“Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.”
— Thich Nhat Hanh
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Basically this case was handled as any other Neuromuscular case would be, other than the replacement of traditional impressions and bite registrations. The patient had chronic headaches and sore facial muscles for most of her life. Due to stress issues, things seemed worse in the last year. After a comprehensive exam, we did the diagnostic tens appointment and fabricated a splint. She wore the splint for three months and was very comfortable—some of the spacing between her front teeth even closed, due to the decrease in improper occlusal forces.
She is very apprehensive about dental work so we used valium prior to her appointment. I allowed four hours to place the three implants and prepare and temporize her upper teeth. We weren’t sure how cooperative she would be, so we allowed extra time. One hour and ten minutes into the appointment, I had placed the three implants and prepared the maxillary arch. I asked her permission to prepare the lower arch at the same visit rather than merely placing a fixed orthotic on them. She agreed and was thrilled to reduce the number of visits required. After another 40 minutes, the lower arch was prepared.
The bite was handled as follows: Using the bite matrix prepared from the pre-op models mounted in her neuromuscular position we segmentally prepared and relined the matrix. I left a posterior stop and prepared the remaining posteriors, then relined. Then we prepared the opposite side and relined. Finally the anteriors were prepared and the matrix again relined. The same procedure was followed for the mandibular arch.
 The final result was a bite matrix of her prepared teeth in the neuromuscular position. I cut the matrix into three segments: two posterior and one anterior. I placed two of the segments in at a time and used them to properly position the arches when taking the occlusal record scans with the iTero. This allowed the patient to bite on the matrix and keep still while I recorded the inter-occlusal position. I changed the segments out as needed for each bite record scan until all scans were recorded (four I believe).
I did not use any cord to retract the case, due to ideal tissue health and only used viscostat for control of minor, localized bleeding. The scanning for both arches and the bite records were completed in about 8-10 minutes. Upper and lower provisionals were created in about 30 minutes. The entire preparation appointment took under three hours.
The seat appointment: She returned for this visit very pleased with the results from the provisionals. In fact, she attended a family wedding the week after the preparation visit and smiled for pictures for the first time in years. Her family was thrilled! We anesthetized, and seated the posterior restorations using Unicem cement. Once the posteriors were in place, we isolated with a rubber dam for the upper arch and bonded the Authentic units in place.
The
lowers were placed following the same procedure. All units were in place and cleaned up in less than two hours.
The bite adjustments took less than five minutes – things were nearly perfect from the lab. The minor adjustments needed were to relieve fremmitus when tapping on the front teeth. The implants will be restored in the fall per her request to spread out the treatment cost.
The total chair time was less than five hours for the preparation and seating of this case. As you can see, we achieved great results and the margins were incredible.
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131 E. 13065 S.
Draper, UT 84020 |
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The editor of this newsletter is Emily Webb of Becden Dental Laboratory, Inc. Please send any questions or comments about this newsletter, or suggestions for articles to: emilyw@becdendental.com
©2009 BECDEN Dental Laboratory, Inc. |
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Full Mouth Neuromuscular Case With iTero
