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Figure 14: After placement of the ceramic restorations, contacts in
the posterior region can now be seen back to the first molar region,
giving this patient a more stable intercuspation in centric occlusion.
Figure 15: A preoperative smile view of a dentally compensated
Class II malocclusion.
Figure 16: From this preoperative incisal/occlusal view, there is a
great deal of crowding and rotation because the teeth are tipped lingually,
constricting the arch form and pushing teeth out of the arch.
Figure 17: An incisal view of teeth #5–8 after breaking the proximal
contacts and separating the teeth (interproximal reduction, or IPR). It
is important to separate the root forms at the gingival crest interproximally
with a mosquito diamond, allowing retraction cord to be placed.
This will ensure proper space for the emergence profiles and healthy
interproximal gingival tissue.
Case Report #3
The patient shown in Figure 15 presented with a dentally
compensated Class II malocclusion. He had never pursued
esthetic dental treatment because he was consistently told
that his functional and esthetic dental problems could not
be corrected without orthognathic surgery and orthodontics
prior to restorative therapy. In his opinion, the cure was
worse than the disease.
After working up the case on study models as previously described,
it was determined that this patient could be helped
prosthetically without surgical intervention. Figure 16 is an
occlusal/incisal view of the preoperative maxillary arch. The
orthodontic approach to unraveling this crowded arch would
be expansion, or tipping the teeth in the labial direction. This
would increase the arch length and allow for proper tooth
alignment. It would also increase the overjet, resulting in a
more Class II-like appearance.
When planning to orthodontically prepare these teeth, it is
important to note that correcting the lingual inclination of
the clinical crowns will have the same effect in gaining arch
length. There will be very little need to prepare these teeth
on the facial surfaces. The majority of the tooth reduction
will be on the proximal and lingual surfaces to orthodontically
correct the clinical crown angulation with the bur
(“diamond-driven orthodontics”).
Prosthetic Tooth Repositioning: A Viable Treatment Option for Select Cases59