PMC6349957_01
Pre-operative frontal view shows edentulous maxillary ridge with healing multiple extraction socket in anterior region.
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The maxillary edentulous ridge revealed recent extraction sockets with sutures in place (Fig. 1A, Fig. 1B). On the mandibular arch, all teeth were present except for 38, 45, 47 and 48 (Fig. 1C). There were multiple amalgam restorations on the posterior teeth and severe attrition on the anterior teeth (Fig. 1A, Fig. 1B, Fig. 1C).
Pre-treatment maxillary occlusal view.
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After cooling, the occlusal template was removed from the vacuum former and trimmed into a horseshoe shape of suitable size to fit the average dental arch (see Figs. 2A and 2B).
Pre-treatment mandibular occlusal view.
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The step by step mock grinding was performed on the primary cast with the help of the OPT by alternately keeping it onto the cast and trimming premature contacts with the sandpaper until the OPT touches the 4 identified teeth cusp-tips (Fig. 3A). Once the premature contacts were ground-off, the incisal edges of the mandibular anteriors were built-up with inlay casting wax (Mighty Wax Hard; Shofu Inc.) with the OPT as a guide to create the occlusal plane (Fig. 3B).
Fabrication of stone-form with copying curvature of volleyball.
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Putty impression (Exaflex; GC Corp.) of the wax-up was taken and cusps which require selective grinding were marked on the cast (Fig. 4A). Putty guide was placed lingually as shown in Figs. 4B and 4C.
Stone-form in thermoplastic vacuum formed machine to adapt template.
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The OPT was placed intra-orally and any interfering cusps or incisal edges were visualized and trimmed accordingly (Fig. 5A). All restored teeth were occlusally refined using fine grit diamond point inclined lingually as shown in Fig. 5B until the OPT touches to almost all cusp tips and incisal edges.
OPT ready to diagnose occlusal discrepancies.
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Maxillary primary impression, final impression, maxilla-mandibular relationship records (Fig. 6), teeth arrangement and try in was carried out in a conventional manner.
Diagnostic wax-up with use of OPT.
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A harmonious balanced occlusion was achieved (Fig. 7).
Putty impression as index for composite restorations intra-orally.
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The patient was pleased with her function and aesthetics being restored (Fig. 8A, Fig. 8B).