Her chief complaint was “I want to cap my worn-down teeth. My teeth are short, and I want to fix up
my mouth.” A review of the patient’s INCB024360 order medical history revealed that she has been diagnosed with bipolar disease since 2007 and was currently taking Prozac (40 mg/2× daily) and Lithium (20 mg/2× daily). The patient was under the care of a physician, and her last physical exam was 5 months prior. She had no medical contraindications to prosthodontic treatment. The patient admitted to a past history of soda swishing in her mouth and admitted to having two alcoholic drinks per day. She was unaware of any parafunctional oral habits. Her oral hygiene regimen consisted of brushing once a day without flossing. The patient had no muscle tenderness selleck chemical or palpable nodes. Her mandibular range of motion was within normal limits, and the temporomandibular joints were asymptomatic. The muscles of mastication and facial expression were also asymptomatic. Lip, cheek, tongue, oral mucosa, and pharyngeal soft tissues were within normal limits. Mandibular examination revealed bilateral mandibular tori. The saliva was thin and serous. The color, size, texture, and contour of the maxillary and mandibular gingiva were within normal limits. General probing depths ranged between 1 and 3 mm with localized bleeding upon probing. The patient had 3 to 6 mm of attached gingiva in the maxilla and 2 to 5 mm in the mandible except tooth #18, which
had no attached gingiva on the buccal and distal surfaces. An examination of the hard tissues revealed multiple carious lesions, crater-like defects, islands of restorations surrounded by worn surfaces, and missing
teeth (Figs 1-4). Abnormal response to the electric pulp tester and thermal test were noted for teeth #6, 7, 10, 13, and 14. Examination of the patient’s occlusion found that centric occlusion was not coincident with the maximum intercuspation (MIP), and an approximately 1 mm horizontal slide was noted after chairside deprogramming of the patient’s musculature. There was medchemexpress an initial tooth contact between tooth #2 and #31. Vertical and horizontal anterior overlap (1 mm) was noted at MIP. No teeth demonstrated clinically detectable pathologic mobility or furcation involvement. The patient had a straight soft-tissue facial profile. Her esthetics, phonetics, occlusal plane, and OVD were evaluated. Interocclusal space at her physiologic rest position was 6 mm. She exhibited an excessive amount of anterior speaking space between the anterior teeth making the S sound. The maxillary anterior teeth appeared short, and the upper central incisors were not visible at rest. The patient had an average smile line. The incisal edge did not follow the lower lip line and smile width up to the second molar with a normal buccal corridor (Fig 5). A pretreatment panoramic radiograph showed dense regular trabeculation. The bone supporting the teeth was leveled with no infra-bony pockets (Fig 6).