Reestablishing aesthetic and function of patient with severe worn dentition: a conservative approach with provisional fixed tooth/implant supported prosthesis

Resumo

Patients with severe parafunctional habits can have
a reduction of their occlusal vertical dimension (OVD) and may
create complex cases of oral rehabilitation, in which the patient may
develop occlusal, masticatory and psychological problems. Objective:
To report a clinical case of restoration of masticatory function and
aesthetics from the production of tooth/implant-supported prostheses
with conservative preparations, reestablishing the OVD and occlusal
stability. Case report: Patient MVN, 55 years old, wheelchair user,
presenting bruxism with a history of gastric reflux due to hiatal
hernia, attended the clinic at the University complaining of dental
sensitivity, difficulty in chewing and aesthetic smile commitment.
At clinical examination it was found widespread wear of teeth.
Radiographic examination showed good periodontal health and
dental implants in good condition of osseointegration. The OVD was
established from the VDR and confirmed by the metric method.
The initial casts were positioned on the articulator for diagnostic
waxing. From the waxing it was possible to make provisional fixed
tooth/implant-supported prostheses. In the lower arch, the prosthesis was screwed on the implants #35, #37, #46, and #47, with the
remaining teeth working as an auxiliary support, while in the upper
arch two interim prosthesis were made, one for the elements #16
and #17 (tooth-supported) and one for the elements #13, #12, #11,
#21, #22, #23, #24 (tooth/implant-supported). Thus, the OVD and
the aesthetics lost by bruxism abrasion were restored. Conclusion:
This case demonstrates the importance of the provisional prostheses
for aesthetic and functional rehabilitation of patients with severe
worn dentition.