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