Post on 09-Oct-2020
transcript
FUNCTIONAL TREATMENT PLANNING
TREATMENT IMAGES
LEARNING OBJECTIVES
•Understand what to evaluate to make functional planning decisions
•Understand when and how occlusal alterations should be considered
•Treatment options available
•How to choose among the options
Esthetics
Function
Structure
Biology
Tooth PositionGingival Levels
Contour & Color
TMJMuscle
Occlusion
RestorationReplacement
EndoPerio
Oral Surgery
DiagnosisExam
History
TMJ
Muscles
Dental
Perio
Photography
Treatment Planning
No treatment
Mounted Models
Equilibration
Restoration
Develop the
Occlusion
Intercuspal position
End to End
Joint
Muscle
Dental
Splint therapy
Pathways
Developing the Occlusion
1.Evaluate the TMJ’s
2.Evaluate muscles
3.Evaluate the teeth
4.Mount Models
5.Develop the occlusion
Step 1: Examine the joints, muscles, and
teeth to determine if the existing occlusion is
physiologic or pathologic
Step 2: Following the examination make a
diagnosis of the current occlusion
Physiologic Pathologic
If the patient’s current occlusion is
physiologic
Are you going to alter it?
If so, where are you going to alter it?
If the patient’s current occlusion is
pathologic
How are you going to alter it?
Occlusal Positions
1) The position of maximum intercuspation MIP
Male 45 years old
• Desires esthetic
improvement of maxillary
teeth with veneers
• Has cracked maxillary right
first and second molars
• No joint or muscle symptoms
Relationship between the
occlusion and muscles
The lateral pterygoid pulls the
condyle in an anterior direction
producing translation
Relationship between the
occlusion and muscles
The lateral pterygoid pulls is
programmed by the posterior teeth
to hold the mandible so that when
we close we close into MIP
Relationship between the
occlusion and muscles
The lateral pterygoid pulls is
programmed by the posterior teeth
to hold the mandible so that when
we close we close into MIP
Intercuspal Position Options
• Use the patient’s existing intercuspal position
Useful when the existing position is asymptomatic, and your treatment plan won’t destabilize the occlusion
Intercuspal Position Options
• Create a new intercuspal position
Useful if your treatment plan will destabilize or remove the existing occlusion, or when the existing occlusion is
pathologic
Occlusal Positions
1) The position of maximum intercuspation
2) Excursive pathways anterior or lateral to MIP
Male 55 years old
• Fractured left lateral incisor
• No esthetic complaints
• No room for a restoration
• No joint or muscle symptoms
Pathway wear End to end wear Crossover
X
The goal in pathway wear patients is to
increase the overjet!
Occlusal Positions
1) The position of maximum intercuspation
2) Excursive pathways anterior or lateral to MIP
3) End to end and crossover occlusion
Male 20 years old
• Fractured left lateral incisor
• No esthetic complaints
• No room for a restoration
• No joint or muscle symptoms
Pathway wear End to end wear Crossover
X
The edge to edge treatment plan will be created on models first
Protrusive
Right lateral
Left lateral
1. Establish maxillary tooth position
2. Transfer desired esthetic changes to the
models
3. Move the articulator end-to-end and correct lower
anteriors
The goal in edge to edge wear patients is broad smooth contacts
The goal in edge to edge wear patients is broad smooth contacts
3. Move the articulator end-to-end and correct lower
anteriors
Left lateral
The goal in edge to edge wear patients is broad smooth contacts
Right lateral
The goal in edge to edge wear patients is broad smooth contacts
4. Evaluate centric contacts in anterior
Equilibrate posteriors Add palatal compositeOR
Female 50 years old
• Unhappy with the esthetics
of her maxillary anterior
teeth
• Concerned about the wear
on her mandibular anterior
teeth
• No joint of muscle symptoms
Pathway wear facets, only on the facial surfaces
Pathway wear End to end wear Crossover
X
There is some evidence of erosion as well as attrition
The radiograph shows the lower anteriors occluding at the palatal
aspect of the uppers
The facets show the depth of the overbite
Her intercuspal position is not Class I, but is acceptable
Not missing any teeth
The model shows a combination of attrition and erosion
Correction by intruding and proclining the upper incisors and
intruding the lower incisors
The gingival levels and occlusal plane illustrate the mandibular
anterior over-eruption
Esthetics
Function
Structure
Biology
Treatment Alternatives
1. Procline upper incisors
2. Retract lower incisors
3. Intrude upper incisors
4. Intrude lower incisors
5. Orthognathic surgery
lip
Diagnosis
1. Upper incisal edge position
Diagnosis
1. Upper incisal edge position
2. Upper incisor inclination
Diagnosis
1. Upper incisal edge position
2. Upper incisor inclination
3. Gingival levels
Diagnosis
1. Upper incisal edge position
2. Upper incisor inclination
3. Gingival levels
4. Lower incisor position
Resting lip levellower incisor level
4mm of lower incisor display at rest and they are worn
Treatment Alternatives
1. Procline upper incisors
Treatment Alternatives
1. Procline upper incisors
2. Retract lower incisors
95% 95%
Treatment Alternatives
1. Procline upper incisors
2. Retract lower incisors
3. Intrude upper incisors
77% 77%
Treatment Alternatives
1. Procline upper incisors
2. Retract lower incisors
3. Intrude upper incisors
Treatment Alternatives
1. Procline upper incisors
2. Retract lower incisors
3. Intrude upper incisors
4. Intrude lower incisors
Treatment Alternatives
1. Procline upper incisors
2. Retract lower incisors
3. Intrude upper incisors
4. Intrude lower incisors
5. Orthognathic surgery
Ortho set up simulating tooth movements and restoration
Note: no changes are being made to the posteriors
Maxillary anteriors proclined
Mandibular anteriors intruded and restored
Mandibular anteriors intruded and restored
Ortho vs Crown Lengthening
Crown lengthening could be
done on the lower instead of
ortho if there is adequate root
length since the tooth position
is good, just over-erupted
Ortho vs Crown Lengthening
Crown lengthening is not a
good option for the upper due
to the retroclined position of
the teeth, the subsequent
tooth preparation would leave
no tooth structure
Composite bonded to allow for bracket placement
Composite bonded to allow for bracket placement
Composite bonded to molars to hold open the vertical
Composite bonded to molars to hold open the vertical
Maxillary proclination and intrusion, mandibular anterior intrusion
Brackets removed for composite bonding
Incisor length corrected with composite prior to re-bracketing
Pencil line represents previous tooth length
Brackets replaced ideally for ortho finishing
Veneers
Concluding Thoughts
Intercuspal position
Pathways
End to End