critical appraisal of articles

1. Altering the vertical
dimension of occlusion in a
perio-restorative patient
BY
DR VINCENT KOCICH

2. BACKGROUND
• Clinical Practice article.
• Clinical Dilemma for restorative dentist .
• Anterior Tooth surface loss.
• Deep overbite with no space for the
restorative material.

3. PRINCIPLE 1
•The location of occlusal plane limits the
scope of improvement in facial height

4. PRINCIPLE 2
The relationship between the incisors and the occlusal
plane reveals the cause of the overbite.

5. Scientific reason behind principle 1 & 2
• Intrusion of incisors is more stable as compare to
extrusion of molars

6. Step by step diagnostic procedure to estimate the
occlusal plane level.
FIRST STEP
• Identification of contact point between maxillary & mandibular second molars
• Level of patient’s upper lip at rest.

7. Clinical case
Application of Principle 1 & 2
Pre-Treatment

8. PROBLEM LIST
• Deep overbite
• Maxiilary incisors were 4mm from the occlusal plane
• Mandibular incisors were also above the occlusal plane

9. CLINICAL CASE

10. POST-TREATMENT
Intrusion of maxillary and mandibular incisors

11. Pre-treatment Post-treatmnt

12. PRINCIPLE 3
The correct gingival position determines whether
intrusion is the right solution and crown proportions
govern the amount of lengthening that is desirable

14. CLINICAL GUIDELINE
• Measure the sulcus depth
• Locate the Cementoenamel junction
• If sulcus depth is 1 or more than one and CEJ
is located at the bottom of the sulcus, position
of the gingival margin is correct,
• Patient has incisal wear.

15. PRINCIPLE 4
The need for jaw surgery depends on the facial
proportions.

16. INDICATIONS
• Severe
overbite
• Disproportion
ate facial
height

17. CASE REPORT 2
Deep anterior overbite & short maxillary incisors

19. DURING TREATMENT

20. POST-TREATMENT

21. CASE 5
Lingually inclined maxillary incisor & severely
abraded mandibular incisor

23. POST-TREATMENT