Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : ZD04 - ZD07 Full Version

Aesthetic and Functional Rehabilitation with Prosthetic Approach and Vertical Dimension Occlusion Increase: A Case Report


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58095.17155
Özlem Özişçi

1. Lecturer, Department of Prosthodontics, Bas¸ kent University, Faculty of Dentistry, Ankara, Cankaya, Turkey.

Correspondence Address :
Özlem Özişçi,
Başkent Üniversitesi Diş Hekimliğ i Fakültesi 2.Kat Protez Kliniği 82. Sokak No:26 06490 Bahçelievler, Ankara, Cankaya, Turkey.
E-mail: oslemozisci@gmail.com

Abstract

Prosthetic rehabilitation of severely worn teeth with loss of vertical dimension is difficult due to limited space and the need for complex treatments. To improve aesthetics, maintain anterior tooth relationships, and provide space for the prosthesis, effective treatment alternatives are needed to increase the Occlusal Vertical Dimension (OVD). This will reduce the need for invasive procedures and endodontic treatments. For optimum treatment, accurate measurements of the OVD, interocclusal resting area, and central relationship recordings are needed. The contours of the facial soft tissues should be examined. Before beginning the full mouth rehabilitation, it should be kept in mind that severe abrasion does not always result in the loss of vertical dimension, and it does not necessarily eliminate all defective occlusal interactions. In preventive and restorative dentistry, managing tooth wear and attrition is a fascinating subject. One of the treatment alternatives after a confirmed diagnosis is full mouth reconstruction along with identifying the sources. It is complex and difficult to manage dental attrition. A clinical evaluation of the patient following the cementation of temporary fixed restorations or the use of a diagnostic splint or temporary removable prosthesis can assist in determining the OVD. It is recommended to utilise fixed restorations rather than a removable appliance to increase OVD since patient adaptation is predictable. In the present case (57-year-old female patient), the vertical dimension was restored with an improvement in both function and aesthetics, providing a satisfactory clinical outcome.

Keywords

Bruxism, Full mouth rehabilitation, Occlusal splint, Tooth wear

Case Report

A 57-year-old female patient came with a chief complaint of significantly worn out dentition to the Department of Prosthodontics. Patient reported unaesthetic anterior teeth, chewing difficulty caused by missing teeth and, upper and lower anterior tooth hypersensitivity. The patient was in good general health, non smoker and with no history of medication allergies. A thorough history was obtained and clinical examination was performed to record baseline data. Excessive wear on the teeth, restoration fractures, metal ceramic crowns on teeth 16, 27, 35, 45, and the lack of teeth 18, 15, 14, 13, 24, 26, 28, 36, 37, 38, 46, 47, 48 were noticed during dental examination (Table/Fig 1),(Table/Fig 2). The anterior teeth had sharp enamel edges, dentinal craters and attrition wear as a result of the lack of posterior support. The patient gave a history of night grinding of teeth since four years. The patient also provided information about previous prosthodontic treatments from seven years ago.

Patient did not use her old Removable Partial Denture (RPD) because it was uncomfortable to wear despite a lack of the mandibular posterior teeth.

The patient with worn out anterior teeth also had a clinically reduced clinical crown height and an edge-to-edge incisor relationship with a reduced overjet and overbite. The lateral view revealed a cross bite in the posterior region (Table/Fig 2)a,b. Excessive dentinal loss was found on the occlusal and incisal surfaces and the attrition had appoached the pulp.

A healthy periodontium was found during the periodontal examination, and multiple missing teeth were revealed on a panoramic radiograph, along with the attrition of the most of the teeth (Table/Fig 3).

During extraoral examination, it was found that there was a decrease in the height of the lower face and the occlusal vertical dimension was significantly reduced due to the absence of mandibular posterior teeth. The distance between the two reference points on the nose and chin was measured using a scale while the mandible was in its physiological rest or centric relation position. The patient was then instructed to either occlude at the maximum intercuspal position or to close her mouth in a way so that all the teeth were in contact, indicating Centric Occlusion (CO). The distance between the two reference points was once again measured with a scale while the patient was in the CO position.

The available treatments included full mouth rehabilitation with metal ceramic restoration, reconstructing the mandibular region that was missing teeth with implants or a removable partial denture.

Various treatment alternatives, such as crown lengthening procedures and implant placements, were explained to the patient after an analysis of their intraoral and extraoral conditions. Patient expressed a fear of all surgical procedures while explaining her financial restrictions. The patient did not want any crown lengthening procedure and implant surgery.

Therefore, it was decided to use cast removable partial dentures for the lower posteriors, individual porcelain fused to metal crowns for the lower anteriors, and porcelain fused to metal fixed partial dentures for the upper arch. Patient’s approval was obtained before clinical procedures began.

Alginate impressions were taken, and cast models were created to replicate the patient’s current occlusion status. Using a facebow record and an interocclusal record made with the aid of a Lucia jig, the patient’s casts were mounted on a semi-adjustable articulator (HanauTM Modular Articulator; Whip Mix Corp., Louisville, United States of America). The patient’s gnathologic examination revealed no signs of disease in the Temporomandibular Joint (TMJ) or masticatory muscles. The gnathologic investigations showed drooping commissures and wrinkles around the mouth. Analysing the temporomandibular joint indicated no pain or tenderness. This showed that the patient’s stomatognathic system had adapted to the occlusal vertical dimension gradually decreasing. However, with the occlusal vertical dimension, it was difficult to restore the worn and missing teeth. A 6 mm increase in the current vertical dimension of occlusion was planned based on the clinical findings and radiographic analyses.

When treating Temporomandibular joint Disorder (TMD) and restoring an OVD that has been disrupted, a stabilisation splint is a conservative initial line of treatment. An occlusal splint temporarily alters the mandible’s occlusal contacts and function. The goal is to maintain centric relation of the mandible through centric relate occlusion against the splint and equal contacts of the posterior teeth. Vertical dimension at rest was also determined. The occlusal vertical dimension was measured and the interocclusal distance was calculated.

An occlusal splint was prepared for canine protection occlusion from hard transparent acrylic to the upper jaw (Table/Fig 4). The goal of the occlusal prescription of the splint was a removable, mutually protective system. The splint had to be worn continuously for six weeks to evaluate the patient’s tolerance for the increase in OVD (at all times other than when eating). The patient was called in for follow-up one week after the initial postinsertion visits since only minor adjustments were required.

The new VDO was determined by a 6 mm increase in the articulator’s incisal guide pin. The actual increase was found 3 mm in the anterior teeth and 2-3 mm in the posterior teeth because the patient’s interocclusal rest space was 2-3 mm larger on the premolar area than the usual distance. The interocclusal rest distance of the patient was 2-3 mm larger than the normal distance in the premolar area, which caused the major increase to be seen in the anterior teeth.

The purpose of the splint’s design was to provide excursive direction of movement for the anterior teeth while providing bilateral contacts of all posterior teeth in centric relation. With the exception of centric relation, all jaw positions the anterior guidance disoccluded the posterior teeth.

At the end of six weeks the patient reported no muscle or joint pain. The restoration of anterior teeth with a single crown is more aesthetically appealing, but because of the short length of the crowns, there was a risk of decementation. The patient was informed of a variety of treatment options, including full coverage metal, Porcelain fused metal, or zirconia for posterior teeth and full coverage porcelain veneered crown or full coverage zirconia for anterior teeth. Finally after considering patient’s choice and financial condition, all the teeth in the mouth were prepared for metal-supported porcelain-fixed bridge prosthesis. The 14-units splinted crown for the maxillary arch (porcelain fused to metal was made for teeth 17, 16, 12, 11, 21, 22, 23, 25, 27) and 10-units splint crown with porcelain fused to metal material for mandibular teeth 35, 34, 33, 32, 31, 41, 42, 43, 44, 45. The final preparation was completed for all of the remaining teeth and definitive impressions with polyvinylsiloxane impression material were made (Elite HD, Zhermack, Italy) (Table/Fig 5).

During the trial period, the patient’s response to the increased vertical dimension was assessed. The patient showed no symptoms and adapted favourably to the new vertical dimension. Customised anterior guide table was used to construct porcelain fused to metal restorations, which were then cemented (Table/Fig 6).

The mandible was classified as having Kennedy’s class I partial edentulous space (1). The altered cast was made by taking another impression on the posterior alveolar ridge with the individual tray that is attached to the Removable Partial Denture (RPD) framework. The definitive mandibular RPD was fabricated and delivered with minimal occlusal adjustment after the RPD framework was adapted and a wax denture trial was completed. The RPD design was consisted of RPI clasps on the mandibular second premolar abutments, and lingual bar major connector. (Table/Fig 7) shows the final restorations in place. The posterior teeth were protected from excursive force and wear by the anterior teeth, whereas the bite force was sustained by the posterior teeth. Daily oral hygiene instructions (proper/daily use of dental aids (such as floss, particular end-tufted, and interdental brushes), and reinforcement of the instructions through demonstrations on models and examinations were administered. Patients who are informed about their oral hygiene status are more likely to practice improved oral hygiene. The patient’s acceptance will also be increased by a thorough explanation of the significance of postcementation instructions, proper/daily use of dental aids (such as floss, particular end-tufted, and interdental brushes), and reinforcement of the instructions through demonstrations on models. As a result, the alveolar mucosa will get better and continue to be healthy.

Discussion

is essential to understand that severe wear does not necessarily result in decreased OVD before treating a patient full mouth rehabilitation. Patients with excessive and ongoing occlusal wear can be complicated and difficult to treat, making it one of the challenging issues to deal with (2),(3). Physiologically and with age, all teeth show some wear as a result of functional activity, but occlusal disorders and parafunctional habits like bruxism can increase speed and intensify this process (4),(5).

Clinical decision-making is complicated by a lack of data about the long-term outcomes of treatment procedures and materials. The popularity of adhesive procedures, a conservative and reversible treatment option, is increasing (6),(7). However, in this case, the use of composite resin restoration was not a suitable fit for patient rehabilitation. The first structure to suffer the parafunctional load of bruxism is dental enamel. Heavy horizontal forces are applied to the teeth when the mandible shifts from side to side, which is not recommended and increases the risk of damage to the teeth and/or supporting tissues. Additionally, because bruxism occurs in eccentric positions, only a few teeth are subjected to the strong stresses that would normally be applied during functional activity when the jaw is in or close to the centric occlusion position (8),(9),(10),(11),(12). Due to the severity of tooth wear, the parafunction-related loss of tooth tissue is related to dental sensitivity, an excessive reduction in the height of the clinical crown, and possible changes in OVD (13),(14).

The remaining tooth structures, which were less than 3 mm and insufficient to provide composite resin adhesion to the dentin surface, were required to support the RPD with full crowns. As a result, the conventional treatment technique was undertaken, which included a trial overlay splint, regular monitoring followed by a definitive prosthesis (15),(16).

A natural overjet and overbite were established, the anterior teeth were lengthened, and the anterior tooth relationship was corrected by increasing the VDO. If VDO is increased without careful consideration, it might cause several problems. The transition period can shorten the overall treatment time depending on the patient’s condition and ability to adjust. There is always a risk that the patient might be unable adapt to a new vertical dimension condition if re-establishment of the occlusal vertical dimension (OVD) is suddenly made to the new prosthesis. Therefore, the rehabilitation of OVD should be done gradually through a comprehensive treatment plan. A trial phase of OVD treatment with interim prosthesis is required as part of the rehabilitation treatment. There is no established standard for how long it takes a patient to adapt to this new VD, but literature suggests a period of four weeks as minimum, whereas six weeks were considered in the present case (10),(11). The primary goal of full mouth rehabilitation procedures is to restore and maintain optimal dental health throughout a patient’s life (17),(18).

The efficacy of the occlusal splint is clinically determined. Patients with occlusal wear on permanent teeth tend to tolerate vertical dimension increase very well, with the increase being within the physiological limits of the orofacial musculature. In cases where the vertical dimensions of the occlusion violate the length of the relaxed contraction of the muscle fibres, especially the masticatory muscles, any treatment involving an increase in the vertical dimensions is certain to fail. The best way to determine if an increase in vertical dimension will be tolerated is by patient examination of acceptable interocclusal distance and speaking space (19).

The method of treatment that was chosen in the present case was based on a simple yet effective rehabilitation procedure for patients needing who needed low-cost rehabilitation with a high probability of long-term success. According to patient’s financial condition, the establishment of posterior occlusion, which was temporarily achieved with a provisional removable partial denture but requires safer patient adaptation to be replaced by a definitive posterior prosthesis, starts with a definitive removable partial denture and improves to rehabilitation with osseointegrated implants. However, the outcome over the long-term depends on more than just the patient’s hygiene and care.

Conclusion

One of the most prevalent treatments for severely worn dentition patients is full mouth reconstruction. The appropriate measurement of the occlusal vertical dimension is an important aspect of the rehabilitation process. In the present case, removable occlusal overlay splint was used to increase the vertical dimension of the occlusion, followed by a final restoration based on an appropriate diagnosis. Patient had no physical symptoms of TMJ like pain and tenderness, and the results were positive as the patient expressed satisfaction with the improvement in facial appearance and aesthetics.

References

1.
Carr AB, McGivney GP, Brown D. McCracken’s Removable Partial Prosthodontics. 1973.
2.
Humel MMC, Takahashi JMFK, Paulillo LAMS, Mesquita MF, Martins LRM. Direct restorative treatment of anterior weared teeth after re-establishment of occlusal vertical dimension: A case report. Gerodontology. 2012;29(4):299-307. [crossref] [PubMed]
3.
Sato S, Hotta TH, Pedrazzi V. Removable occlusal overlay splint in the management of tooth wear: A clinical report. The Journal of Prosthetic Dentistry. 2000;83(4):392-95. [crossref] [PubMed]
4.
Gargari M, Ceruso FM, Prete V, Pujia A. Prosthetic-restorative approach for the restoration of tooth wear. Vdo increase, rehabilitation of anatomy and function and aesthetic restoration of anterior teeth. Case report. Oral Implantol (Rome). 2012;5(2-3):70-74.
5.
Rahman MM, Biswas U, Banik RK, Abid M, Anwar RB. Life changing dentistry with Full Mouth Rehabilitation– A case report. Update Dent Coll J [Internet]. 2022;12(1):40-44. Cited on 2022 May 29. [crossref]
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DOI and Others

DOI: 10.7860/JCDR/2022/58095.17155

Date of Submission: May 29, 2022
Date of Peer Review: Jul 19, 2022
Date of Acceptance: Sep 19, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 01, 2022
• Manual Googling: Sep 12, 2022
• iThenticate Software: Sep 16, 2022 (7%)

ETYMOLOGY: Author Origin

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