Full Mouth Rehabilitation in a Patient with Severely Worn Dentition

심하게 마모된 치열을 가진 환자의 완전구강회복

  • Seo, Jae-Min (Department of Prosthodontics, School of Dentistry, Chonbuk National University)
  • 서재민 (전북대학교 치의학전문대학원 치과보철학교실)
  • Received : 2010.09.12
  • Accepted : 2010.12.25
  • Published : 2010.12.30

Abstract

Inadequate or unstable posterior support cause extrusion of antagonistic teeth and overloading of remaining teeth. Extrusion of antagonistic teeth result in collapsed occlusal plane and decreased prosthetic space. Also, overloading of remaining teeth increase occlusal wear or anterior extrusion of anterior teeth, which is resulting in loss of anterior guidance, disharmony of occlusion and decreased prosthetic space. In this case, careful evaluation of OVD(occlusal vertical dimension) is the general first trial to regain appropriate function and esthetics. Simultaneously, adequate anterior guidance and harmonious occlusal plane should be established in the repeatable reference position of the mandible. We report this case because severely worn dentition achieved functional and esthetic results from full mouth rehabilitation with increased vertical dimension and use of centric relation.

다수의 구치 상실로 인한 구치부 지지의 부족은 일차적으로 대합치의 정출 및 잔존치의 과도한 교합하중을 발생시킨다. 대합치의 정출은 교합평면의 부조화(reverse curve)와 보철수복공간의 부족을 일으킬 수 있다. 잔존치의 과도한 교합하중 역시 전치의 전방돌출이나, 잔존치의 급속한 마모를 일으켜 적절한 전방유도의 상실 및 교합의 부조화, 보철수복공간의 부족을 일으킬 수 있다. 이러한 환자의 경우, 치과의사는 현재의 교합수직고경이 적절한지의 여부를 판단한 후, 환자가 적응할 수 있는 범위 내에서 기능적, 심미적인 수직고경을 정하고, 반복재현 가능한 하악위에서 적절한 전방유도와 교합평면을 설정해야 한다. 본 증례에서는 구치부 상실 및 대합치의 정출, 그리고 잔존치의 심한 마모로 인하여 교합수직고경 및 교합평면이 붕괴된 환자의 완전구강회복 증례를 문헌 고찰과 함께 보고하고자 한다.

Keywords

References

  1. 정재현, 최민호, 박영록. 심한 교모증 환자에서의 진단 및 치료계획 수립. 대한치과턱관기능교합학회지 2003;19:240-245
  2. Rosental SF, Land MF, Fujimoto J. Comtemporary fixed prosthodontics 4th. Elsevier; 2008.
  3. Dawson PE. Evaluation, diagnosis and treatment of occlusal problems 2nd ed. St. Louis; Mosby 1989
  4. Rugh JD, Drago CJ. Vertical dimension : A study of clinical rest position and jaw muscle activity. J Prosthet Dent 1981;45:670-675, https://doi.org/10.1016/0022-3913(81)90426-1
  5. Ramfjord SP, Blankenship J. Increased occlusal vertical dimension in adult monkeys. J Prosthet Dent 1981;45(1):74-83 https://doi.org/10.1016/0022-3913(81)90015-9
  6. Olsen, ES. A radiographic study of variations in the physiologic rest position of the mandible in seventy edentulous individuals. abstract, J Dent Res 1951; 30:517
  7. Dombrady, L. Investigation into the transient instability of the rest position. J Prosthet Dent 1966;16:479-490 https://doi.org/10.1016/0022-3913(66)90052-7
  8. Atwood, DA. A cephalometric study of the clinical rest position of the mandible. Part III. J Prosthet Dent 1958;8:698-708 https://doi.org/10.1016/0022-3913(58)90057-X
  9. Sheppard IM, Sheppard SM. Vertical dimension measurements. J Prosthet Dent 1975;34:269-277 https://doi.org/10.1016/0022-3913(75)90103-1
  10. Tallgren A. Changes in adult face height due to aging, wear and loss of teeth and prosthetic treatment. A roentgen cephalometric study mainly on Finnish women. Acta Odontal Scan 1957;15:1-112 https://doi.org/10.3109/00016355709041090
  11. Tallgen A. The reduction in face height of edentulous in partially edentulous subjects during long-term denture wear, a longitudinal roentgenographic cephalometric study. Acta Odontal Scan 1966;24:195-239 https://doi.org/10.3109/00016356609026127
  12. Swerdlow H. Roentgenocephalometric study of vertical dimension changes in immediate denture patient. J Prosthet Dent 1964;14:635-650 https://doi.org/10.1016/0022-3913(64)90199-4
  13. Atwood DA. A cephalometric study of the clinical rest position of the mandible. Part II. J Prosthet Dent 1957;8:544-552
  14. Cohen S. A cephalometric study of rest position in edentulous persons : Influence of variations in head position. J Prosthet Dent 1957;7:467-472 https://doi.org/10.1016/0022-3913(57)90052-5
  15. 김남중, 이성복, 최대균, 박남수. 교합고경의 인위적인 증가에 따른 저작계의 반응에 관한 연구. 대한치과의사학회지 1995;33(4)
  16. Waerhaug J, Hansen ER. Periodontal changes incident to prolonged occlusal overload in monkeys. Acta Odontal Scan 1966;24:91-104 https://doi.org/10.3109/00016356609026121
  17. Carlsson GE, Ingervall B, Kocak G. Effect of increasing vertical dimension on the masticatory system in subjects with natural teeth. J Prosthet Dent 1979;41:284-289 https://doi.org/10.1016/0022-3913(79)90008-8
  18. 권긍록. 교합고경이 붕괴된 환자의 보철치료. 대한치과턱관절기능교합학회지 2004;20:169-181
  19. Pleasure MA. Correct vertical dimension and freeway space. J Am Dent Assoc 1951;43:160-163 https://doi.org/10.14219/jada.archive.1951.0188
  20. McGee GF. Use of facial measurements in determining vertical dimension. J Am Dent Assoc 1947;35:342-350 https://doi.org/10.14219/jada.archive.1947.0361
  21. Thomson JR. The rest position of the mandible and its significance to dental science. J Am Dent Assoc 1946;33:151-180 https://doi.org/10.14219/jada.archive.1946.0034
  22. Niswonger ME. The rest position of the mandible and centric relation. J Am Dent Assoc 1934;21:1572-1582
  23. Mack MR. Vertical dimension : A dynamic concept based on facial form and oropharyngeal function. J Prosthet Dent 1991;66:478-485 https://doi.org/10.1016/0022-3913(91)90508-T
  24. 황두연, 양자호. 수직고경의 회복에 대한 문헌적 고찰. 대한치과보철학회지 1997;35:211-220
  25. Silverman MM. The speaking method in measuring vertical dimension. J Prosthet Dent 1964;14(4): 635-650 https://doi.org/10.1016/0022-3913(64)90199-4
  26. Pound E. The vertical dimension of speech : the pilot of occlusion. J Calif Dent Assoc 1978;6(2):42-47
  27. Shanahan TEJ. Physiologic vertical dimension and centric relation. J Prosthet Dent 1956;6:741-747 https://doi.org/10.1016/0022-3913(56)90070-1
  28. Turner KA, Missirlian DM. Restoration of the extremely worn dentition. J Prosthet Dent 1984;4: 467-474
  29. The glossary of prosthodontics terms. J Prosthet Dent 2005;94(1):10-92 https://doi.org/10.1016/j.prosdent.2005.03.013
  30. Lucia VO. A technique for recording centric relation. J Prosthet Dent 1964;14(3):492-505 https://doi.org/10.1016/S0022-3913(64)80017-2
  31. Long JH. Locating centric relation with a leaf gauge. J Prosthet Dent 1973;29(6):608-610 https://doi.org/10.1016/0022-3913(73)90267-9
  32. Woelfel JB. New device for accurately recording centric relation. J Prosthet Dent 1986;56(6):716-727 https://doi.org/10.1016/0022-3913(86)90152-6
  33. Campos AA, Nathanson D, Rose L. Reproducibility and condylar position of a physiologic maxillomandibular centric relation in upright and supine body position. J Prosthet Dent 1996;76(3):282-287 https://doi.org/10.1016/S0022-3913(96)90172-9
  34. McHorris WH. Centric relation. J Gnathology 1986;5:5-21
  35. Williamson EH, Steinke RM, Morse PK, Swift TR. Centric relation : A comparison of muscle determined position and operator guidance. Am J Ortho 1980;77:133-145 https://doi.org/10.1016/0002-9416(80)90002-0
  36. Dawson PE. Centric relation. Its effect on occlusomuscle harmony. Dent Clin North Am 1979;23(2): 169-180
  37. 최진웅, 최대균, 박남수, 최부병. 하악 중심위 유도 방법에 따른 하악위의 재현성 및 변위량에 관한 비교연구. 대한치과보철학회지 1988;26
  38. 이승정, 최대균. 한국 성인유치악자 하악치열궁의 교합평면에 관한 연구. 경희치대 논문집 1987
  39. 권긍록, 우이형, 최대균. 정상 한국인의 하악 전방 운동시 시상과로각과 절치로각에 관한 연구. 대한치과보철학회지 1987;27
  40. Schuyler CH. The function and importance of incisal guidance in oral rehabilitation. J Prosthet Dent 1963;13:1011-1030 https://doi.org/10.1016/0022-3913(63)90255-5
  41. Kohno S, Masanori Nakano. The measurement development of anterior guidance. J Prosthet Dent 1987;57:620-625 https://doi.org/10.1016/0022-3913(87)90348-9
  42. Wood GN. Centric relation and the treatment position in rehabilitating occlusions: A physiologic approach. Part II: The treatment position. J Prosthet Dent 1988;61(1):15-18
  43. Hobo S, Iwata T. Reproducibility of mandibular centricity in three dimensions. J Prosthet Dent 1985;53:649-654 https://doi.org/10.1016/0022-3913(85)90013-7
  44. Weinberg LA. The role of muscle deconditioning for occlusal corrective procedures. J Proshet Dent 1991;66:250-255
  45. 최미라. 심하게 마모된 치열의 보철수복. 대한턱관절기능교합학회지 2009;25:335-345
  46. Brown KE. Reconstruction considerations for severe dental attrition. J Prosthet Dent 1980;44:384-388 https://doi.org/10.1016/0022-3913(80)90094-3