • Swallowing technique
treatment procedures1
Treatment Procedures
  • Initial treatment
    • Strategic extraction
      • Teeth that were essential for prosthodontic rehabilitation
      • Teeth that had a hopeless long-term periodontal prognosis
      • Maxillary and mandibular central & lateral incisors
      • Maxillary right canine(Orthodontoc treatment ; refuse)
    • Endodontic treatment
      • Mandibular left second molar  cast gold crown
    • Periodontal therapy
      • Scaling & root planning ; all 4 quadrants
      • Flap surgery ; maxillary right & left quadrants due to pocket depth
      • Free gingival graft ; facial aspect of the mandibular right first premolar
    • Oral hygiene instructions to patient
treatment procedures2
Treatment Procedures
  • Immediate provisional overlay removable partial dentures
    • Diagnostic cast
    • Heat-polymerizing acrylic resin / tooth-colored Heat-polymerizing acrylic resin / denture teeth
    • Wrought wire clasp
treatment procedures3
Treatment Procedures
  • Immediate provisional overlay removable partial dentures
    • Tissues were allowed to heal for 4 months.
    • During this period, periodontal treatment was completed.
    • Vertical dimension of occlusion, esthetics, phonetics, and function were evaluated.

Favorable???

Final Restorations

treatment procedures4
Treatment Procedures
  • Final restorations
treatment procedures5
Treatment Procedures
  • Final restorations