Multidisciplinary treatment in a case of loss of posterior vertical dimension
Traumatic occlusion due to anterior crossbite malocclusion, missing posterior teeth and generalized moderate chronic periodontitis were some of the problems presented by this 58-year-old patient. The problems also included high mobility of the maxillary left central incisor, high gingival recession with attachment loss and periodontal deep pockets. The loss of supporting periodontal tissue was more evident on the maxillary left central incisor which was due to the traumatic position of the tooth aggravated by a forced anterior position of the mandible and a non-adjusted crown that promoted bacterial plaque accumulation. The absence of mandibular posterior teeth also worsened the clinical situation. Orthodontic treatment was performed only on the mandibular arch and implant anchorage devices were used to accomplish lingual inclination of the mandibular incisors. The definitive prosthetic treatment allowed reestablishment of appropriate esthetics on the maxillary anterior teeth with posterior stable occlusal contacts and eliminating the occlusal trauma. This condition promoted periodontal health of the left central incisor that remained stable over a 7-year follow-up. This clinical procedure with a long-term follow-up demonstrated that multidisciplinary management including orthodontics, implants and prosthetics can improve a debilitated traumatic occlusion and a severely periodontal compromised tooth.