Abstract

Dr. Guido Fichera: The adult patient with compromised dentition and secondary malocclusion: orthodontic considerations and interdisciplinary treatment 

The adult patient often presents an oral condition characterized by compromised dentition and secondary malocclusion.

According to the Prosthetic Diagnostic Index of the American College of Prosthodontists and the recent classification of periodontal disease by the European Federation of Periodontology, the clinical diagnostic parameters that define the degree of oral impairment and the consequent treatment problems are:

- location and number of lost teeth

-status of structural loss and periodontal involvement of the residual teeth,

- tissue condition of the edentulous ridges

- severity of primary and/or secondary malocclusion.

Secondary malocclusion can be defined as the malocclusion resulting from the morphological alteration and dento-alveolar compensation due to dental wear (attrition, erosion, abrasion) and to pathological migrations from periodontal disease and loss of teeth.

The simultaneous presence of edentulous ridges with different degrees of atrophy, a diminuished number of teeth, the loss of periodontal support and the compromised structural condition of the residual teeth leads to specific clinical considerations in comparison to primary malocclusion in the evaluation, diagnosis and orthodontic and interdisciplinary treatment.

The bruxism habitus can further complicate the management of oral rehabilitation due to the presence of highly detrimental forces, in particular when parts or the whole occlusal table are made up of artificial restorative-prosthetic materials.

In the context of the interdisciplinary approach that aims to correct secondary malocclusion, the additive composite restorations of the occlusal surface of worn teeth, the use of "full crown restorations" for elements with extensive loss of tooth substance , the use of implants to replace lost teeth and the adjunctive or comprehensive orthodontic treatment are the main corrective measures to be integrated in a strategic way according to reproducible and tested work protocols.

In addition to an adequate engineering management of the rehabilitation plan, the occlusal design performs a fundamental function for the ability to modulate the control of forces at the level of the different restorative, prosthetic and implant interfaces.

The purpose of the course is to present specific considerations about the diagnostic process, the planning of the occlusal design and the clinical strategies that can help to manage and success in ortho-perio-restorative-implant treatment of interdisciplinary complex cases with structurally compromised teeth, secondary malocclusions and force control problems, according to the principle of maximum therapeutic efficacy at the lower biological cost.