FINAL RESULT

FINAL RESULT
Comparing the patient’s before and after photos, you can see the length has been restored to his teeth as well as to the bottom third of his face. He no longer has TMJ pain and loves his new smile. “This is an example of the results we typically get when we diagnose the complete chewing system,” says O’Rourke. “This type of dentistry is only possible with a rejuvenation-trained technologist and dentist working closely as a team."

STEP 9
Dr. Stewart put the patient through a series of test positions to verify proprioceptive guidance. These positions verified that proper function had been restored.

STEP 8
O’Rourke waxed, pressed, cut back and layered the crowns using IPS e.max from Ivoclar Vivadent. Dr. Stewart cemented the crowns using systematic checkpoints to verify each step and ensure accuracy to the level of 8 microns; this is an intricate process that dentists and technologists learn at the Texas Center.

STEP 7
Using the prep guide O’Rourke fabricated, Dr. Stewart prepped teeth #5 through #12 for crowns and temporaries.

STEP 6
With four of the coronoplasties completed—on teeth #23, 24, 26 and 27—you can see how the lost tooth structure is replaced with composite.

STEP 5
Here you can see where O’Rourke waxed back lost tooth structure. So that Dr. Stewart could replicate the waxup in the mouth during the coronoplasty, O’Rourke fabricated a series of clear, polyvinyl matrices and occlusal seating devices into which Dr. Stewart applied flowable composite. The matrices helped ensure the coronoplasty was accurate to an 8-micron tolerance.

STEP 4
When O’Rourke received the models with the open CR bites at the laboratory, he mounted them on his own AD2 articulators. After evaluating the case using the four keys of rejuvenation dentistry—the airway, joints, occlusion and tooth anatomy—he called Dr. Stewart to discuss the restorative options. They decided that the most minimally invasive approach was to perform additive coronoplasty by building composite on the patient’s teeth in order to restore vertical dimension and proper tooth form, and get the teeth to come together and hold an 8-micron shim on each contact.

However, the patient expressed a desire to crown eight of his maxillary teeth so the dental team refined the treatment plan: they would place IPS e.max crowns on teeth #5 through #12 and perform additive coronoplasty on the remaining teeth.

STEP 3
After pouring models and mounting them on AD2 articulators from Advanced Dental Designs, Dr. Stewart compared the models to the patient to verify what was on the articulator replicated what was in the mouth.

STEP 2
As the C2O no longer needed adjustments, Dr. Stewart took three bite registrations over a period of a few weeks to help confirm joint stability. Once the joints were verified to be stable, the patient’s mandibular-to-cranial-base discrepancy was evident.

RESTORATIVE PROBLEM
The 49-year-old patient presented to Dr. Hal Stewart, Flower Mound, TX, with TMJ pain and tooth wear. He had lost a substantial amount of tooth structure which was collapsing his bite and causing him to lose vertical dimension in the lower third of his face.

STEP 1
Before a diagnosis was made, the dental team had to ensure stable condylar position. Dan O’Rourke, Owner, O’Rourke Dental Studio, Bristol, NH, fabricated the Texas Center’s C20, a clear, hard maxillary orthotic that Dr. Stewart seated in the patient’s mouth. Over the next three months, Dr. Stewart took measurements and made adjustments to the appliance to seat the condyles in their proper superior, anterior and medial position.