altering vertical dimension in the perio-restorative patient - Kokich ...

CASE PRESENTATION
Treating clinicians
Orthodontist: Vincent G. Kokich, DDS, MSD
Restorative dentist: Rhonda Savage, DDS
CLINICAL TREATMENT PLANNING
Age at initial presentation: 58 years [Au: Is this correct?]
Initial presentation: [Au: Please provide.]
Active treatment completed: [Au: Please provide.]
• Inadequate tooth display on smiling
• No maxillary tooth display at rest
TMJ and mandibular range of motion
Introduction and background
This 58-year-old man was concerned about the appearance of
his maxillary anterior teeth, particularly the wear of the maxillary
and mandibular incisors and the lack of tooth display
when smiling. He was an architect and had the financial capability
to have ideal treatment. His primary goals were to preserve
his teeth and improve his smile.
Medical history
His medical history was noncontributory.
Diagnostic findings
Extraoral and facial findings
• Relatively flat facial profile
• Good frontal symmetry
• No joint sounds
• No history of locking or limited range of motion
• No history of muscle pain
Dental cast analysis
• Angle Class II molar and canine relationships
• Excessive overbite
• Both mandibular permanent first molars missing
• Extreme wear of both maxillary and mandibular incisors
• History of protrusive bruxing habit
Intraoral findings
• Minimal prior restoration of teeth
• Less-than-ideal spacing in the mandibular anterior region
• Relatively healthy gingival support
• Evidence of extreme wear on the maxillary and mandibular
incisors
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