Gregory J. Tarantola
Clinical Cases in Restorative and Reconstructive Dentistry
Gregory J. Tarantola
Clinical Cases in Restorative and Reconstructive Dentistry
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Wiley-Blackwell's "Clinical Cases" series is designed to recognize the centrality of clinical cases to the profession by providing actual cases with an academic backbone. Clinical Cases in Restorative and Reconstructive Dentistry describes the principles and demonstrates their practical, every-day application through a range of representative cases building from the simple to the complex and from the common to the rare. This unique approach supports the new trend in case-based and problem-based learning, thoroughly covering topics ranging from infant oral health to complex pulp therapy. Highly…mehr
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Wiley-Blackwell's "Clinical Cases" series is designed to recognize the centrality of clinical cases to the profession by providing actual cases with an academic backbone. Clinical Cases in Restorative and Reconstructive Dentistry describes the principles and demonstrates their practical, every-day application through a range of representative cases building from the simple to the complex and from the common to the rare. This unique approach supports the new trend in case-based and problem-based learning, thoroughly covering topics ranging from infant oral health to complex pulp therapy. Highly illustrated in full color, Clinical Cases in Restorative and Reconstructive Dentistry's format fosters independent learning and prepares the reader for case-based examinations.
The book presents actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in restorative and reconstructive dentistry. The book begins by laying the groundwork of the fundamental principles that apply to all cases and outlining the ten decisions to be made with all cases. The main sections of the book cover the cases themselves, examining them both by type of restoration / solution, and by type of problem. This unique approach enables the reader to build their skills, aiding the ability to think critically and independently.
Clinical Cases in Restorative and Reconstructive Dentistry's case-based format is particularly useful for pre-doctoral dental students, post-graduate residents and practitioners, both as a textbook from which to learn about the challenging and absorbing nature of restorative and reconstructive dentistry, and also as a reference tool to help with treatment planning when perplexing cases arise in the dental office.
Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
The book presents actual clinical cases, accompanied by academic commentary, that question and educate the reader about essential topics in restorative and reconstructive dentistry. The book begins by laying the groundwork of the fundamental principles that apply to all cases and outlining the ten decisions to be made with all cases. The main sections of the book cover the cases themselves, examining them both by type of restoration / solution, and by type of problem. This unique approach enables the reader to build their skills, aiding the ability to think critically and independently.
Clinical Cases in Restorative and Reconstructive Dentistry's case-based format is particularly useful for pre-doctoral dental students, post-graduate residents and practitioners, both as a textbook from which to learn about the challenging and absorbing nature of restorative and reconstructive dentistry, and also as a reference tool to help with treatment planning when perplexing cases arise in the dental office.
Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
Produktdetails
- Produktdetails
- Clinical Cases
- Verlag: Wiley & Sons
- 1. Auflage
- Seitenzahl: 496
- Erscheinungstermin: 7. September 2010
- Englisch
- Abmessung: 274mm x 219mm x 27mm
- Gewicht: 1504g
- ISBN-13: 9780813815640
- ISBN-10: 0813815649
- Artikelnr.: 31187588
- Herstellerkennzeichnung
- Libri GmbH
- Europaallee 1
- 36244 Bad Hersfeld
- 06621 890
- Clinical Cases
- Verlag: Wiley & Sons
- 1. Auflage
- Seitenzahl: 496
- Erscheinungstermin: 7. September 2010
- Englisch
- Abmessung: 274mm x 219mm x 27mm
- Gewicht: 1504g
- ISBN-13: 9780813815640
- ISBN-10: 0813815649
- Artikelnr.: 31187588
- Herstellerkennzeichnung
- Libri GmbH
- Europaallee 1
- 36244 Bad Hersfeld
- 06621 890
Gregory J. Tarantola, D.D.S. is former Clinical Director of the Department of Education at The Pankey Institute for Advanced Dental Education in Key Biscayne, Florida. In January of 2002, he opened a full time restorative practice and now lives and practices in Jacksonville, Florida. He also continues to lecture around the country and around the world on comprehensive, masticatory system dentistry in a relationship based setting.
Author xi
Contributors to Appendices xi
Acknowledgments xiii
Introduction xv
Part 1 Didactics 3
Chapter 1 Fundamental Principles of the Comprehensive Approach 5
The Case for the Four-Part Comprehensive Evaluation 5
The Details of the Four-Part Comprehensive Evaluation 5
The Initial Conversation 6
The Clinical System-Based Masticatory System Examination 8
Imaging 22
Articulated Diagnostic Casts 25
Chapter 2 The People Side of Dentistry 27
The Importance of Behavioral and Communication Skills 27
The All-Important 5 Questions 27
The Codiscovery Process 29
Which Approach Is Best-The 4 Quadrants 33
Dentistry: A Blend of Technical, Emotional, and Intellectual Skills 33
Chapter 3 The 4 Essential Skills of the Comprehensive Dentist 37
Section A Bite Splint Therapy 38
Section B Definitive Occlusal Therapy: Equilibration 45
Section C The Diagnostic Blueprint-Wax-Up 50
Section D Provisionalization55
Chapter 4 The 10 Decisions 63
Section A TMJ Diagnosis and Condylar Position 64
Section B Vertical Dimension 66
Section C Lower Incisal Edge Position 74
Section D Upper Incisal Edge Position 77
Section E Centric Stop Design 86
Section F Anterior Guidance 91
Section G Curve of Spee 98
Section H Curve of Wilson 101
Section I Cusp to Fossa Angle 102
Section J The Aesthetic Occlusal Plane 105
Part 2 Case Studies 109
Chapter 5 Nonremovable Implant Restoration with Natural Teeth 111
Case 1 Nonremovable maxillary implant restorations with natural teeth
restorations including crowns, veneers, and fixed partial dentures 112
Case 2 Transitioning a maxillary tooth-supported fixed partial denture to
an implant-supported fixed partial denture along with other single crowns
and tooth-supported fixed partial dentures 121
Case 3 Lower reconstruction with lower left being implant-supported,
important neutral zone consideration affecting design; upper reconstruction
landmarks acceptable; temporomandibular disorder managed 129
Case 4 Maxillary fixed partial denture supported by both teeth and implants
along with other maxillary and mandibular implant-supported crowns and
tooth-supported crowns and fixed partial dentures 133
Case 5 Maxillary extractions, periodontal surgery, orthodontics, veneers,
and fixed partial dentures on teeth; mandibular extractions, implants,
fixed partial dentures on teeth and implants 139
Case 6 Multiple congenitally missing teeth, past
orthognathics/orthodontics, tooth position inconsistencies handled
restoratively, multiple implants, tooth-supported crowns and fixed partial
dentures, implant-supported crowns and fixed partial dentures 143
See also: Chapter 6 Case 1 148
Chapter 7 Case 7 216
Chapter 14 Case 4 342
Chapter 6 TM Disorders Followed by Reconstruction 147
Case 1 Osteoarthritis of the left TMJ managed with bite splint therapy
followed by implant-supported restorations and tooth-supported restorations
148
Case 2 Intracapsular and muscular components of a temporomandibular
disorder managed with bite splint therapy followed by occlusal therapy and
a full reconstruction 152
Case 3 Intracapsular and muscle disorder resolved with bite splint therapy
followed by occlusal reconstruction with maxillary lingual porcelain
veneers 157
Case 4 Intracapsular and muscle disorder with resultant occlusal plane
asymmetry resolved with bite splint therapy and followed by occlusal
therapy with restoration only on the lower left 162
Case 5 Past condylar replacement due to avascular necrosis followed by
posterior occlusal reconstruction 166
Case 6 Temporomandibular disorder resolved with bite splint therapy
followed by definitive occlusal therapy including a maxillary
reconstruction and mandibular functional changes with composite 171
Case 7 Past mandibular orthognathic surgery to correct maxillary to
mandibular malrelationship caused by condylar degeneration; intracapsular
and muscle pain resolved with bite splint therapy followed by definitive
occlusal therapy with posterior reconstruction and anterior composites 178
See also: Chapter 15 case 1 350
Chapter 16 case 1 360
Chapter 7 Restorations to Achieve Aesthetic and Functional Changes 183
Case 1 Restoration of anterior aesthetics and anterior guidance in a deep
overbite damaged by bruxism with upper and lower anterior reconstruction
184
Case 2 Posterior reconstruction with severe interferences to the centric
arc of closure 189
Case 3 Restoration of aesthetics and anterior guidance damaged by wear by
increasing overbite with upper and lower anterior crowns 195
Case 4 Maxillary reconstruction at open vertical dimension to improve
aesthetics, length, buccal profiles, and functional landmarks; mandibular
restorations only recontoured 199
Case 5 Maxillary and mandibular aesthetic and functional reconstruction
with lab-processed composite restorations to treat amelogenesis imperfecta
204
Case 6 Restorations maxillary bicuspid-to-bicuspid done first as part of a
comprehensive plan; maxillary left central incisor implant and other
functional discrepancies corrected with reshaping and equilibration 210
Case 7 Maxillary and mandibular dental reconstruction including 4 dental
implants replacing unrestorable teeth; impaired aesthetics due to recession
handled with grafts and all porcelain restorations 216
See also: Chapter 16 case 1 360
Chapter 8 Complete Implant-Supported Restorations 221
Case 1 Complete implant-supported maxillary reconstruction- transitioning
the anterior teeth from tooth-supported to implant-supported 222
Case 2 Complete maxillary nonremovable restoration supported by 6 implants
converted from a completed removable restoration on 4 implants 226
Case 3 Complete implant-supported nonremovable maxillary and mmandibular
reconstructions; transitioning from natural teeth that were not predictably
restorable 231
Case 4 Maxillary extractions, immediate implant placement, immediate
loading, and complete nonremovable zirconia restoration with pink porcelain
237
Case 5 Mandibular implant bar-supported full removable denture converted to
a nonremovable restoration to improve comfort of the neutral zone and
phonetics 240
Chapter 9 Orthognathics 245
Case 1 Severe anterior open bite corrected with maxillary-only
orthognathics and occlusal therapy with upper incisor restorations 246
Case 2 Mandibular orthognathic surgery and chin implant; managing a
temporomandibular disorder during treatment; posterior restorative
dentistry including implants 250
Case 3 Maxillary and mandibular orthognathic surgery with chin advancement;
prerestorative occlusal therapy with equilibration and composite additions
256
See also: Chapter 16 Case 1 360
Chapter 10 Bruxism and Wear Reconstruction 261
Case 1 Restoration of worn lower anterior teeth in a deep bite without
changing other restorations 262
Case 2 Severe wear from parafunctional habits restored with a complete
reconstruction at an increased vertical dimension of occlusion 266
See also: Chapter 16 Case 2 366
Chapter 11 Perioprosthesis 275
Case 1 Full maxillary periodontal-restorative reconstruction improving
aesthetics and function; lower posterior reconstruction following
conventional surgery, bone and soft tissue grafts, covering recession 276
Case 2 Posterior reconstruction in conjunction with conventional
periodontal surgery; root resection, pocket elimination 282
Chapter 12 Implants in the Aesthetic Zone 289
Case 1 Hopeless maxillary central incisor transitioned to an
implant-supported restoration (delayed placement and delayed loading) with
crowns on the remaining incisors along with occlusal therapy 290
Case 2 Extraction and immediate implant placement, delayed loading, and
restoration maxillary central incisors; pink porcelain to simulate papilla
296
Case 3 Congenitally missing maxillary lateral incisors, orthodontics to
open lateral incisor space, dental implants, and other aesthetic
improvements 302
Case 4 Congenitally missing upper right cuspid; upper right lateral incisor
lost in an accident; implant placed in cuspid position with 2-unit
cantilever restoration, pink porcelain to simulate gingival 307
Case 5 Maxillary central incisor extracted and replaced with a dental
implant, delayed placement, and delayed loading 311
See also Chapter 7 case 6 210
Chapter 13 Removable Implant-Supported Restoration with Natural Teeth 313
Case 1 Maxillary implant-supported bar-retained removable partial denture
along with tooth-supported restorations to reconstruct occlusion and
vertical dimension 314
Case 2 Combination mandibular fixed anterior-removable posterior
reconstruction with Locator attachments 319
See also: Chapter 14 Case 4 342
Chapter 14 Combination Fixed-Removable Restoration on Natural Teeth 323
Case 1 Maxillary bar-supported removable partial denture; lower crowns with
semiprecision removable partial denture 324
Case 2 Maxillary fixed partial dentures with precision removable partial
denture; mandibular bar-supported complete denture 331
Case 3 Maxillary telescope case: alumina copings on natural teeth and
removable overstructure; mandibular telescope case: Galvano copings on
natural teeth and nonremovable overstructures 337
Case 4 Mandibular anterior fixed partial denture and posterior removable
partial denture with implants and Locator attachments for added support and
retention; maxillary reconstruction, telescope case with 1 dental implant
included along with 6 teeth 342
Chapter 15 Implant-Supported Complete Dentures 349
Case 1 Maxillary extensive bone graft followed by implant-supported bars
and bar-supported overdenture after managing a temporomandibular disorder;
flange needed for lip support necessitating a removable rather than a
nonremovable approach 350
Case 2 Severe maxillary and mandibular resorption; maxillary bone grafting;
maxillary and mandibular implant-supported bar and bar-supported dentures;
flange needed for lip and cheek support necessitating a removable rather
than a nonremovable approach 355
Chapter 16 Reconstructions on All Natural Teeth 359
Case 1 Severe anterior overjet handled with occlusal/restorative treatment
in lieu of orthognathics; muscular component of a temporomandibular
disorder also managed 360
Case 2 Failed multiple reconstructions; original deep overbite with current
condition in provisionals with an opened vertical dimension and anterior
overjet; managed with a new reconstruction harmonizing a physiologic deep
overbite 366
Case 3 Maxillary reconstruction combined with extractions and periodontal
surgery to improve periodontal architecture; landmarks of lower acceptable
with minor modification 373
Case 4 Full mouth reconstruction utilizing crown-lengthening surgery,
extractions, single crowns, veneers, and a fixed partial denture sequenced
over 2 years 379
Case 5 Maxillary complete fixed partial denture on 9 Galvano telescopic
copings; mandibular anterior fixed partial denture on 4 Galvano copings 385
See also: Chapter 6 Case 6 171
Chapter 14 Case 3 337
Chapter 14 Case 4 342
Appendix 1 Definitive Occlusal Therapy Using the T-Scan III, by Robert
BKerstein, D.M.D391
Appendix 2 What Your Laboratory Technician Needs to Provide Excellence, by
Jerry Ulaszek, C.D.T433
Index 449
Contributors to Appendices xi
Acknowledgments xiii
Introduction xv
Part 1 Didactics 3
Chapter 1 Fundamental Principles of the Comprehensive Approach 5
The Case for the Four-Part Comprehensive Evaluation 5
The Details of the Four-Part Comprehensive Evaluation 5
The Initial Conversation 6
The Clinical System-Based Masticatory System Examination 8
Imaging 22
Articulated Diagnostic Casts 25
Chapter 2 The People Side of Dentistry 27
The Importance of Behavioral and Communication Skills 27
The All-Important 5 Questions 27
The Codiscovery Process 29
Which Approach Is Best-The 4 Quadrants 33
Dentistry: A Blend of Technical, Emotional, and Intellectual Skills 33
Chapter 3 The 4 Essential Skills of the Comprehensive Dentist 37
Section A Bite Splint Therapy 38
Section B Definitive Occlusal Therapy: Equilibration 45
Section C The Diagnostic Blueprint-Wax-Up 50
Section D Provisionalization55
Chapter 4 The 10 Decisions 63
Section A TMJ Diagnosis and Condylar Position 64
Section B Vertical Dimension 66
Section C Lower Incisal Edge Position 74
Section D Upper Incisal Edge Position 77
Section E Centric Stop Design 86
Section F Anterior Guidance 91
Section G Curve of Spee 98
Section H Curve of Wilson 101
Section I Cusp to Fossa Angle 102
Section J The Aesthetic Occlusal Plane 105
Part 2 Case Studies 109
Chapter 5 Nonremovable Implant Restoration with Natural Teeth 111
Case 1 Nonremovable maxillary implant restorations with natural teeth
restorations including crowns, veneers, and fixed partial dentures 112
Case 2 Transitioning a maxillary tooth-supported fixed partial denture to
an implant-supported fixed partial denture along with other single crowns
and tooth-supported fixed partial dentures 121
Case 3 Lower reconstruction with lower left being implant-supported,
important neutral zone consideration affecting design; upper reconstruction
landmarks acceptable; temporomandibular disorder managed 129
Case 4 Maxillary fixed partial denture supported by both teeth and implants
along with other maxillary and mandibular implant-supported crowns and
tooth-supported crowns and fixed partial dentures 133
Case 5 Maxillary extractions, periodontal surgery, orthodontics, veneers,
and fixed partial dentures on teeth; mandibular extractions, implants,
fixed partial dentures on teeth and implants 139
Case 6 Multiple congenitally missing teeth, past
orthognathics/orthodontics, tooth position inconsistencies handled
restoratively, multiple implants, tooth-supported crowns and fixed partial
dentures, implant-supported crowns and fixed partial dentures 143
See also: Chapter 6 Case 1 148
Chapter 7 Case 7 216
Chapter 14 Case 4 342
Chapter 6 TM Disorders Followed by Reconstruction 147
Case 1 Osteoarthritis of the left TMJ managed with bite splint therapy
followed by implant-supported restorations and tooth-supported restorations
148
Case 2 Intracapsular and muscular components of a temporomandibular
disorder managed with bite splint therapy followed by occlusal therapy and
a full reconstruction 152
Case 3 Intracapsular and muscle disorder resolved with bite splint therapy
followed by occlusal reconstruction with maxillary lingual porcelain
veneers 157
Case 4 Intracapsular and muscle disorder with resultant occlusal plane
asymmetry resolved with bite splint therapy and followed by occlusal
therapy with restoration only on the lower left 162
Case 5 Past condylar replacement due to avascular necrosis followed by
posterior occlusal reconstruction 166
Case 6 Temporomandibular disorder resolved with bite splint therapy
followed by definitive occlusal therapy including a maxillary
reconstruction and mandibular functional changes with composite 171
Case 7 Past mandibular orthognathic surgery to correct maxillary to
mandibular malrelationship caused by condylar degeneration; intracapsular
and muscle pain resolved with bite splint therapy followed by definitive
occlusal therapy with posterior reconstruction and anterior composites 178
See also: Chapter 15 case 1 350
Chapter 16 case 1 360
Chapter 7 Restorations to Achieve Aesthetic and Functional Changes 183
Case 1 Restoration of anterior aesthetics and anterior guidance in a deep
overbite damaged by bruxism with upper and lower anterior reconstruction
184
Case 2 Posterior reconstruction with severe interferences to the centric
arc of closure 189
Case 3 Restoration of aesthetics and anterior guidance damaged by wear by
increasing overbite with upper and lower anterior crowns 195
Case 4 Maxillary reconstruction at open vertical dimension to improve
aesthetics, length, buccal profiles, and functional landmarks; mandibular
restorations only recontoured 199
Case 5 Maxillary and mandibular aesthetic and functional reconstruction
with lab-processed composite restorations to treat amelogenesis imperfecta
204
Case 6 Restorations maxillary bicuspid-to-bicuspid done first as part of a
comprehensive plan; maxillary left central incisor implant and other
functional discrepancies corrected with reshaping and equilibration 210
Case 7 Maxillary and mandibular dental reconstruction including 4 dental
implants replacing unrestorable teeth; impaired aesthetics due to recession
handled with grafts and all porcelain restorations 216
See also: Chapter 16 case 1 360
Chapter 8 Complete Implant-Supported Restorations 221
Case 1 Complete implant-supported maxillary reconstruction- transitioning
the anterior teeth from tooth-supported to implant-supported 222
Case 2 Complete maxillary nonremovable restoration supported by 6 implants
converted from a completed removable restoration on 4 implants 226
Case 3 Complete implant-supported nonremovable maxillary and mmandibular
reconstructions; transitioning from natural teeth that were not predictably
restorable 231
Case 4 Maxillary extractions, immediate implant placement, immediate
loading, and complete nonremovable zirconia restoration with pink porcelain
237
Case 5 Mandibular implant bar-supported full removable denture converted to
a nonremovable restoration to improve comfort of the neutral zone and
phonetics 240
Chapter 9 Orthognathics 245
Case 1 Severe anterior open bite corrected with maxillary-only
orthognathics and occlusal therapy with upper incisor restorations 246
Case 2 Mandibular orthognathic surgery and chin implant; managing a
temporomandibular disorder during treatment; posterior restorative
dentistry including implants 250
Case 3 Maxillary and mandibular orthognathic surgery with chin advancement;
prerestorative occlusal therapy with equilibration and composite additions
256
See also: Chapter 16 Case 1 360
Chapter 10 Bruxism and Wear Reconstruction 261
Case 1 Restoration of worn lower anterior teeth in a deep bite without
changing other restorations 262
Case 2 Severe wear from parafunctional habits restored with a complete
reconstruction at an increased vertical dimension of occlusion 266
See also: Chapter 16 Case 2 366
Chapter 11 Perioprosthesis 275
Case 1 Full maxillary periodontal-restorative reconstruction improving
aesthetics and function; lower posterior reconstruction following
conventional surgery, bone and soft tissue grafts, covering recession 276
Case 2 Posterior reconstruction in conjunction with conventional
periodontal surgery; root resection, pocket elimination 282
Chapter 12 Implants in the Aesthetic Zone 289
Case 1 Hopeless maxillary central incisor transitioned to an
implant-supported restoration (delayed placement and delayed loading) with
crowns on the remaining incisors along with occlusal therapy 290
Case 2 Extraction and immediate implant placement, delayed loading, and
restoration maxillary central incisors; pink porcelain to simulate papilla
296
Case 3 Congenitally missing maxillary lateral incisors, orthodontics to
open lateral incisor space, dental implants, and other aesthetic
improvements 302
Case 4 Congenitally missing upper right cuspid; upper right lateral incisor
lost in an accident; implant placed in cuspid position with 2-unit
cantilever restoration, pink porcelain to simulate gingival 307
Case 5 Maxillary central incisor extracted and replaced with a dental
implant, delayed placement, and delayed loading 311
See also Chapter 7 case 6 210
Chapter 13 Removable Implant-Supported Restoration with Natural Teeth 313
Case 1 Maxillary implant-supported bar-retained removable partial denture
along with tooth-supported restorations to reconstruct occlusion and
vertical dimension 314
Case 2 Combination mandibular fixed anterior-removable posterior
reconstruction with Locator attachments 319
See also: Chapter 14 Case 4 342
Chapter 14 Combination Fixed-Removable Restoration on Natural Teeth 323
Case 1 Maxillary bar-supported removable partial denture; lower crowns with
semiprecision removable partial denture 324
Case 2 Maxillary fixed partial dentures with precision removable partial
denture; mandibular bar-supported complete denture 331
Case 3 Maxillary telescope case: alumina copings on natural teeth and
removable overstructure; mandibular telescope case: Galvano copings on
natural teeth and nonremovable overstructures 337
Case 4 Mandibular anterior fixed partial denture and posterior removable
partial denture with implants and Locator attachments for added support and
retention; maxillary reconstruction, telescope case with 1 dental implant
included along with 6 teeth 342
Chapter 15 Implant-Supported Complete Dentures 349
Case 1 Maxillary extensive bone graft followed by implant-supported bars
and bar-supported overdenture after managing a temporomandibular disorder;
flange needed for lip support necessitating a removable rather than a
nonremovable approach 350
Case 2 Severe maxillary and mandibular resorption; maxillary bone grafting;
maxillary and mandibular implant-supported bar and bar-supported dentures;
flange needed for lip and cheek support necessitating a removable rather
than a nonremovable approach 355
Chapter 16 Reconstructions on All Natural Teeth 359
Case 1 Severe anterior overjet handled with occlusal/restorative treatment
in lieu of orthognathics; muscular component of a temporomandibular
disorder also managed 360
Case 2 Failed multiple reconstructions; original deep overbite with current
condition in provisionals with an opened vertical dimension and anterior
overjet; managed with a new reconstruction harmonizing a physiologic deep
overbite 366
Case 3 Maxillary reconstruction combined with extractions and periodontal
surgery to improve periodontal architecture; landmarks of lower acceptable
with minor modification 373
Case 4 Full mouth reconstruction utilizing crown-lengthening surgery,
extractions, single crowns, veneers, and a fixed partial denture sequenced
over 2 years 379
Case 5 Maxillary complete fixed partial denture on 9 Galvano telescopic
copings; mandibular anterior fixed partial denture on 4 Galvano copings 385
See also: Chapter 6 Case 6 171
Chapter 14 Case 3 337
Chapter 14 Case 4 342
Appendix 1 Definitive Occlusal Therapy Using the T-Scan III, by Robert
BKerstein, D.M.D391
Appendix 2 What Your Laboratory Technician Needs to Provide Excellence, by
Jerry Ulaszek, C.D.T433
Index 449
Author xi
Contributors to Appendices xi
Acknowledgments xiii
Introduction xv
Part 1 Didactics 3
Chapter 1 Fundamental Principles of the Comprehensive Approach 5
The Case for the Four-Part Comprehensive Evaluation 5
The Details of the Four-Part Comprehensive Evaluation 5
The Initial Conversation 6
The Clinical System-Based Masticatory System Examination 8
Imaging 22
Articulated Diagnostic Casts 25
Chapter 2 The People Side of Dentistry 27
The Importance of Behavioral and Communication Skills 27
The All-Important 5 Questions 27
The Codiscovery Process 29
Which Approach Is Best-The 4 Quadrants 33
Dentistry: A Blend of Technical, Emotional, and Intellectual Skills 33
Chapter 3 The 4 Essential Skills of the Comprehensive Dentist 37
Section A Bite Splint Therapy 38
Section B Definitive Occlusal Therapy: Equilibration 45
Section C The Diagnostic Blueprint-Wax-Up 50
Section D Provisionalization55
Chapter 4 The 10 Decisions 63
Section A TMJ Diagnosis and Condylar Position 64
Section B Vertical Dimension 66
Section C Lower Incisal Edge Position 74
Section D Upper Incisal Edge Position 77
Section E Centric Stop Design 86
Section F Anterior Guidance 91
Section G Curve of Spee 98
Section H Curve of Wilson 101
Section I Cusp to Fossa Angle 102
Section J The Aesthetic Occlusal Plane 105
Part 2 Case Studies 109
Chapter 5 Nonremovable Implant Restoration with Natural Teeth 111
Case 1 Nonremovable maxillary implant restorations with natural teeth
restorations including crowns, veneers, and fixed partial dentures 112
Case 2 Transitioning a maxillary tooth-supported fixed partial denture to
an implant-supported fixed partial denture along with other single crowns
and tooth-supported fixed partial dentures 121
Case 3 Lower reconstruction with lower left being implant-supported,
important neutral zone consideration affecting design; upper reconstruction
landmarks acceptable; temporomandibular disorder managed 129
Case 4 Maxillary fixed partial denture supported by both teeth and implants
along with other maxillary and mandibular implant-supported crowns and
tooth-supported crowns and fixed partial dentures 133
Case 5 Maxillary extractions, periodontal surgery, orthodontics, veneers,
and fixed partial dentures on teeth; mandibular extractions, implants,
fixed partial dentures on teeth and implants 139
Case 6 Multiple congenitally missing teeth, past
orthognathics/orthodontics, tooth position inconsistencies handled
restoratively, multiple implants, tooth-supported crowns and fixed partial
dentures, implant-supported crowns and fixed partial dentures 143
See also: Chapter 6 Case 1 148
Chapter 7 Case 7 216
Chapter 14 Case 4 342
Chapter 6 TM Disorders Followed by Reconstruction 147
Case 1 Osteoarthritis of the left TMJ managed with bite splint therapy
followed by implant-supported restorations and tooth-supported restorations
148
Case 2 Intracapsular and muscular components of a temporomandibular
disorder managed with bite splint therapy followed by occlusal therapy and
a full reconstruction 152
Case 3 Intracapsular and muscle disorder resolved with bite splint therapy
followed by occlusal reconstruction with maxillary lingual porcelain
veneers 157
Case 4 Intracapsular and muscle disorder with resultant occlusal plane
asymmetry resolved with bite splint therapy and followed by occlusal
therapy with restoration only on the lower left 162
Case 5 Past condylar replacement due to avascular necrosis followed by
posterior occlusal reconstruction 166
Case 6 Temporomandibular disorder resolved with bite splint therapy
followed by definitive occlusal therapy including a maxillary
reconstruction and mandibular functional changes with composite 171
Case 7 Past mandibular orthognathic surgery to correct maxillary to
mandibular malrelationship caused by condylar degeneration; intracapsular
and muscle pain resolved with bite splint therapy followed by definitive
occlusal therapy with posterior reconstruction and anterior composites 178
See also: Chapter 15 case 1 350
Chapter 16 case 1 360
Chapter 7 Restorations to Achieve Aesthetic and Functional Changes 183
Case 1 Restoration of anterior aesthetics and anterior guidance in a deep
overbite damaged by bruxism with upper and lower anterior reconstruction
184
Case 2 Posterior reconstruction with severe interferences to the centric
arc of closure 189
Case 3 Restoration of aesthetics and anterior guidance damaged by wear by
increasing overbite with upper and lower anterior crowns 195
Case 4 Maxillary reconstruction at open vertical dimension to improve
aesthetics, length, buccal profiles, and functional landmarks; mandibular
restorations only recontoured 199
Case 5 Maxillary and mandibular aesthetic and functional reconstruction
with lab-processed composite restorations to treat amelogenesis imperfecta
204
Case 6 Restorations maxillary bicuspid-to-bicuspid done first as part of a
comprehensive plan; maxillary left central incisor implant and other
functional discrepancies corrected with reshaping and equilibration 210
Case 7 Maxillary and mandibular dental reconstruction including 4 dental
implants replacing unrestorable teeth; impaired aesthetics due to recession
handled with grafts and all porcelain restorations 216
See also: Chapter 16 case 1 360
Chapter 8 Complete Implant-Supported Restorations 221
Case 1 Complete implant-supported maxillary reconstruction- transitioning
the anterior teeth from tooth-supported to implant-supported 222
Case 2 Complete maxillary nonremovable restoration supported by 6 implants
converted from a completed removable restoration on 4 implants 226
Case 3 Complete implant-supported nonremovable maxillary and mmandibular
reconstructions; transitioning from natural teeth that were not predictably
restorable 231
Case 4 Maxillary extractions, immediate implant placement, immediate
loading, and complete nonremovable zirconia restoration with pink porcelain
237
Case 5 Mandibular implant bar-supported full removable denture converted to
a nonremovable restoration to improve comfort of the neutral zone and
phonetics 240
Chapter 9 Orthognathics 245
Case 1 Severe anterior open bite corrected with maxillary-only
orthognathics and occlusal therapy with upper incisor restorations 246
Case 2 Mandibular orthognathic surgery and chin implant; managing a
temporomandibular disorder during treatment; posterior restorative
dentistry including implants 250
Case 3 Maxillary and mandibular orthognathic surgery with chin advancement;
prerestorative occlusal therapy with equilibration and composite additions
256
See also: Chapter 16 Case 1 360
Chapter 10 Bruxism and Wear Reconstruction 261
Case 1 Restoration of worn lower anterior teeth in a deep bite without
changing other restorations 262
Case 2 Severe wear from parafunctional habits restored with a complete
reconstruction at an increased vertical dimension of occlusion 266
See also: Chapter 16 Case 2 366
Chapter 11 Perioprosthesis 275
Case 1 Full maxillary periodontal-restorative reconstruction improving
aesthetics and function; lower posterior reconstruction following
conventional surgery, bone and soft tissue grafts, covering recession 276
Case 2 Posterior reconstruction in conjunction with conventional
periodontal surgery; root resection, pocket elimination 282
Chapter 12 Implants in the Aesthetic Zone 289
Case 1 Hopeless maxillary central incisor transitioned to an
implant-supported restoration (delayed placement and delayed loading) with
crowns on the remaining incisors along with occlusal therapy 290
Case 2 Extraction and immediate implant placement, delayed loading, and
restoration maxillary central incisors; pink porcelain to simulate papilla
296
Case 3 Congenitally missing maxillary lateral incisors, orthodontics to
open lateral incisor space, dental implants, and other aesthetic
improvements 302
Case 4 Congenitally missing upper right cuspid; upper right lateral incisor
lost in an accident; implant placed in cuspid position with 2-unit
cantilever restoration, pink porcelain to simulate gingival 307
Case 5 Maxillary central incisor extracted and replaced with a dental
implant, delayed placement, and delayed loading 311
See also Chapter 7 case 6 210
Chapter 13 Removable Implant-Supported Restoration with Natural Teeth 313
Case 1 Maxillary implant-supported bar-retained removable partial denture
along with tooth-supported restorations to reconstruct occlusion and
vertical dimension 314
Case 2 Combination mandibular fixed anterior-removable posterior
reconstruction with Locator attachments 319
See also: Chapter 14 Case 4 342
Chapter 14 Combination Fixed-Removable Restoration on Natural Teeth 323
Case 1 Maxillary bar-supported removable partial denture; lower crowns with
semiprecision removable partial denture 324
Case 2 Maxillary fixed partial dentures with precision removable partial
denture; mandibular bar-supported complete denture 331
Case 3 Maxillary telescope case: alumina copings on natural teeth and
removable overstructure; mandibular telescope case: Galvano copings on
natural teeth and nonremovable overstructures 337
Case 4 Mandibular anterior fixed partial denture and posterior removable
partial denture with implants and Locator attachments for added support and
retention; maxillary reconstruction, telescope case with 1 dental implant
included along with 6 teeth 342
Chapter 15 Implant-Supported Complete Dentures 349
Case 1 Maxillary extensive bone graft followed by implant-supported bars
and bar-supported overdenture after managing a temporomandibular disorder;
flange needed for lip support necessitating a removable rather than a
nonremovable approach 350
Case 2 Severe maxillary and mandibular resorption; maxillary bone grafting;
maxillary and mandibular implant-supported bar and bar-supported dentures;
flange needed for lip and cheek support necessitating a removable rather
than a nonremovable approach 355
Chapter 16 Reconstructions on All Natural Teeth 359
Case 1 Severe anterior overjet handled with occlusal/restorative treatment
in lieu of orthognathics; muscular component of a temporomandibular
disorder also managed 360
Case 2 Failed multiple reconstructions; original deep overbite with current
condition in provisionals with an opened vertical dimension and anterior
overjet; managed with a new reconstruction harmonizing a physiologic deep
overbite 366
Case 3 Maxillary reconstruction combined with extractions and periodontal
surgery to improve periodontal architecture; landmarks of lower acceptable
with minor modification 373
Case 4 Full mouth reconstruction utilizing crown-lengthening surgery,
extractions, single crowns, veneers, and a fixed partial denture sequenced
over 2 years 379
Case 5 Maxillary complete fixed partial denture on 9 Galvano telescopic
copings; mandibular anterior fixed partial denture on 4 Galvano copings 385
See also: Chapter 6 Case 6 171
Chapter 14 Case 3 337
Chapter 14 Case 4 342
Appendix 1 Definitive Occlusal Therapy Using the T-Scan III, by Robert
BKerstein, D.M.D391
Appendix 2 What Your Laboratory Technician Needs to Provide Excellence, by
Jerry Ulaszek, C.D.T433
Index 449
Contributors to Appendices xi
Acknowledgments xiii
Introduction xv
Part 1 Didactics 3
Chapter 1 Fundamental Principles of the Comprehensive Approach 5
The Case for the Four-Part Comprehensive Evaluation 5
The Details of the Four-Part Comprehensive Evaluation 5
The Initial Conversation 6
The Clinical System-Based Masticatory System Examination 8
Imaging 22
Articulated Diagnostic Casts 25
Chapter 2 The People Side of Dentistry 27
The Importance of Behavioral and Communication Skills 27
The All-Important 5 Questions 27
The Codiscovery Process 29
Which Approach Is Best-The 4 Quadrants 33
Dentistry: A Blend of Technical, Emotional, and Intellectual Skills 33
Chapter 3 The 4 Essential Skills of the Comprehensive Dentist 37
Section A Bite Splint Therapy 38
Section B Definitive Occlusal Therapy: Equilibration 45
Section C The Diagnostic Blueprint-Wax-Up 50
Section D Provisionalization55
Chapter 4 The 10 Decisions 63
Section A TMJ Diagnosis and Condylar Position 64
Section B Vertical Dimension 66
Section C Lower Incisal Edge Position 74
Section D Upper Incisal Edge Position 77
Section E Centric Stop Design 86
Section F Anterior Guidance 91
Section G Curve of Spee 98
Section H Curve of Wilson 101
Section I Cusp to Fossa Angle 102
Section J The Aesthetic Occlusal Plane 105
Part 2 Case Studies 109
Chapter 5 Nonremovable Implant Restoration with Natural Teeth 111
Case 1 Nonremovable maxillary implant restorations with natural teeth
restorations including crowns, veneers, and fixed partial dentures 112
Case 2 Transitioning a maxillary tooth-supported fixed partial denture to
an implant-supported fixed partial denture along with other single crowns
and tooth-supported fixed partial dentures 121
Case 3 Lower reconstruction with lower left being implant-supported,
important neutral zone consideration affecting design; upper reconstruction
landmarks acceptable; temporomandibular disorder managed 129
Case 4 Maxillary fixed partial denture supported by both teeth and implants
along with other maxillary and mandibular implant-supported crowns and
tooth-supported crowns and fixed partial dentures 133
Case 5 Maxillary extractions, periodontal surgery, orthodontics, veneers,
and fixed partial dentures on teeth; mandibular extractions, implants,
fixed partial dentures on teeth and implants 139
Case 6 Multiple congenitally missing teeth, past
orthognathics/orthodontics, tooth position inconsistencies handled
restoratively, multiple implants, tooth-supported crowns and fixed partial
dentures, implant-supported crowns and fixed partial dentures 143
See also: Chapter 6 Case 1 148
Chapter 7 Case 7 216
Chapter 14 Case 4 342
Chapter 6 TM Disorders Followed by Reconstruction 147
Case 1 Osteoarthritis of the left TMJ managed with bite splint therapy
followed by implant-supported restorations and tooth-supported restorations
148
Case 2 Intracapsular and muscular components of a temporomandibular
disorder managed with bite splint therapy followed by occlusal therapy and
a full reconstruction 152
Case 3 Intracapsular and muscle disorder resolved with bite splint therapy
followed by occlusal reconstruction with maxillary lingual porcelain
veneers 157
Case 4 Intracapsular and muscle disorder with resultant occlusal plane
asymmetry resolved with bite splint therapy and followed by occlusal
therapy with restoration only on the lower left 162
Case 5 Past condylar replacement due to avascular necrosis followed by
posterior occlusal reconstruction 166
Case 6 Temporomandibular disorder resolved with bite splint therapy
followed by definitive occlusal therapy including a maxillary
reconstruction and mandibular functional changes with composite 171
Case 7 Past mandibular orthognathic surgery to correct maxillary to
mandibular malrelationship caused by condylar degeneration; intracapsular
and muscle pain resolved with bite splint therapy followed by definitive
occlusal therapy with posterior reconstruction and anterior composites 178
See also: Chapter 15 case 1 350
Chapter 16 case 1 360
Chapter 7 Restorations to Achieve Aesthetic and Functional Changes 183
Case 1 Restoration of anterior aesthetics and anterior guidance in a deep
overbite damaged by bruxism with upper and lower anterior reconstruction
184
Case 2 Posterior reconstruction with severe interferences to the centric
arc of closure 189
Case 3 Restoration of aesthetics and anterior guidance damaged by wear by
increasing overbite with upper and lower anterior crowns 195
Case 4 Maxillary reconstruction at open vertical dimension to improve
aesthetics, length, buccal profiles, and functional landmarks; mandibular
restorations only recontoured 199
Case 5 Maxillary and mandibular aesthetic and functional reconstruction
with lab-processed composite restorations to treat amelogenesis imperfecta
204
Case 6 Restorations maxillary bicuspid-to-bicuspid done first as part of a
comprehensive plan; maxillary left central incisor implant and other
functional discrepancies corrected with reshaping and equilibration 210
Case 7 Maxillary and mandibular dental reconstruction including 4 dental
implants replacing unrestorable teeth; impaired aesthetics due to recession
handled with grafts and all porcelain restorations 216
See also: Chapter 16 case 1 360
Chapter 8 Complete Implant-Supported Restorations 221
Case 1 Complete implant-supported maxillary reconstruction- transitioning
the anterior teeth from tooth-supported to implant-supported 222
Case 2 Complete maxillary nonremovable restoration supported by 6 implants
converted from a completed removable restoration on 4 implants 226
Case 3 Complete implant-supported nonremovable maxillary and mmandibular
reconstructions; transitioning from natural teeth that were not predictably
restorable 231
Case 4 Maxillary extractions, immediate implant placement, immediate
loading, and complete nonremovable zirconia restoration with pink porcelain
237
Case 5 Mandibular implant bar-supported full removable denture converted to
a nonremovable restoration to improve comfort of the neutral zone and
phonetics 240
Chapter 9 Orthognathics 245
Case 1 Severe anterior open bite corrected with maxillary-only
orthognathics and occlusal therapy with upper incisor restorations 246
Case 2 Mandibular orthognathic surgery and chin implant; managing a
temporomandibular disorder during treatment; posterior restorative
dentistry including implants 250
Case 3 Maxillary and mandibular orthognathic surgery with chin advancement;
prerestorative occlusal therapy with equilibration and composite additions
256
See also: Chapter 16 Case 1 360
Chapter 10 Bruxism and Wear Reconstruction 261
Case 1 Restoration of worn lower anterior teeth in a deep bite without
changing other restorations 262
Case 2 Severe wear from parafunctional habits restored with a complete
reconstruction at an increased vertical dimension of occlusion 266
See also: Chapter 16 Case 2 366
Chapter 11 Perioprosthesis 275
Case 1 Full maxillary periodontal-restorative reconstruction improving
aesthetics and function; lower posterior reconstruction following
conventional surgery, bone and soft tissue grafts, covering recession 276
Case 2 Posterior reconstruction in conjunction with conventional
periodontal surgery; root resection, pocket elimination 282
Chapter 12 Implants in the Aesthetic Zone 289
Case 1 Hopeless maxillary central incisor transitioned to an
implant-supported restoration (delayed placement and delayed loading) with
crowns on the remaining incisors along with occlusal therapy 290
Case 2 Extraction and immediate implant placement, delayed loading, and
restoration maxillary central incisors; pink porcelain to simulate papilla
296
Case 3 Congenitally missing maxillary lateral incisors, orthodontics to
open lateral incisor space, dental implants, and other aesthetic
improvements 302
Case 4 Congenitally missing upper right cuspid; upper right lateral incisor
lost in an accident; implant placed in cuspid position with 2-unit
cantilever restoration, pink porcelain to simulate gingival 307
Case 5 Maxillary central incisor extracted and replaced with a dental
implant, delayed placement, and delayed loading 311
See also Chapter 7 case 6 210
Chapter 13 Removable Implant-Supported Restoration with Natural Teeth 313
Case 1 Maxillary implant-supported bar-retained removable partial denture
along with tooth-supported restorations to reconstruct occlusion and
vertical dimension 314
Case 2 Combination mandibular fixed anterior-removable posterior
reconstruction with Locator attachments 319
See also: Chapter 14 Case 4 342
Chapter 14 Combination Fixed-Removable Restoration on Natural Teeth 323
Case 1 Maxillary bar-supported removable partial denture; lower crowns with
semiprecision removable partial denture 324
Case 2 Maxillary fixed partial dentures with precision removable partial
denture; mandibular bar-supported complete denture 331
Case 3 Maxillary telescope case: alumina copings on natural teeth and
removable overstructure; mandibular telescope case: Galvano copings on
natural teeth and nonremovable overstructures 337
Case 4 Mandibular anterior fixed partial denture and posterior removable
partial denture with implants and Locator attachments for added support and
retention; maxillary reconstruction, telescope case with 1 dental implant
included along with 6 teeth 342
Chapter 15 Implant-Supported Complete Dentures 349
Case 1 Maxillary extensive bone graft followed by implant-supported bars
and bar-supported overdenture after managing a temporomandibular disorder;
flange needed for lip support necessitating a removable rather than a
nonremovable approach 350
Case 2 Severe maxillary and mandibular resorption; maxillary bone grafting;
maxillary and mandibular implant-supported bar and bar-supported dentures;
flange needed for lip and cheek support necessitating a removable rather
than a nonremovable approach 355
Chapter 16 Reconstructions on All Natural Teeth 359
Case 1 Severe anterior overjet handled with occlusal/restorative treatment
in lieu of orthognathics; muscular component of a temporomandibular
disorder also managed 360
Case 2 Failed multiple reconstructions; original deep overbite with current
condition in provisionals with an opened vertical dimension and anterior
overjet; managed with a new reconstruction harmonizing a physiologic deep
overbite 366
Case 3 Maxillary reconstruction combined with extractions and periodontal
surgery to improve periodontal architecture; landmarks of lower acceptable
with minor modification 373
Case 4 Full mouth reconstruction utilizing crown-lengthening surgery,
extractions, single crowns, veneers, and a fixed partial denture sequenced
over 2 years 379
Case 5 Maxillary complete fixed partial denture on 9 Galvano telescopic
copings; mandibular anterior fixed partial denture on 4 Galvano copings 385
See also: Chapter 6 Case 6 171
Chapter 14 Case 3 337
Chapter 14 Case 4 342
Appendix 1 Definitive Occlusal Therapy Using the T-Scan III, by Robert
BKerstein, D.M.D391
Appendix 2 What Your Laboratory Technician Needs to Provide Excellence, by
Jerry Ulaszek, C.D.T433
Index 449