Marcelo Oliveira MAZZETTO
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.
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.
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.
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.
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