49 Missing teeth: #14,#18,#25,#26,#27,#28,#33,#35 #36,#38,#43,#44,#45#46#47#48 Previous prepared teeth: #13,#15,#16,#17,#23,#24 #11#12#21#22 cavity fi

Size: px

Start display at page:

Download "49 Missing teeth: #14,#18,#25,#26,#27,#28,#33,#35 #36,#38,#43,#44,#45#46#47#48 Previous prepared teeth: #13,#15,#16,#17,#23,#24 #11#12#21#22 cavity fi"

滕蓟
5 years ago
Views:

1 neutral zone technique

2 49 Missing teeth: #14,#18,#25,#26,#27,#28,#33,#35 #36,#38,#43,#44,#45#46#47#48 Previous prepared teeth: #13,#15,#16,#17,#23,#24 #11#12#21#22 cavity fillings as domed shape Arch form: Upper & lower are all ovoid shape. Lower right edentulous ridge resorption : knife edge, less keratinized gingiva Occlusion : Bite collapse. 2 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

3 study casts X Missing: #14,#25,#26,#36,#38,#45,#46,#47,#48 residual dental roots: #18,#27,#28,#33,#35,#43,#44 #11,#12,#21,#22: previous unsatisfied endo with post #12,#22: unknown radiopaque mass over apex & apical radiolucency The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 3

4 BOP FI B B Mobility B Tooth P BOP FI B,L Mobility 1~ ~2 1 2~3 L Tooth B EPT: all positive : #14,#18,#25,#26,#27,#28,#33,#35 #36,#37,#38,#43,#44,#45#46#47#48 : #11,#12,#13,#15 #16,#17,#21,#22, #23,#24,#34 Due to the financial requirement, this p't was not willing to receive the interim dentures. Treatment Options for upper arch Option I: FPD (prepared teeth) + RPD >> chosen by patient #16#17 metal crowns, #13x#15 PFM bridge, #23#24 PFM crowns #11#12#21#22 root retained for over-denture UA & left distal free end RPD 4 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

Option II: FPD (prepared teeth & upper incisors) + RPD #11#12#21#22 crown lengthening + casting post core + PFM crowns #16#17metal crowns, #13x#15 PFM bridge, #23#24 PFM crowns Left distal free end

5 Option II: FPD (prepared teeth & upper incisors) + RPD #11#12#21#22 crown lengthening + casting post core + PFM crowns #16#17metal crowns, #13x#15 PFM bridge, #23#24 PFM crowns Left distal free end RPD Option III: FPD (prepared teeth & upper incisors) + implant supported bridge #11#12#21#22 crown lengthening + casting post core + PFM crowns #16#17metal crowns, #13x#15 PFM bridge, #23#24 PFM crowns #25X#27 implant supported bridge Treatment Options for lower arch Option I: bilateral free end RPD >> chosen by patient Option II: FPD + RPD #32x#34 PFM bridge bilateral free end RPD Option III: FPD + implant supported FPDs #32x#34 PFM bridge #35,#36,#43,#44x#46 implant supported FPDs Option IV: #33,#35,#36,#43,#44x#46 implant supported FPDs Definitive Treatment Plan 1. Extraction:#37 2. OD: #11,#12,#13,#15 #16,#17,#21,#22, #23,#24,#34 3. Prosthodontic evaluation by baseplate & occlusion rim >determination of occlusal plane & OVD 4. #16#17 metal crowns, #13x#15 PFM bridge, #23#24 PFM crowns 5. upper & lower RPDs The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 5

6 RPD Design Major connector:palatal-coverage fulcrum line Rest seat Casting clasp Major connector: Linguo-plate Rest seat Casting clasp Wrought wire Baseplate & occlusion for determination of OVD 6 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

7 Study casts Diagnostic Wax Up The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 7

8 Upper teeth preparation and the space checking with the diagnostic wax up were done. VDR: 64 mm VDO: 61 mm (wearing the diagnostic occlusal rims) Impression taking by silicone (condensation type) Reproduction of the same cast for baseplate fabrication) 1 st Bite registration with baseplate & occlusion rim VDR: 66.5mm VDO: 64 mm (bite registration with the occlusal rims) 8 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

9 Mounting Upper Master Cast with 1 st bite registration #13x#15,#23#24 PFM FPDs & #16,#17 metal crowns try-in 2 nd Bite registration with baseplate & occlusion VDR: 62.5mm VDO:60.5mm The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 9

10 #13x#15,#23#24 PFM FPDs & #16#17 metal crowns try in temporary cementation Lower arch mouth preparation & upper custom tray border molding, upper & lower teeth final impression with condensation silicone FM RPD metal frameworks try in & altered cast impression making with ZOE Bite registration 10 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

11 Upper & lower wax dentures try in Wax denture try-in: Extra-oral view The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 11

12 Occlusal Scheme Right excursion Left excursion Left excursion w/o dentures 12 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

13 protrusion canine 1st bicuspid guidance; guidance Follow Up (4 days later) PIP The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 13

14 () 14 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

15 () x Without dentures The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 15

16 With dentures in mouth Q 1. f/u 2. financial A 1. reline reline 2. VD 16 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

17 Q A Q A Q A Q A VD bite collapserrcontact#24,34 contactrestorative spacebase plate & wax rimvdrest position VDO biterestorative spacecontact #24,34 occlusion restorative space caseverticalhorizontal thinkingbiteverifygold standardverifylowerrecord base restorative spacevertical dimension horizontalvd rest positionocclusionlip incompetence mentalis muscle strength #24,34fixed index record base VD bite registrationlip incompetence mentalis muscle strength upper RPDinfra-bulge retainerlower RPDsupra-bulge retainer muscle strengthlower infra-bulgemuscle retainerupper T-bar distal abutment The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 17

18 Q A Q A Q A Q A Q A functionalcheck VD VD; speech function swallowing function upper incisor occlusal rimcdwax denture try-inlip line, mouth angle, facial midline, lateral profile mounting master castvddiagnostic wax-up diagnostic wax-upvd#24,34index interocclusal recordvertical stopvd lower archdesignprognosis dental implants dental CT evaluation, bone graft lower incisorsaltered castrotation lower incisorcingulum rest seat lingual platevertical stoprpd framework 18 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

19 78 aveoloplasty Asthma; Chronic ischemic heart disease; Esophageal reflux; Essential hypertension; Osteoarthrosis NaposinVoltaren No facial asymmetry Interpupillary line parallel to occlusal plane Downward of oralis angularis Concave profile The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 19

20 Panoramic findings Problem list Edentulous ridges. Edentulous ridges with high frenum. High positioned frenum. Torus. Torus. Hyperglossia. Big tongue. 20 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

Treatment plan options: Plan 1 : Treatment course 2010/8/6 Upper : conventional complete

conventional CD Upper + lower alginate impression for individual tray fabrication.

21 Treatment plan options: Plan 1 : Treatment course 2010/8/6 Upper : conventional complete denture Lower : implant retained denture Plan 2 : (final tx plan) Upper + lower : conventional CD Upper + lower alginate impression for individual tray fabrication. 2010/9/6 Final impression (border molding with green compound + impression with ZOE). 2010/9/8 Neutral zone technique. Master cast evaluation Neutral zone technique Baseplate with metal retention loop on top. Green compound The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 21

22 Step 1. Decide upper occlusal wax rim Check the maxillary occlusal plane of wax rim with occlusal fox plate. Anteriorly, the occlusal plane was parallel with the interpupillary line and posteriorly, the occlusal plane was parallel with Camper's line. Step 2. Rest vertical dimension RVD = 72 mm Step 3. Neutral zone technique decide OVD Step 4. green compound Neutral zone 22 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

23 Step 5. Facebow transferbite registration making index lower molding compound Wax denture try-in Dentsply Excellence IPN,shade:A3 The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 23

24 balancing occlusion 24 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

25 Neutral zone technique 1931Sir Wilfred Fish polished surfaces retention stability dead space, neutral zone Beresin and Schiesser Neutral zone ridgeatrophymuscle tone CA neutral zoneindication The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 25

26 Neutral zone Primary impressions and secondary impressions Try in the base plates Construction of lower base plate Neutral zone impression Lower index and wax rim in laboratory Take bite Teeth arrangement in laboratory Wax denture try in and completion ~Gahan and Walmsley, B.D.J., 2005 march Step by step Primary impression Stock tray Alginate Secondary impression Individual tray Border modeling Impression by Low viscosity materials Zinc oxide eugenol Provide the maximal support from underlying structure Represent muscle activity Try in base plate Extension, stability, and comfort Upper Base plate + upper wax rim Establish the incisal level, occlusal plane and palatal contour Lower Base plate + occlusal pillar and fin Base plate : Provide appropriate support Decision by muscle activity Insert the upper base plate + wax rim Support the facial muscles Allow the tongue to be positioned on the teeth and palatal contours during function Mould of lower denture by high viscous materials Tissue conditioner Modeling compound () Control the volume of the material Insert the upper base plate Insert the lower base plate Instruct the patient to perform repeated actions Swallow and sip. () Pronounce the vowels and count from 1 to 10. Smile, grin, lick and purse lips. Repeat and check. Index in the laboratory : Preserve the space of the neutral zone Plaster index Wax rim fabrication Teeth arrangement Registration of upper and lower arch Face bow transfer Wax denture try in and completion. 26 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

27 References : 1. M. J. Gahan and A. D. Walmsley. The neutral zone impression revisited. British Dental Journal 2005;198: David R. Cagna, Joseph J. Massad and Frank J. Schiesser. The neutral zone revisited : From historical concepts to modern application. The Journal of Prosthetic Dentistry 2009;101: M. J. Gahan and A. D. Walmsley. The neutral zone impression revisited. British Dental Journal 2005;198: Amit Porwal, Preet Jain, Siddesh.P.Birader, Santosh Nelogi, Naveen.H.C. Neutral Zone Approach for Rehabilitation of Severely Atrophic Ridge. International Journal of Dental Clinics volume 2 issue 3 July-September Victor E. Beresin, and Frank J. Schiesser. The neutral zone in complete dentures. The Journal of Prosthetic Dentistry, volume 95 number 2 February Q A Q neutral zone technique case neutral zone technique atrophic ridgemuscle tone tongue neutral zone technique 1. centric position moldingvd bitevdmolding 2. green compound Molding molding compoundmolding The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 27

28 A 1. wax rimlower compound rimvd VDmolding 2. neutral zone, soft linercompound.green compound, muscle tone, checkmolding finishbuccal sidemobile material(soft liner etc.)recheckcompound functionrecheck Q A Q A Q A Class IIImalocclusionlowerbuccal occlusionnormalupper upper CDupperretentionlower lower moldingbuccalupper posterior ridge lingualized occlusion cross-bite balanced occlusionocclusion balanced occlusion Monoplane occlusion cross bitestability monoplaneset uppacking edge-to-edge. 0.5 mm 28 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

29 Q A Q A neutral zone techniqueretention functional movement stable case, upper occlusal rimswallowtongue lower neutral zone 1. Upper occlusal rimtongue palateupper occlusal rim upper occlusal rim tongue upper liplower lip lower neutral zone 2. Upper occlusal rim Upper & lower occlusal rimtongue tongueupper & lower neutral zone upper CD rockingridgelower CD retention neutral zone The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 29

malignantneedy Personality disorder DSM-IV, Diagnostic and Statistical Manual of Mental Disrders,4th edition disorder DSM-IV 1. A c l u s t e r A paranoidschizoid schizotypal 2.

30 malignantneedy Personality disorder DSM-IV, Diagnostic and Statistical Manual of Mental Disrders,4th edition disorder DSM-IV 1. A c l u s t e r A paranoidschizoid schizotypal 2. B c l u s t e r B antisocialborderline narcissistic 3. C c l u s t e r C a v o i d a n c e o b s e s s i v e - compulsivedependence B 30 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

31 1. 2. The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 31

32 3. dependent-- rejecting-- manipulative-- VIP 1. once a patient, always a patient 2. avoid confrontation 3. team approach Reference Massachusetts General Hospital Handbook of General Hospital Psychiatry, 6 th edition 中華民國贋復牙科學會 /The Academy of Prosthetic Dentistry, Republic of China

33 - The influences of implant therapy in dental treatment planning 1960 () () () () 1, ,6,7,8,9 () The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 33

34 (horizontal offset) (cusp) 10 () 11 References 1. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Adell R, Lekholm U, Rockler B, Brånemark PI. Int J Oral Surg Dec;10(6): Biomaterials, biocompatibility, and peri-implant considerations. Lemons J, Natiella J. Dent Clin North Am Jan;30(1):3-23. Review 3. Long-term stability of osseointegrated implants in bone regenerated with the membrane technique. 5-year results of a prospective study with 12 implants. Buser D, Dula K, Lang NP, Nyman S. Clin Oral Implants Res Jun;7(2): Restoration-driven implant placement with restorationgenerated site development. Garber DA, Belser UC. Compend Contin Educ Dent Aug;16(8):796, , 804. Review. 5. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. Tarnow DP, Magner AW, Fletcher P. J Periodontol Dec;63(12): The effect of inter-implant distance on the height of interimplant bone crest. Tarnow DP, Cho SC, Wallace SS. J Periodontol Apr;71(4): Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, Salama M, Salama H, Garber DA. J Periodontol Dec;74(12): Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region. Choquet V, Hermans M, Adriaenssens P, Daelemans P, Tarnow DP, Malevez C. J Periodontol Oct;72(10): Current trends in implantology: part II--treatment planning, aesthetic considerations, and tissue regeneration. Saadoun AP, Le Gall MG, Touati B. Pract Proced Aesthet Dent Nov- Dec;16(10):707-14; quiz 716. Review. 10. Atlas of tooth-and implant-supported prosthodontics, Chapter 5. Reduction of implant loading via therapeutic biomechanics Lawrence A. Weinberg, DDS,MS Quintessence Timing, positioning, and sequential staging in esthetic implant therapy: a four-dimensional perspective. Funato A, Salama MA, Ishikawa T, Garber DA, Salama H. Int J Periodontics Restorative Dent Aug;27(4): 中華民國贋復牙科學會 /The Academy of Prosthetic Dentistry, Republic of China

35 (internal connection) 1,2 Semper 3,4 2. (tolerance; clearance) 2 20µm ,8,9 3. Branemark 16 Straumann 2% (Astra Tech;Dentsply Xive) Nobel Biocare Replace Select cam groove)camlog CAMLOGReplace Select 45%10 (preload) 11,12 The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 35

36 6 Biomet 3iGold-Tite0.76µm Bobel BiocareTorq-Ti () 64 (Ti6Al4V) 67(Ti6Al7N) 13 - Reference 1. Norton MR. Anin-vitroevaluationofthestrengthofaninter-nal conical interface compared to a butt joint interface in implant design. Clin Oral Implant Res 1997;8: Mollersten L, Lockowandt P, Linden LA. Comparison of strength and failure mode of seven implant systems: An in vitro test. J Prosthet Dent 1997;78: Semper W, Kraf t S, Kr üger T, Nelson K. Theoretical considerations: Implant positional index design. J Dent Res 2009;88: Semper W, Kraft S, Krüger T, Nelson K. Theoretical optimum of implant positional index design. J Dent Res 2009;88: Steinebrunner L, Wolfart S, Ludwig K, Kern M. Implantabutment interface design affects fatigue and fracture strength of implants. Clin. Oral Impl. Res. 19, 2008; Binon PP, McHugh JM. The effect of eliminating implant/ abutment rotational misfit on screw joint stability. Int J Prosthodont 1996;9: Lang LA, Sierraalta M, Hoffensperger M, Wang RF (2003). Evaluation of the precision of fit between the Procera custom abutment and various implant systems. Int J Oral Maxillofac Implants 18: Binon PP. Implants and components: entering the new millennium. Int J Oral Maxillofac Implants 2000;15: Ma T, Nicholls JI, Rubenstein JE. Tolerance measurements of various implant components. Int J Oral Maxillofac Implants 1997;12: Goodacre CJ, K an JYK, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent 1999;81: Andersson B, Ödman P, Lindvall AM, Brånemark P-I. Cemented single crowns on osseointegrated implants after 5 years: Results from a prospective study on CeraOne. Int J Prosthodont 1998;11: Martin WC, Woody RD, Miller BH, Miller AW. Implant abutment screw rotations and preloads for four different screw materials and surfaces. J Prosthet Dent 2001;86: Squier RS, Psoter WJ, Taylor TD. Removal Torques of Conical, Tapered Implant Abutments: The Effects of Anodization and Reduction of Surface Area. Int J Oral Maxillofac Implants 2002;17: 中華民國贋復牙科學會 /The Academy of Prosthetic Dentistry, Republic of China

37 a. -Ash 7th edition 6mm, 5mm, 7mm b. Rosenstiel Contemporary Fixed Prosthodontics 4th edition1mm c. Furrel effectshillingburgsorensen and Martinoffor Gutmen 1~1.5mm d. 5-1x2-1x2=3mm 3mm e. Furrel f. 3. a. Dr. Tarnow 3mm horizontal biological width b. Biological width Dr. Kan c. Papilla 1992 Dr. Tarnow 5mm The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 37

Papilla100%2003 papilla 3.4mmrang 1~7mm d. gingival fiber papillagingival fiber 1. 2011 Dr.

buccal side papilla 2. 2010 D r. K a n 0.7~1.5mm1.

38 Papilla100%2003 papilla 3.4mmrang 1~7mm d. gingival fiber papillagingival fiber Dr. Kan2~8 3. thin biotype 4. scallop Papilla 5. complication buccal side papilla 6. buccal side papilla D r. K a n 0.7~1.5mm1.1mm thin biotype () (02) prosthor@ms48.hinet.net 38 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

39 ICP"China" ICP ICPICP 2011AAP a. AAP b. () The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 39

40 3. a b. c. (facebook) 4. () 5. () a. -- b a. ::: : b. 5/7 09:30 5/7 11:30 5/28 10:30 6/4 10:30 6/11 09:30 6/11 11:30 6/18 10:30 6/25 10: c. d. 9/105/1411/5 7. : 70% 8. () ICP 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

41 1. ICP3/26 ICPICP AAP 3. PGY () 2. a. b. c. d. e /19()9:00-12:00 11/19()1:30-4:00 Dr. Wen-Chow Wu (NT6000/) The topic will involve implant dentistry and part of maxillofacial prosthodontics /11/ /20()09:00-17:00 Dr. Jean ONeal (us ) The topic will start from esthetic evaluation to esthetic treatment planning to restoration including veneers, all ceramic crowns and implant restoration in esthetic area. f. 2011AAP The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 41

42 7. a. b. 3/26 c. facebook 4. 3/26 ICP T a. 5/7 b. 5/ /26 : /29/ PGY a. (7)/ () b. / 2. 4/11: 2011AAP() 10/27-10/ Dr. Ueli Grunder 100/8/6-7 () (2) 100/6/19 () 7/9 (SJCD International) Logo 42 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

可撤式植體贋復的現代觀舉辦時間暨地點 : 1000918 250 1000925 138 7.

9/25 主持人 0900-1020 1020-1040 Coffee break 1040-1200

1510-1630 1630-1700 報名須知 1. 3000 3000 2000 4000 1. 2. 3.02-25469157 1000 2.

43 可撤式植體贋復的現代觀舉辦時間暨地點 : (100) 315 主辦單位 : 協辦單位 : 演講程序表 : 演講時間講員演講題目 9/18 主持人 9/25 主持人 Coffee break Lunch break Tea break 報名須知 The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 43

44 /3/26 neutral zone technique / 5/ 8 44 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

45 2011/ 5/ / 6/ / 6/ 11 The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 45

46 2011/ 6/ / 6/ / 6/ 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

47 ending! The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 47

ICPTaiwan, China International College of

48 ICPTaiwan, China International College of Prosthodontists (ICP) Academy of Prosthetic Dentistry, Republic of China ICP ICP97ICP 98110ICPICP Academy of Prosthetic Dentistry, Chinese Taipei ICPChinaAcademy of Prosthetic Dentistry, Taiwan, China100115ICP ICP ICP Chinese Taipei Taiwan, China 2011IJP( International Journal of ProsthosonticsICP) 2011ICP Academy of Prosthetic Dentistry, Taiwan, China ICP ICP ICP WHOTaiwan, China Taiwan, China ICP ICPICP Asian Academy of Prosthodontics(AAP)AAPICP AAPCountry/RegionsTaiwan, China Academy of Prosthetic Dentistry, Chinese TaipeiAAP 48 中華民國贋復牙科學會 / The Academy of Prosthetic Dentistry, Republic of China

1. Generalized chronic periodontitis. 2. Occlusal attrition. 3. Posterior bite collapse 4. Chronic apical periodontitis of 15, 44 Periodontal treatmen

1. Generalized chronic periodontitis. 2. Occlusal attrition. 3. Posterior bite collapse 4. Chronic apical periodontitis of 15, 44 Periodontal treatmen 1 1. 2. 3. addition silicone agar functional impression wax 56 Missing teeth of 11,12,14,18,21,22,24,25,26,27,28,34,37,38,46,47,48 Uneven occlusal plane and loss of vertical dimension Multiple occlusal