Odontologo

Prosthodoníics

Prosthetic rehabilitation of extremeiy worn dentitions Case reports
Cenk Cura, DDS, PhDVAhmet Saraçoglu. DDS, PhDVBerran Öztürk, DDS,
Ttie stomatognathic system is a complicated structure, and patients usually adapt to their existing vertical dimension of occlusion. Therefore, prosttietic rehabilitation of decreased vertical dimension of occlusion should be considered oniywhen dictated by esthetic or functional requirements. If the loss of vertical dimension is significant, provisional prostheses shouid be used before the final prosthesis to prevent tension or pain in the temporomandibular joints and the muscles as the patient adapts to the new dimensions. Acrylic resin provisional prostheses were used for three patients before the tinai prosthesis was fabricated withthe restored vertical dimension of occiusion. The period of use varied, depending on the patient's individual adaptive ability. The important aspect is to find the most comfortable position for the patient. (Quintessence Int 2002,33:225-230) Key words: acrylic resin, interocclusal splint, prosthetic rehabilitation, provisionai prostinesis, tooth wear, vertical dimension of occlusion

ooth wearwithin physiologic limfts is considered normal. Excessive occlusal surface wear can cause changes in the vertical dimension of occlusion and pathosis in the temporomandibular joint (TMJ) and the masticatory muscles.'•Bruxism is generaUy believed to be the most significant cause of tooth wear, but other factors must also be considered. Some congenital tooth anomalies, parafuncfional habits,abrasion caused by diet, erosion, and early posterior tooth loss may result in excessive loss of vertical dimension of occlusion. Habits as well as dietary and salivary factors are often cofactors. Abrasive and acidic components of the diet should also be considered in the etiologj,' of extensive dental wear.^''' Occlusal wear does not always have to be restored. Some patients adapt to the decreasedvertical dimension of occlusion without clinical symptoms. The adaptation of the stomatognathic system to this decreased vertical dimension has been reported in several studies.^ ^ The goal of occlusal therapy is to facihtate this adaptation. Several factors must be considered when prosthetic rehabilitation is required in a patient with occlusal wear and a resultant loss of vertical dimension ofocclusion. In particular, the use of a provisional pros-

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tbesis should he considered to prevent tension or pain in the temporomandibular joint and the muscles as the patient adapts to the restored vertical dimension. The stages of definitive and provisional prosthodontic treatment are diagnosis, clinical evaluation, provisional treatment, and final restoration. This article will describe theprosthodontic treatment of three patients who had excessive loss of vertical dimension of occlusion. The focus of the discussion will be the basic principles and procedures of fabricating provisional prostheses that will establish an accurate estimate of the optimum vertical dimension.
TREATMENT STAGES Diagnosis

'Assistant Professor, Department of Prosthodontios, Aegean University, Faculty otDentistry, izmir, Turkey. 'Protessor, Department of Prosthodontics, Aegean University. Faculty of Dentistry, Izmir. Turkey. Repn'nt requests: Dr Cenk Cura. Ege Üriversitesi, Dishekimligi FakDItesi. Protetik Dis Tedavisi Anabilim Daii, 35tOO Bornova. izmir. Turkey. E-mail: Cenkcura@hotmail.oom

In the diagnosis stage, the question of whether the patient's vertical dimension of occlusion has to bechanged should be assessed. In this assessment, pain or fafigue in the TMJ and masticatory muscles, difficulty in jaw movements, and disappearance of anterior guidance as a result of tooth wear should be evaluated. Hypersensitivity, pain, and tooth mohility are the most common findings in patients with severe tooth wear. The existing dental restorations should also be considered in the diagnosis...