Immediate stabilization of anterior guidance polyethylene fiber periodontal patient

Dr. Mario Romero Felix
Diploma in General Dentistry ACDRC, Lake Worth Florida
Diploma in occlusion, Dawson Center for Advanced Dental Education, St. Petersburg Florida
Leading Professor of occlusion, INCAFOE-G
President AORYBG mromero@buenaliento.com
www.buenaliento.com

Abstract:

If all our treatments are based on the premise that occlusal stability is the single most important factor regarding the balance of the stomatognathic system is concerned, it is necessary to achieve within this stability, adequate anterior guidance (which achieves all teeth disclusion subsequent eccentric movements).

Many patients with periodontal occlusal trauma present (interference) as a result of migration and tooth hypermobility. It is critical that the treating dentist (periodontist) understand that in cases of generalized periodontal problems, a destructive component that does not respond to conventional therapies, almost invisible, is the occlusal (a periodontist experienced was not overlooked) .

It is the primary objective of this article present the multidisciplinary treatment of a patient with these characteristics.

Summary:

If all our treatments start from the premiss that occlusal stability is the single most important factor Concerning the equilibrium of the stomathognatic system, our main objective is to achieve, in that stability, an accurate prior guidance (that will later desoclude all teeth in any Excentric movement of the mandible).

Many patients with periodontal problems suffer from occlusal trauma (interferences) as a consequence of migration and dental hipermobility. It is extremely important that the chief dentist (periodontist) understands that in many generalized periodontal cases, a destructive component that does not response to conventional therapy, almost invisible, is the occlusal trauma (a well trained periodontist will notice the problem).

It is the main objective of this article to present a multidisciplinary approach to a patient with these characteristics.

Introduction:

Periodontal disease can lead to loss not only of periradicular bone structure but also the dental organ. This clinical reality is known and has been directly observed by millions of dentists in the world, but what often escapes us is the component that occlusal trauma, in most cases, occurs as a side effect of the disease.
 

But it is also important to consider the horizontal component of the occlusion, or lateral movement of the mandible. The stomatognathic system protects itself from these forces with the previous guide (1) (canine and incisor) (picture 2).

Requirements for a good occlusal therapy:

For the stomatognathic system must be functioning properly certain aspects such as:

1. Condyles comfortable (1): match centric relation with maximum intercuspal of the teeth (this is what can be achieved with occlusal adjustment).

2. Previous Guide in harmony with the envelope function (1): anterior guidance not only with aesthetic harmony but, more importantly, functional harmony, ie that the relationship of the incisal edges of the lower incisor to the palatal surfaces of the upper incisor allow suitable disclusion later. (see graph 1)

3. Harmony in the occlusal plane (1), ie that is sufficiently "flat" for the previous guide disclusion occur all the posterior teeth when the condyles leave his position of centric relation.

How to diagnose occlusal trauma in periodontally compromised patients?

Patients with periodontal always affected by a nearly invisible enemy that contributes largely to bone loss associated with the disease.

I speak of the invisibility of the enemy as only an experienced clinician with a clear understanding of physiological concepts of occlusion can diagnose and refer the treatment of occlusal trauma specialist, or if their skills are very broad, treating directly.

Patients usually arrive at the office by bleeding gums, visual examination inflammatory changes are observed at the gingival and even the presence of supra-and subgingival calculus, easily detectable aspects for the clinician trained (photo 3). What is sometimes not so obvious is the causal factor of excessive wear on incisal observe and / or occlusal surfaces (figure 4) and contribute to the deterioration of periodontal support tissues, "occlusal interference" (picture 5 , 6 and 7).

3. Harmony in the occlusal plane (1), ie that is sufficiently "flat" for the previous guide disclusion occur all the posterior teeth when the condyles leave his position of centric relation.

Treatment:

In the article "occlusal adjustment by selective grinding. A conservative alternative to temporomandibular dysfunction, "published in Volume 2 No. 4 of this magazine, we describe in detail the clinical sequence of treatment of occlusal trauma. In this article we focus exclusively to the last step of occlusal adjustment, harmonization of the previous guide.

The patient presented below was diagnosed with chronic periodontitis (Moderate-Advanced) Widespread presence of Grade 2 mobility (mobility pathological buccal lingual comprehensive non-intrusive) and periodontal pockets of 7-8 mm on average. In the anterior sextant parts that had a higher mobility were the No. 21 and 22.

Something I noticed the periodontist treating on the first date was the presence of joint pain, accompanied by injury abfractivas in premolar and molar area prompting the interconsultation.

When we reviewed the patient the first thing we noticed (through palpation) was the lowest beam sustained contraction of the left pterygoid, to which the patient responded to pain. We could not achieve muscle relaxation in the first date, which is why we manufacture a previous acrylic guide (figure 8) (which occurs later disclusion and muscle relaxation) accompanied by a drug treatment based on muscle relaxants for 3 days.

In the second date (after 3 days) the patient came with relaxed muscles, asymptomatic, then proceeded to verify the centric position of the condyles to identify the contact early and proceed with occlusal adjustment. While setting the only way we could not conclude was the harmonization of the previous guidance due to hypermobility and consequent hypersensitivity of parts No. 21 and 22.

After inspected the occlusal adjustment (at 7 days) and check that it had eliminated all symptoms pointed to the periodontist to continue with your treatment plan.

Periodontal treatment included surgery with bone grafts in deeper pockets. Here are pictures of control after 90 days of completion of occlusion and periodontal therapy. (Photo 9 and 10).

In the second date (after 3 days) the patient came with relaxed muscles, asymptomatic, then proceeded to verify the centric position of the condyles to identify the contact early and proceed with occlusal adjustment. While setting the only way we could not conclude was the harmonization of the previous guidance due to hypermobility and consequent hypersensitivity of parts No. 21 and 22.

After inspected the occlusal adjustment (at 7 days) and check that it had eliminated all symptoms pointed to the periodontist to continue with your treatment plan.

Periodontal treatment included surgery with bone grafts in deeper pockets. Here are pictures of control after 90 days of completion of occlusion and periodontal therapy. (Photo 9 and 10).

Conclusions:

Many patients who come to our privacy practices characteristic signs of masticatory system instability. As dentists we must understand that our patients restore without removing these signs greatly increases the chances of failure. All patients with periodontal disease should be considered high risk for occlusal problems.

Recommendations:

We believe that all dental professionals should receive training in the area of occlusion and restorative treatments and to offer more predictable.

Bibliography:

1. PE. Dawson. Occlusal Equilibration. Evaluation, diagnosis and treatment of occlusal problems. Second Edition. Mosby 1989

2. MF. Romero. Occlusal adjustment by selective grinding. A conservative alternative to temporomandibular dysfunction. Dental Formula, AORYBG official organ. No., 2005