Abstract

Integrated Orthodontic-Restorative Treatment Strategies in Patients with Dental Wear and Restorative-Prosthodontci Needs

by Fichera Guido Mario Angelo

The adult patient, in addition to having completed the growth process and having a lower ability to adapt, often presents an oral condition characterized by compromised dentition and secondary malocclusion. Secondary malocclusion can be defined as the malocclusion resulting from the morphological alteration and dento-alveolar compensation from dental wear (attrition, erosion, abrasion) and from pathological migrations from periodontal disease and loss of dental elements; the simultaneous presence of edentulous rights with different degrees of atrophy, a smaller number of dental elements, the loss of periodontal support and the compromised structural state of the residual dental elements entails specific clinical considerations in comparison to primary malocclusion in the evaluation, diagnosis and orthodontic treatment. The bruxist habitus can further complicate the management of oral rehabilitation due to the presence of highly destructive forces, in particular when the portions of the occlusal table are made up of artificial restorative-prosthetic materials. In the context of the interdisciplinary approach, additive reconstructions in composition of the occlusal morphologies of dental elements undermined by dental wear processes, the use of “full Crown restoration” for elements with extensive loss of dental substance and the use of implants in the replacement of lost dental elements constitute the main corrective measures with which orthodontic treatment often needs to be integrated. In addition to an adequate engineering design of the rehabilitation plan, the occlusal design performs a fundamental function for the ability to modulate the control of forces at the level of the various restorative, prosthetic and implant interfaces. The purpose of the communication is to present how Timing and methods of carrying out these corrective measures, to be integrated with orthodontic treatment, can be essential clinical elements in determining the final success of oral rehabilitation in compliance with the principle of maximum therapeutic effectiveness at the lowest biological cost .

Learning Objectives

After this lecture, you will be able to know the more relevant clinical features of adult patient with compromised dentition, secondary malocclusion and force control problems
After this lecture, you will be able to know the different restorative techniques for the morphological restoration of structurally compromised teeth
After this lecture, you will be able to know the different combined clinical strategies of orthodontic-restorative treatment of the dentition compromised by wear and with restorative-prosthetic needs