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Figure 10: A full-arch retracted preoperative view of a patient in
centric relation with no posterior tooth contact. He has no TMJ
symptoms at this time.
Figure 11: As the incisal edges of teeth #7–10 are reduced out of
contact, the posterior teeth begin to come into contact.
Figure 12: Following the incisal reduction of teeth #7–10, contacts of
the posterior maxillary teeth can be seen from this maxillary arch view.
Figure 13: Tooth preparation of the maxillary incisors completed for
all-ceramic restorations.
Case Report #2
The patient shown in a preoperative, retracted view in
Figure 10 is positioned in centric relation. It is evident
that this patient is occluding on the anterior only and has
no posterior tooth contact. He has been told that his only
option is to have jaw surgery followed by orthodontics and
restorative therapy. After mounting the preoperative study
models in centric relation on a semi-adjustable articulator,
it was determined that if the maxillary anterior arch form
could be slightly expanded facially (increasing the overjet),
it would likely allow the mandible to close and the posterior
teeth to contact.
When the maxillary teeth #7–10 are reduced incisally, the
posterior teeth will come into contact. Therefore, the operative
plan will be to prepare teeth #7–10 and place 360-degree
ceramic restorations to correct the arch form in the facial
direction and tilt the long axis of the crowns slightly toward
the facial aspect, creating overbite and overjet. As the incisal
edges are shortened, the posterior teeth come into contact
(Figs. 11, 12). Once this occurs, the teeth must then be depth
cut on the facial and palatal aspects to allow for the thickness
of the ceramic material (Fig. 13).
Figure 14 shows the case completed after the four maxillary
incisor restorations are delivered. Note the functional
contact that now exists in centric occlusion for the patient.
Although the crossbite cannot be addressed without restoration
of the posterior teeth and a full-mouth reconstruction,
the patient has gained a stable occlusal situation by the restoration
of four teeth without invasive orthognathic surgery.
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