Title: Determining the cast core inclination in absence of guidance from natural teeth – a distinctive clinical technique
Authors Khurshid A Mattoo, Areej Darraj, Gupta I
Among the most difficult cases of full mouth occlusal rehabilitation, very few fall in the realm where there is left no guidance for restorative build up either from adjacent teeth or from opposing teeth. In such cases, one has to utilize basic knowledge and understanding of complete denture fabrication and innovate to rehabilitate the dentition successfully. An adult female complaining of non functional teeth reported to comprehensive clinic for restoration of her entire dentition. Medical history disclosed a case of active rheumatoid arthritis, while clinical examination revealed grossly decayed natural dentition. The extent of damage was severe with ninety percent of the coronal tooth structure in entire visible dentition destroyed by caries. Endodontic treatment and crown lengthening procedures were compulsory to accomplish the prosthodontic objectives. Complexity of rehabilitation lied in determining the inclination of cast core in relation to the most aesthetic placement of the crowns which had to be fabricated after the cementation of cores. Principles of complete denture rehabilitation were implied by using a modified trial denture base occlusal rim, on which jaw relation was first determined. Artificial teeth were modified and arranged following which a trial was done. This trial denture was then used as a template to give inclinations to the underlying cores during laboratory procedures. Single crowns, a six unit partial denture and a cast partial denture were prosthetic components of rehabilitation. The patient was highly satisfied with the functional outcome and continues to be to on a follow up protocol.
Keywords: dowel core, complete denture, crown lengthening, endodontic, rheumatoid arthritis.