Journal of the Korean Academy of Esthetic Dentistry
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v.23
no.1
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pp.4-15
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2014
A face-bow and an articulator have been used as crucial devices in a prosthodontic reconstruction of a collapsed occlusal plane. In order to avoid inaccuracy of median line in maxilla and the canted occlusal plane both of which may result from using a facebow with ear rods, a facebow that locate a patient's facial median line as reference line has been under development. A mounting technique that tries to bring a center of patient's face into line with the center of the articulator, called esthetic mounting, is currently employed to overcome the imprecision resulted from mounting with ear-bow transfer. We would like to study a case that used OP finder 1, one of the esthetic mounting techniques.
The severe wear of anterior teeth facilitates the loss of anterior guidance, which protects the posterior teeth from wear during excursive movement. The collapse of posterior teeth also results in the loss of normal occlusal plane and the reduction of the vertical dimension. This case report describes 77-year-old female, who had the loss of anterior guidance, the severe wear of dentition, and the reduction of the vertical dimension. Occlusal overlay splint was used after the decision of increasing vertical dimension by anatomical landmark, facial and physiologic measurement. Once the compatibility of the new vertical dimension had been confirmed, interim fixed restoration and the permanent reconstruction was initiated. This case reports that a satisfactory clinical result was achieved by restoring the vertical dimension with an improvement in esthetics and function.
Purpose : This study was performed to determine the proper reference line for taking axial computed tomograms from which the good cross-sectional views can be reformatted by multiplanar reconstruction. Methods : Three dry mandibles with implanted gutta percha cones in the extracted socket were scanned axially according to 6 reference lines of 2 mandibular positions with computed tomogram Hitachi W550. The accuracy of measurements of the lengths of implanted gutta perch a cones in the each cross-sectional view reformatted from axial computed tomogram by multiplanar reconstruction was evaluated. Results: The difference between the measurements and the real length of implant was smallest in the bucco-lingual views reformatted from the axial views scanned according to the reference line of group V-a. The smaller the angle difference between reference line and occlusal line was, the smaller the difference between the measurements in the bucco-lingual views reformatted from axial views and the real length of implant. The majority of measured widths of implants in the bucco-lingually reformatted views were larger than the actual values. Conclusions : When the mandible is inclined within the limitation of gantry angle and scanned with the reference line coincident with occlusal plane, the bucco-lingual view can be reformatted without deformation of images from the axially scanned images.
With the fourth industrial revolution, digitization is accelerating in all healthcare areas. In the field of dentistry, active discussions on digital dental technologies are ongoing, with increasing interest from clinicians daily. Thus far, accuracy and efficiency have primarily been emphasized in digital dentistry, and interest in occlusion has been relatively low. This is because digital dentistry has been predominantly used to restore small numbers of teeth rather than extensive prosthetic reconstruction. However, in the future, most dental treatments will undergo a digital transformation that will require the application of digital technology to more extensive prosthetic rehabilitation, for which discussion of occlusion is essential. In extensive prosthetic reconstruction, occlusion and articulation involve determining the position of the dental arch in relation to the reference plane of the skull or the long axis of the face and the position of the transverse horizontal axis. It also includes determining an occlusal surface with a shape that allows the mandible to move in an eccentric path and masticate most efficiently without any occlusal interference. To better understand how digitization will impact dentistry, this review article summarizes and discusses occlusion and articulation using digital dental technologies. This discussion is divided into several aspects, including facial scan, virtual articulation, augmented reality, and virtual reality.
Background: Mandibular deficiency leading to facial asymmetry causes cosmetic deformity as well as psychological stigma for the patient. Correction of these mandibular asymmetries is a major challenge. The study investigates the efficacy of bidirectional mandible distraction for the treatment of mandibular deficiency. Methods: This prospective study included six individuals aged between 17 and 24.4 years. Five patients had hemifacial microsomia and one had unilateral temporomandibular joint ankyloses. All patients underwent mandibular distraction osteogenesis. Postoperative skeletal changes in affected mandible, and changes in occlusal plane and oral commissure cant were evaluated using three-dimensional reconstruction. Patient satisfaction and understanding of the procedure were assessed through three questionnaires administered during pre-distraction, distraction and post-distraction phases. Results: In pre-distraction phase, aesthetic appearance seemed to be the primary indication for surgery. In distraction phase, pain while chewing was the primary handicap. In post-distraction phase all patients were satisfied with the aesthetic outcome. The facial deformity was improved through mandibular distraction osteogenesis. On the affected side in all the patients, height and length of the mandible increased. Canting of the occlusal plane and oral commissure was corrected. Conclusion: Bidirectional mandible distraction is an effective treatment for correction of mandible deformities in adult patients.
Journal of the Korean Academy of Esthetic Dentistry
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v.25
no.2
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pp.68-78
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2016
Recently, digital technology has become increasingly prevalent in the dental clinic. Using a milling machine for clinic, it is possible to produce provisional restoration inside the clinic. This can promote large clinical cases such as full mouth rehabilitation with the help of a tabletop scanner, which is capable of semi-adjustable articulator equipment, and a powerful dental CAD software with excellent user convenience. In this case report, a full-mouth rehabilitation was done with digital technology to a 55 year-old female patient, who has lost vertical dimension through the attrition, and has got inclined occlusal plane with unplanned and repeated dental reconstruction. Through the design and milling of the provisional restoration in the clinic and the duplication of these provisionals by double scanning technique, a good functional and esthetic result could be achieved.
Kim, Il-Kyu;Park, Jong-Won;Lee, Eon-Hwa;Yang, Jung-Eun;Chang, Jae-Won;Pyun, Yeong-Hun;Ju, Sang-Hyun;Wang, Boon
Maxillofacial Plastic and Reconstructive Surgery
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v.32
no.5
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pp.447-453
/
2010
The hemifacial microsomia is characterized by variable underdevelopment of the craniofacial skeleton, external ear, and facial soft tissues. So, patients with hemifacial microsomia have an occlusal plane canting and malocclusion with facial asymmetry. Distraction osteogenesis (DO) with an intraoral or extraoral device is a technique using tension to generate new bone with gradual bone movement and remodeling. DO has especially been used to correct craniofacial deformities such as a hemifacial microsomia, facial asymmetry, and mandible defect that could not adequately be treated by conventional reconstruction with osteotomies. It has a significant advantage to lengthen soft and hard tissue of underdeveloped site without bone graft and a few complication such as nerve injury or muscle contracture. A 13-years old girl visited our clinic for the chief complaint of facial asymmetry. She had a left hypoplastic maxilla and mandible, occlusal plane canting and malocclusion. We diagnosed hemifacial microsomia and lanned DO to lengthen the affected side. Le Fort I osteotomy, left mandibular ramus and symphysis osteotomy were performed. The internal distraction devices fixed with screw on maxillary and mandibular ramus osteotomy sites. External devices were adapted to lower jaw for DO on symphysis osteotomy site and to upper jaw for rapid maxillary expansion (RME). At 7days after surgery, distraction was started at the rate of 1mm per day for 13days, and after 4months consolidation periods, distraction devices were removed. Simultaneous multiple maxillo-mandibular distraction osteogenesis with RME resulted in a satisfactory success in correcting facial asymmetry as well as occlusal plane canting for our hemifacial microsomia.
The purpose of this study is to locate the proper position of the lower occlusal plane according to individual skeletal pattern. Cephalometric films of 234 subjects of the control group, 358 of the pretreatment group and 358 of the treated group were analyzed to study proper relationships between vertical dimension ratio(VDR) and lower occlusomandibular plane angle(LOM). The control group was divided into two subgroups by the age. The first subgroup consisted of 113 subjects of the age 14 years and under and with the mean age of 10.82 years. The other subgroup consisted of 113 subjects of the age 18 years and above with the mean age of 23.76 years. The pretreatment group was divided into three subgroups by the age. The first subgroup consisted of 274 subjects of the age 14 years and under with the mean age of 11.36 years. The second subgroup consisted of 54 subjects of the age 14 through 18 years with the mean age of 15.4 years. The last subgroup consisted of 30 subjects of the age 18 years and above with the mean age of 21.35 years. The treated group was also divided into three subgroups by the age. The first subgroup consisted of 145 subjects of the age 14 years and under with the mean age of 12.91 years. The second subgroup consisted of 166 subjects of the age 14 through 18 years with the mean age of 15.64 years. The last subgroup consisted of 47 subjects of the age 18 years and above with the mean age of 21.61 years. Cephalometric films of the sample were traced. Measurements were made to a hundredth using a program specifically prepared for this study, and the results were entered into a 486DX PC. Means and Standard deviations of all the veriables were calculated for each group. Correlation coefficients between pertinent variables were calculated. Significance tests on those coefficients, one-way ANOVA and t-tests between variables or groups were performed. On the basis of the results studied above, certain subjects were selected from the control and the treated groups to locate the proper position of the occlusal plane, and designated as the optimal occluaion group. The subjects of this optimal occlusion group had 1-3 mm overbite, 1-3 mm of overjet and less than 1.75 mm of curve of Spee. A total subjects of 187 in this group consisted 104 treated subjects and 83 control group. Regression analysis was carried out between VDR and LOM, and regression equations were tabulated for this optimal occlusion group. The results were as follows : 1. Highly significant correlations were observed between various variables useful for identifying vertical component of skeletal frame, but any one particular variable did not accurately indicate the magnitude of anterior vertical overbite. 2. Of the variables useful identifying vertical component of skeletal frame, The VDR showed the highest correlation to the LOM. 3. Of the total sample, 80 percent had overbite within the normal range, irrespective of VDR. 4. The optimal occlusion group was divided into 9 subgroups by the age and the anteroposterior skeletal pattern, and correlation coefficient and determination coefficient between VDR and LOM of each group were calculated. Correlation coefficients and determination coefficients were found to be significantly high in all groups. 5. Regression equation was induced for each of the optimal occlusion group to find proper LOM according to the VDR. 6. It was found that the mean value of the cant of occlusal plane itself is not enough for a diagnosis and a treatment plan. Rather, It is very important to locate the proper occlusal plane for an Individual skeletal pattern.
There are varieties of severe malocclusions, which can be treated orthodontically, but with a great deal of effort. Anterior openbite, in particular, is one malocclusion thought to be more difficult to treat, and therefore, most of them have to be corrected by means of surgical intervention. To solve these problems, numerous studies pertinent to treatment modalities have been introduced with controversies on the effectiveness of treatment. Suggested treatment modalities for anterior openbite are based directly or indirectly on the neuromuscular and morphological features and on the etiologic and/or the environmental factors. Even though the vertical relationship of the face is increased due to the growth variation, the normal occlusal relationship can be achieved by the adequate dentoalveolar compensatory mechanism, but in the case of inadequate or negative dentoalveolar compensation, openbite is likely to be present. If the skeletal dysplasia is too severe to be solved by orthodontic treatment alone, combined treatment with surgery should be done to restore the function and the esthetics of the orofacial complex. In many cases, however, orthodontic alteration of the dentition pertinent to the given skeletal pattern with the proper diagnosis and treatment planning can bring satisfactory results. The treatment changes with the Multiloop Edgewise Archwire(MEAW) therapy occurred mainly in the dentoalveolar region and showed a considerable similarity to the natural dentoalveolar compensatory mechanism. In other words, the MEAW technique allows orthodontists to produce the natural dentoalveolar compensation orthodontically. Even if an openbite is corrected by the orthodontic dentoalveolar compensation suitable for the skeletal pattern, relapse may still occur by the persisting etiologic factors which originally prohibited the natural dentoalveolar compensation. The etiologic factors should be determined at the time of initial diagnosis and should be controlled during treatment and retention.
Purpose: This study was performed to evaluate the effect of changing the orientation of a reconstructed image on the accuracy of linear measurements using cone-beam computed tomography (CBCT). Materials and Methods: Forty-two titanium pins were inserted in seven dry sheep mandibles. The length of these pins was measured using a digital caliper with readability of 0.01 mm. Mandibles were radiographed using a CBCT device. When the CBCT images were reconstructed, the orientation of slices was adjusted to parallel (i.e., $0^{\circ}$), $+10^{\circ}$, $+12^{\circ}$, $-12^{\circ}$, and $-10^{\circ}$ with respect to the occlusal plane. The length of the pins was measured by three radiologists, and the accuracy of these measurements was reported using descriptive statistics and one-way analysis of variance (ANOVA); p<0.05 was considered statistically significant. Results: The differences in radiographic measurements ranged from -0.64 to +0.06 at the orientation of $-12^{\circ}$, -0.66 to -0.11 at $-10^{\circ}$, -0.51 to +0.19 at $0^{\circ}$, -0.64 to +0.08 at $+10^{\circ}$, and -0.64 to +0.1 at $+12^{\circ}$. The mean absolute values of the errors were greater at negative orientations than at the parallel position or at positive orientations. The observers underestimated most of the variables by 0.5-0.1 mm (83.6%). In the second set of observations, the reproducibility at all orientations was greater than 0.9. Conclusion: Changing the slice orientation in the range of $-12^{\circ}$ to $+12^{\circ}$ reduced the accuracy of linear measurements obtained using CBCT. However, the error value was smaller than 0.5 mm and was, therefore, clinically acceptable.
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