Occlusal Concepts Application in Resolving Implant Prosthetic Failure: Case Report
The prosthetic management of a poor implant treatment is presented in this case report. The recommended occlusion concepts for implant-supported prostheses were applied for the resolution of the case. The rehabilitation of the posterior segments provided a mutually protected occlusion with adequate distribution of the axial and lateral bite forces with stable posterior occlusion. The clinical exam indicated the need for modification in the vertical dimension of occlusion. Sufficient interocclusal rest space was present to test the alteration in the vertical dimension. The aim was to achieve an occlusion scheme that followed four specific criteria: (1) centric contacts and centric relation of the jaw-to-jaw position; (2) anterior guidance only; (3) shallow anterior angle of tooth contact; and (4) vertical dimension of occlusion with acceptable tooth form and guidance. The success of an oral rehabilitation relies in following the aforementioned criteria, appropriate interaction between the dental laboratory technician and the clinician, careful elaboration of the provisional rehabilitation with all the desired details to be reproduced in the final prosthetic restoration and sufficient follow-up time of the provisional prostheses before placing the final restoration.
Figure 1. Initial panoramic radiography. Figure 2. Initial profile teleradiography (note the maxillomandibular relationship).
Figure 3. (a) Initial frontal aspect (Note bilateral cross-bite). (b) and (c) Initial lateral view—right (b) and left side (c) (Note infraocclusion of the posterior teeth). Figure 4. (a) and (b) Lateral view to verify the possibility of rehabilitation of the anteroposterior curves—right (a) and left side (b). Figure 5. Frontal view of the maxillomandibular relationship in the planned VDO with the mandible guided into CR (Lucia jig). Figure 6. Frontal aspect of casts after diagnostic waxing.
Figure 7. (a) Frontal view after installation of the temporary crowns (Note the relationship of the posterior teeth without the cross-bite and the absence of contact of anterior teeth due to the modification established in VDO). (a) and (b) Lateral aspects of the maxillomandibular relationship established after the installation of the provisional crowns: effective simultaneous bilateral contact on the posterior teeth. Figure 8. (a) Frontal aspect of the orthodontic appliance to promote labial movement of teeth #10 and #11. (b) Frontal aspect after the orthodontic movement. Figure 9. Cemented customized zirconia abutment. Figure 10. Frontal view of the installed prosthetic rehabilitation.
Figure 11. (a) and (b) Lateral views of the installed prostheses—right (a) and left (b) sides. (c) Occlusal view of the contact points obtained in CR. Figures 12. (a) and (b) Canine guidance obtained with the final restoration. Right (a) and left (b) sides. Figure 13. (a) and (b) Initial (a) and final (b) frontal aspect of the patient. (c) Effect of the rehabilitation in the esthetics of the smile. Figure 14. Final profile teleradiography.
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