PROSTHETIC REHABILITATION OF A PATIENT WITH WORN DENTITION: A CASE REPORT

Atatürk Üniv Diş Hek Fak Derg (J Dent Fac Atatürk Uni) Cilt:31, Sayı:3, Yıl: 2021, Sayfa: 444-8 UÇAR, ÇEKİÇ NAGAŞ Olgu Sunumu/ Case Report PROSTHETIC REHABILITATION OF A PATIENT WITH WORN DENTITION: A CASE REPORT≠ Makale Kodu/Article code: 3998 Makale Gönderilme tarihi: 28.02.2019 Kabul Tarihi: 10.06.2019 AŞINMIŞ DENTISYONA SAHIP HASTANIN PROTETIK REHABILITASYONU: VAKA RAPORU≠ Dt. Ece UÇAR* Prof. Dr. Işıl ÇEKİÇ NAGAŞ* Makale Kodu/Article code: 4568 Makale Gönderilme tarihi: 03.09.2020 Kabul Tarihi: 03.03.2021 DOI : 10.17567/ataunidfd.890549 Ece Uçar: ORCID ID: 0000-0002-8931-7332 Işıl Çekiç Nagaş: ORCID ID: 0000-0002-2768-7207 ABSTRACT Vertical height loss occurring due to parafunctional habits might cause speech, chewing and aesthetic problems. Patients often adapt to the new vertical size, in some cases the occlusal vertical size needs to be restored. A 54-year-old male patient applied to the clinic with abrasion of teeth and complaints about chewing and aesthetic. Following clinical and radiographic evaluations, appropriate vertical size for the patient was determined. Then, temporary prosthesis were fabricated and used for 2 months period. During these 2 months, the patient was checked regularly and no temporomandibular disease was observed. At the end of this period, the patient's permanent prostheses were made. In this case, there were no functional, aesthetic problems or temporomandibular disease in the periodic controls. In conclusion, when the vertical size should be increased, permanent prostheses should not be made without adapting the patient to the new vertical size. Keywords: Attrition; occlusal vertical dimension; prosthetic rehabilitation; temporomandibular disorder; tooth wear. ÖZ Parafonksiyonel alışkanlıklar nedeniyle meydana gelen dikey boyut kaybı konuşma, çiğneme ve estetik sorunlara neden olabilir. Hastalar genellikle yeni dikey boyuta uyum sağlar, ancak bazı durumlarda oklüzal dikey boyutun restore edilmesi gerekmektedir. 54 yaşındaki erkek hasta, kliniğe dişlerde aşınma, çiğneme ve estetik şikayetler ile başvurdu. Klinik ve radyografik değerlendirmeleri takiben, hasta için uygun dikey boyut belirlendi. Daha sonra, geçici protezler hazırlandı ve 2 ay süre ile kullanıldı. 2 ay boyunca hasta düzenli olarak kontrol edildi ve herhangi bir temporomandibular hastalık gözlenmedi. Bu sürenin sonunda, hastanın daimi protezleri yapıldı. Bu vakada, yapılan periyodik kontrollerde fonksiyonel, estetik bir problem veya temporomandibular hastalık görülmemiştir. Sonuç olarak, dikey boyutun yükseltilmesi gereken durumlarda, hasta yeni dikey boyuta alışmadan kalıcı protezler yapılmamalıdır. Anahtar Kelimeler: Atrizyon; oklüzal dikey boyut; protetik rehabilitasyon; temporomandibular bozukluk; diş aşınması. * Gazi University, Faculty of Dentistry, Department of Prosthodontics, Ankara This study was presented at Gazi Üniversitesi Diş Hekimliği Fakültesi 1. Genç Akademisyenler Kongresi 2020, in Ankara, Turkey, on February 20–21, 2020. ≠ Kaynakça Bilgisi: Uçar E, Çekiç Nagaş I. Aşınmış dentisyona sahip hastanın protetik rehabilitasyonu: vaka raporu. Atatürk Üniv Diş Hek Fak Derg 2021; 31: 444-8. Citation Information: Ucar E, Cekic Naga I. Prosthetic rehabilitation of a patient with worn dentition: a case report. J Dent Fac Atatürk Uni 2021; 31: 444-48. INTRODUCTION Dental abrasions, which are considered as a threat to dentition, can also be caused by other factors except caries and trauma.1,2 Apart from caries and trauma, there are many reasons for enamel and dentin loss. Normal and abnormal chewing, parafunctional habits, and incorrect oral hygiene procedures are the most frequently mentioned reasons in the literature.1 Although wear caused by friction of teeth during chewing is accepted as a natural process, some factors increase the severity of wear.3,4 There are 4 types of dental wear called attrition, abrasion, erosion, abfraction.5 The attrition; is the loss of dental tissue that occurs when dental tissues come into contact with each other and divided into two categories as physiological and pathological. Physiological attrition occurs as a result of normal chewing. Pathological attrition is the condition when patient’s wear is more than expected normal amount considering his/her age. Malpositions, malocclusions, 444 UÇAR, ÇEKİÇ NAGAŞ parafunctional habits can cause pathological intrusion.6 Abrasion is the loss of dental tissue seen as a result of abnormal mechanical effects. It is classified according to its etiology and among many others commonly as a result of toothbrush abrasion.5,6 Erosion is the loss of dental tissue caused by chemical reasons and there is no bacterial agent effect. There are external and internal reasons in its etiology. Food and drink consumption are considered as external causes whereas diseases such as reflux, bulimia nervosa are considered to be internal causes. Abfraction occurs as a result of occlusal forces and there is enamel loss in the cervical regions.5,6 The chewing system is a complex system consisting of teeth, bones, muscles, ligaments and temporomandibular joint (TMJ).7 Occlusal wear generally coexists with lose occlusal vertical dimension (OVD).8 TMJ, periodontal ligament and teeth may adapt to some changes in the OVD. For this reason, occlusion and OVD do not always need to be restored. However, in some serious cases, OVD may cause discomfort such as loss of aesthetics, loss of chewing function, loss of muscle tone, dentin sensitivity, pulpitis and TMJ disorders.3,9 In cases where the vertical size needs to be increased, prosthetic treatment should not be initiated immediately in order to provide the necessary time for the muscle and TMJ to adapt. Partial prostheses or occlusal splints should be used first to ensure compliance.6,10 Therefore, the reasons for wear and loss of vertical size must be correctly determined in order to perform a healthy treatment.3-5 The aim of this clinical report is to describe the rehabilitation of a patient having aesthetic and functional complaints caused by multiple tooth and vertical dimension loss by using fixed and removable prostheses in maintained occlusal vertical dimension. CASE REPORT A 54-year-old male patient applied to the Gazi University, Department of Prosthodontics with reduced vertical size due to multiple tooth loss in the maxillary arch and tooth abrasion in both arches (Figure 1). The patient was provided an informed consent form. In the systemic anamnesis, there wasn’t any sign of systemic disorders. Additionally, in the dental anamnesis taken, it was found out that tooth loss was caused by caries and there were complaints associated with clenching at night. In the intraoral examination, it was observed that there was multiple tooth loss in the maxilla and mandible, and dentine was exposed in the incisal edges of the maxillary and mandibular anterior teeth. According to The Tooth Wear Evaluation System, the patient's occlusal and incisal abrasion wa (...truncated)