Importance of Periodic Control after Fitting a Total
Prosthesis - Case Report


Marcelo Oliveira MAZZETTO
Wilson ABRÃO
Marco Antonio M. RODRIGUES DA SILVA

Faculdade de Odontologia de Ribeirão Preto Universidade de São Paula, Ribeirão Preto, SP Brasil


Braz Dent J (1990) 1(1): 51-54 ISSN 0103-6440

| Introduction | Care Report | Discussion  | References |


A patient was seen at the Total Prosthesis Clinic complaining of facial pain after using the same prosthesis for 46 years. Clinical examination revealed TMJ disturbance due to a loss of the vertical dimension caused by a wearing of the teeth. Diagnosis indicated replacement with new prostheses, with a gradual recuperation in the vertical dimension by the application of resin over the lower teeth and a reconditioning of the support tissues. After the alleviation of pain, correction of the dysfunction and reestablishment of the vertical dimension of occlusion, new prostheses were made. At the end of treatment, the patient felt a relaxed facial musculature, lifting the mandible to a resting position instead of constantly maintaining it in occlusion as before. The patient was given instructions as to use, conservation and hygiene of the prostheses and oriented to return for annual evaluation of occlusion and of the supporting oral structures, as well as the stability of the prostheses.


Key words: total prosthesis, vertical dimension, conservation.


Introduction

The Clinic of the School of Dentistry of Ribeirão Preto frequently receives patients with total prostheses with more than 10 years of use. Upon inquiring if at the time of installing the prostheses they had received orientation as to how to use, preserve and conserve the prostheses, as well as of the necessity of periodic evaluation, the response was always negative. This demonstrates the lack of general attention shown to edentulous patients even today. This could lead to the false impression that, while other dental specialities have evolved, especially in the area of prevention, the area of Total Prostheses remains as it was in its early days. However, this is not really the case. What actually occurs is that, in fact, most dentists, especially in a general clinic, offer this type of information to their patients without adequate training and even without sufficient knowledge to do this satisfactorily. Often the professional only takes the impressions of the patient, leaving the rest of the work - from the making of the models to the selection of the form and size of the teeth - to the laboratory technicians.

According to Nagle et al. (1%5), a total prosthesis which follows all of the technical requirements during its construction ought to be seen at least once a year. After this time, detailed examination not only of its actual condition but also of the structures of support is necessary. Really, if one considers that during this period physiologic bone reabsorption and a wearing of the occlusion surfaces of the artificial teeth occur, a reduction in the vertical dimension is expected to occur, besides a compromise in the retention, stability and support of the prosthesis. Thus, periodic control is indispensable.


Case Report

A 66 year old female patient, having used the same total prosthesis for 46 years (Figure 1A,B), was seen at the Clinic of the Dental School of Ribeirão Preto, complaining of facial pain. Upon clinical examination, a temporomandibular joint dysfunction caused by an exaggerated loss of vertical dimension was found. According to Weinberg (1979, 1980a,b), this problem was caused by the dislocation of the condyle in the interior of the glenoid fossa to a position posterior and/or superior, initially causing an inflammation of the region and then osteoarthritis with pain. On examination of the prostheses, a complete wasting of the mandibular teeth was found, caused by attrition of the porcelain teeth of the maxillary prosthesis against the acrylic teeth of the mandibular prosthesis (Figure lA), causing a loss of vertical dimension (Figure lB). The supporting tissues showed moderate, generalized inflammation, especially of the maxilla.

The clinical picture indicated the need of new prostheses, with a gradual recuperation in the vertical dimension and reconditioning of the support tissues. Thus, already on the first visit, the vertical dimension was recuperated about 2 mm by the addition of autopolymerized acrylic resin over the teeth of the lower prosthesis in use. (Figure lC), forming a straight, smooth plane. At the same time, the prosthesis was filled with "Resil", to recuperate the tissues.

Fifteen days later, the patient returned to the Clinic with less facial pain, complaining only of difficulty in chewing. A new 2-mm layer of resin was applied to the prosthesis. Twenty days later, the patient returned without any type of pain, but still complaining of difficulty in chewing.

Having eliminated the causes and symptoms of pain and the temporomandibular dysfunction, new prostheses were constructed using the actual vertical dimension of the patient with her old prostheses in occlusion to register the intermaxillary relations since the correct vertical dimension had been restored (Figure 1D).

The centric relation was recorded with an intraoral Gothic arc tracer and the models were placed in a semiadjustable articulator (Gnatus). A straight occlusal plane (without the curve of Spee) was followed in the mounting of the teeth, especially the posterior ones, with only the second maxillary molars in an inclined position, in order to form a ramp to permit free lateral movements and avoid the "Chistensen" phenomenon when in protrusion, thus permitting balancing in the protrusion position.

The functional fitting showed good centric contact and adequate occlusal balance in lateral movements. At each phase, the vertical dimension was always confirmed and tested. Upon final fitting of the prostheses (Figure 1E, F), the patient was asked to return the following day for adjustment.

Upon returning, the patient's principal complaint was of pain at the alveolar crest. The vertical dimension, confirmed by phonetic measurements and methods, was correct. A few adjustments in occlusion and trimmings of the lateral faces of the mandibular prosthesis were made. Upon return 72 hours later, the patient no longer complained of any functional discomfort. The border sensibility was lessened. One week later, without complaints, the patient was requested to return after 90 days for another evaluation.


Discussion

After her last visit, the patient was completely comfortable with her new prostheses, being able to speak and chew, and was satisfied with the esthetic appearance.

The pain disappeared and according to the patient inicial discomfort upon awakening had disappeared. She felt a relaxing of the facial muscles, being able to easily maintain the mandible at rest contrary to the constant occlusion position. before treatment.

Periodic visits to the dentist by patients with total prostheses are an important factor for the success of treatment, not only in terms of the prostheses duration but also in terms of patient comfort. Thus, besides routine instruction regarding use, conservation and hygiene of the prostheses, the dental surgeon ought to orient his patients to return to his office at least once a year to evaluate occlusion, vertical dimension, prosthetic stability and the condition of supporting tissues. Only in this manner can situations as the case presented be avoided.


References

Nagle RJ, Lears VH: Protesis dental - Dentaduras completas. 2nd ed. Toray SA, Barcelona 1965 .

Weinberg LA: The etiology, diagnosis and treatment of TMJ. Disfunction-pain syndrome. Part I: Etiology. J Prosth Dent 42: 654-663, 1979

Weinberg LA: The etiology, diagnosis and treatment of TMJ. Disfunction-pain syndrome. Part II: Differential diagnosis. J Prosth Dent 43: 58-70, 1980a

Weinberg LA: The etiology, diagnosis and treatment of TMJ. Disfunction-pain syndrome. Part III: Treatment. J Prosth Dent 43: 86-195, 1980b


Correspondence: Dr. Marcelo Oliveira Mazzetto, Departamento de Odontologia Restauradora, Faculdade de Odontologia de Ribeirão Preto, USP, 14050 Ribeirão Preto, SP, Brasil.


Accepted October 9, 1990
Eletronic publication: august 1997


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