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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 14  |  Issue : 4  |  Page : 225-230

Oral rehabilitation by semi-adjustable articulator


Department of Fixed Prosthodontics, Faculty of Dentistry, Aleppo University, Aleppo, Syria

Date of Submission07-Jan-2017
Date of Acceptance07-Aug-2017
Date of Web Publication21-Dec-2017

Correspondence Address:
Mohammad A Sarraj
Department of Fixed Prosthodontics, Faculty of Dentistry, Aleppo University, Aleppo
Syria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tdj.tdj_2_17

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  Abstract 

Many patients attend to clinics and suffer of disease of tooth loss, partially or completely. Prosthodontics is the dental specialty that cares with the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of these patients. A 39-years-old patient needs rehabilitation because she has a deep bite and the collapse of the occlusal vertical dimension, where it was processed using a semi-adjustable articulator, it have been used method of preparation on the gypsum for provisional fixed partial denture, then we began treatment with patient after take observations of the preparation on gypsum, we has been used of the metal ceramic as a restoration.

Keywords: fixed partial denture, occlusal vertical dimension, preparation on gypsum


How to cite this article:
Sultan M, Sarraj MA. Oral rehabilitation by semi-adjustable articulator. Tanta Dent J 2017;14:225-30

How to cite this URL:
Sultan M, Sarraj MA. Oral rehabilitation by semi-adjustable articulator. Tanta Dent J [serial online] 2017 [cited 2018 Aug 17];14:225-30. Available from: http://www.tmj.eg.net/text.asp?2017/14/4/225/221378




  Introduction Top


Prosthodontics is the dental specialty that cares with the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of these patients [1].

In many instances, prosthodontic treatment necessitates irreversible alterations to the remaining hard tissues. In order to justify such alterations, significant benefits of the treatment should be apparent. Therefore, to reach a satisfactory outcome, comprehensive diagnostic planning and work-up should be conducted before embarking on the definitive prosthodontic rehabilitation. Further, the diagnostic work-up allows visualizing the outcome and helps in deciding on the most adequate treatment plan for a specific case.

For dental abnormalities, the conventional prosthodontic protocol involves obtaining diagnostic models that represent the patient's dental arches upon which the diagnostic work-up can be performed. The complexity of the treatment ranges from single or few teeth restorations, to the complete dentition. The planned treatment can involve altering the tooth morphology, altering the vertical dimension of occlusion, reorganizing the occlusion and restoring all the teeth of at least one dental arch [2],[3]. In the dental laboratory, the diagnostic work-up involves preparing dental models, reducing part of the teeth and building the contours with wax [2],[3],[4].

The Ideal diagnostic work-up should be applicable, transferable, conservative and aesthetic. Three critical criteria must be fulfilled [1]. The dental modifications should preserve the emergence profile. Therefore, although the dental modifications can be significant at the incisal or occlusal surfaces, they should be less prominent closer to the soft tissues. Further, excessive reduction should be avoided as this can affect the health of dental pulp [2]. The soft tissues should not be altered as they will aid in transferring the diagnostic information [3]. The occlusal contacts should be accurately located against the opposing teeth.

The outcome of this 'trial' treatment can be demonstrated to the patient for approval or suggestion of any further modifications. In this manner, the patient will be more informed of the final outcome. Subsequently, the diagnostic work-up will facilitate the 'outcome based treatment' which implies that the magnitude of irreversible alteration to the teeth is dictated by the final outcome rather than the initial patient presentation [5],[6].

History

Thirty-nine-year-old patient presented to the Department of Fixed Prosthodontics, Faculty of Dentistry, Aleppo University [Figure 1]. She is vegetarian and suffers from a lack of blood calcium and allergic asthma bronchitis. The patient suffers from failure crowns, and the failure is in the fall or breaks covered porcelain, especially in the teeth 18–19, and excess overbite [Table 1]. Its panoramic images was represented in [Figure 2].
Figure 1: The initial state of the patient showing deep bite and the collapse of the occlusal vertical dimension.

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Table 1: Shows general state of the patient when came, medical and clinical history

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Figure 2: Panorama shows the previous processors and current situation.

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Treatment steps

Extraction

After a clinical and radiography examination, it was performed following extraction of teeth:

  1. 2,12 because remaining roots,
  2. 21 because of caries under the gum line to 3 mm,
  3. 29 because of the large buccal counter, so as to achieve aesthetically.


Surgical lengthening

It was performed surgical lengthening of the teeth 18–19, to earn length of clinical crown, which is considered, functionally and aesthetically important before the start of treatment, Also indicate a lot of references [Figure 3]. Several authors [7] said that edges of the fixed partial denture must be cosmetic and consistent, for the six teeth anterior superior, the edges of free gingiva should be symmetrical and this is what goes against Sultan and Kadoor [8] and Abdukarim and Seraj Aldean [9] in the design of smile. They pointed out that the ideal conditions of the edges of free gingiva of upper central incisor are symmetrical in 14% of human and close to symmetry in 23% and far from asymmetry in 63% in the same sample, and when cosmetic is not first required to the patient, we decided to amend the edge of the gum only on the 8 and the neglect of asymmetry of others [Figure 4].
Figure 3: Surgical lengthening on the teeth 18-19.

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Figure 4: Asymmetry of the upper incisor.

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Semi-adjustable articulator

Impressions were made by condensation silicon (zetaplus; Zhermack, Badia Polesine, Italy) [Figure 5], then they were poured by yellow stone gypsum (Vallen, Syria) [Figure 6]. We adjusted the casts to an articular (Stratos 300; Ivoclar Vivadent, Liechtenstein, UK) [Figure 7]. According to the the manufacturer's instructions, the Stratos 300 articulator is suitable for demanding and complex dental restorations for which the joint angles have to be individually set. Its ergonomic design with spacious column construction enables easy and efficient handling, it has possibility of individual and average-value model orientation, easy handling, centric locking catch for accurate operation, separable upper and lower frame, freely advancing guided joint axis, ergonomic design with ample working space, ISS screw for side-shift movement, practice-oriented accessories assortment, compatible with split-cast systems and systems for coordination (Adesso-Split, Quick-Split), and finally it has 45° incline support [10].
Figure 5: The impression of the mandibular.

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Figure 6: We poured the impression by yellow stone gypsum.

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Figure 7: Stratos 300 and its components.

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The upper jaw relationship was adjusted with intracranial through facial bow [Figure 8], then we adjusted the relationship between the jaws through with a red waxy plate and above it (Voco, Cuxhaven, Germany) as in [Figure 9], then we proved the upper jaw according to the facial bow at Stratos 300 and then adjusted the lower jaw through the wax according to the relationship [Figure 10]. It was taken on the rest vertical dimension in the mouth and was 76 mm, while the occlusal vertical dimension was 71 mm, and occlusal vertical dimension to be accessible was 73 mm and therefore must lift 3 mm. Initially we raised the occlusal vertical dimension 2 mm by provisional fixed denture where it was lifting by Stratos 300 [11].
Figure 8: Determine the relation between upper jaw and intracranial by facial bow.

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Figure 9: Determine the relation between the jaws by waxes.

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Figure 10: The jaws adjusted on the articulator.

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Preparation the gypsum

All of the previous steps were done before starting preparations the teeth, then, gypsum preparation was performed, this way was chosen to make the provisional prosthodontic because the teeth in the patient's mouth need to know the method of preparation and knowledge of solid dental tissues dimensions to be removed so that we achieve aesthetically and enables us to this preparation before starting on the patient's mouth [Figure 11]. Then we made provisional prosthodontic [Figure 12]. The static and movement occlusion was adjusted on Stratos 300 after determine the condylar guidance angulation an average of 30° [Figure 13] [12].
Figure 11: Preparation on the gypsum.

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Figure 12: Provisional fixed prosthodontic on the articulator.

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Figure 13: Adjusted static and movement occlusion.

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For the provisional prosthodontic, we interested with adjusting of restoration edges, durability, resistance, stability, accuracy and dimensional stability, aesthetic, adjust occlusion and acceptance of periodontitis and easy cleaning of the patient [7].

We used the multilayered technology in the appropriate edges of provisional fixed denture, which described previously by Sultan and Kadoor [8].

Errors in the provisional fixed denture:

  1. Increase in the counter of upper incisors
  2. Failure of Spee and Monsoon curves
  3. The teeth 7–8 less out crop than 9–11 and therefore, we must avoid this difference in final restoration through the final preparation and control of thickness of porcelain and metal.


Preparation the teeth

After initial preparation of the teeth and cementation of the provisional prosthodontic after we adjusted it by multilayer technology, the final preparation of the teeth, taking into account the following things:

  1. Preservation of tooth tissues
  2. Resistor and installer of the preparation
  3. Durability of the restoration
  4. Accuracy of the marginal fit
  5. Protective of the periodontal [Figure 14] [13].
Figure 14: Preparation the teeth.

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Semi-adjustable articulator

We adjusted the upper jaw relationship with intracranial through face bow (Stratos 300), and then we adjusted the relationship between the jaws by the same way as mentioned earlier, at this stage we must to raise the occlusal vertical dimension 1 mm [Figure 15] [11].
Figure 15: We raised the occlusal vertical dimension 1 mm.

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We must to plan restoration units, in the case rehabilitation through fixed denture must be single as much as possible and bridges should be a simple extension [Figure 16] [14].
Figure 16: Planning restoration units.

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Then we began waxing and casting, and adjusted it on the articulator [Figure 17].
Figure 17: Test the core metal on the casts.

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Then we tested it in the patient's mouth to make sure the accuracy of clinical trials [Figure 18].
Figure 18: The fixed prosthodontic at the patient.

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Choose the ceramic color

The best time to choose the color is in the light of day when the temperature light absolute Calvin 5600, however, more dentists choose color under artificial light in the clinic. Standard light is daylight when exposed to sunlight in the middle part of the day when the sky is overcast we used guide (Vitapan 3D-Master; Germany) because its advantages and accuracy in color matching and ease of use [8].

And finally we cementation the prosthodontic by glass ionomer cement (Ivoclar Vivadent, Liechtenstein, UK) [Figure 19].
Figure 19: The patient after finishing the treatment.

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  Conclusion Top


Through the treatment steps and the end results shows what they offer prosthodontic treatment of the positive psychological impact on the patient, in addition to the advantages of the use of semi-adjustable articulator, which enabled us to get the planning and implementation of a precise plan of treatment, the preparation on gypsum enabled us to discover the mistakes that left behind in final prosthodontic.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Keith J. The glossary of prosthodontic terms J Prosthet Dent 2005; 94:10–92.  Back to cited text no. 1
    
2.
Keough B. Occlusion based treatment planning for complex dental restorations Part 1. J Periodontics Restorative Dent 2003; 23:237–247.  Back to cited text no. 2
    
3.
Besimo E, Rohner P. Three-dimensional treatment planning for prosthetic rehabilitation. J Periodontics Restorative Dent 2005; 25:81–87.  Back to cited text no. 3
    
4.
Abduo J. An innovative prostheses design for rehabilitation of severely mutilated dentition. A case report. J Adv Prosthodont 2011; 3:37–42.  Back to cited text no. 4
    
5.
Magne P, Belser C. Novel porcelain laminate preparation. approach driven by a diagnostic mock-up. J Esthet Restor Dent 2004;16:7–16.  Back to cited text no. 5
    
6.
Gurel G. Porcelain laminate veneers minimal tooth preparation by design. Dent clin 2007; 51:419–431.  Back to cited text no. 6
    
7.
Kenneth A, Barry D. Esthetic dentistry: a clinical approach to techniques and material. 2nd ed. St Louis, MO: Mosby; 2001. pp. 197–230.  Back to cited text no. 7
    
8.
Sultan M, Kadoor J. Fixed prosthodontics science. Syria: Aleppo University Publications 2014; pp. 221–280.  Back to cited text no. 8
    
9.
Abdukarim A, Seraj Aldeen A. Smile design. Syria: Aleppo University Publication 2015; pp. 110–250.  Back to cited text no. 9
    
10.
11.
Lyka A. Removable prosthodontics science. Syria: Tishreen University Publications 2003; pp. 450–600.  Back to cited text no. 11
    
12.
Ferrario VF, Sforza C, Dellavia C. Evidence of an influence of asymmetrical occlusal interferences. J oral Rehab 2003; 30:34-40.  Back to cited text no. 12
    
13.
Shillingburg R.T, Richard J, Susan B. Fundamentals of Tooth Preparations for Cast Metal and Porcelain Restorations. 2nd ed.; Quintessence Publishing 1991. p. 225–30.  Back to cited text no. 13
    
14.
Johansson A, Omar R. Rehabilitation of the worn dentition, review article. J Oral Rehabil 2008;35:548–66.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19]
 
 
    Tables

  [Table 1]



 

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