2010 RWISO Journal - Roth Williams International Society of ...

All available intraoral photographs that had been taken
in the past were put together to analyze the event of tooth
wear in this patient (Figure 13).
Figure 13 The event of upper canine wear during orthodontic
treatment. The right canine shows definite wear (red arrows)
during fixed-appliance therapy. The sharp anatomy (blue circle)
of the left canine tip at the time of eruption is shown in the
photograph (May 2000). It was gone before the
fixed-appliance therapy.
The upper right canine showed no wear before the
initial stage of fixed-appliance therapy in June 2001. The
canine wear occurred sometime during the following 8
months, and further wear seemed to have occurred between
February 2002 and December 2002. The upper left canine
erupted with sharp anatomy in May 2000. However, the tip
was worn down already on the day of bracket bonding, and
the wear progressed during the fixed-appliance therapy. In
the absence of anatomy at the cusp tips and incisal edges, as
in Figures 3-c and 3-e, proper anterior guidance and canine
guidance in movement would not have taken place (Figure
14). This in turn would have caused further wear with the
passage of time, as shown in Figures 6 and 7. 10
Figure 14 Mandibular movement of the mounted models.
Figure 14-a Intraoral movement shown in Figure 5-a was
reproduced with models mounted on a semiadjustable
articulator in SCP. There were nonchewing-side interferences
of the functional cusps of the upper left molars (red arrows).
Figure 14-b Intraoral movement shown in Figure 5-b was reproduced
using models. There were nonchewing-side interferences
of the functional cusps of the right upper molars (red arrows).
Stable condylar position (SCP) could not be recorded in
the presence of dysfunction of the masticatory system, 11 so
a maxillary anterior-guided orthosis12 was prepared and the
patient wore it for 2 months, until all clinical signs and symptoms
of TMJ dysfunction disappeared. The orthosis (Figure
15) allowed the condyles to assume their superior, anterior,
and medial (SAM) positions in intimate contact with the
thinnest part of the biconcavity of the disc, and made possible
the diagnosis of a SCP from the maximum intercuspal
position (MIP). The SCP was recorded with Axi-Path recording,
so the mounted models would arc close in centric. 13,14
Figure 15 Maxillary anterior guided orthosis. The patient
wore the removable plate continuously until all the
symptoms disappeared and SCP was obtained.
RWISO Journal | September 2010
65