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Augmenting retention and stability of an occlusal device for a partially dentate patient using existing extracoronal attachments: a clinical report
Augmenting retention and stability of an occlusal device for a partially dentate patient using existing extracoronal at tachments: a clinical report Saleh A. Al-Rowaieh, DDS, MSDa Bneid Al-Qar Dental Center, Ministry of Health, Kuwait Occlusal devices are a valid treatment modality in certain clinical situations. For an occlusal device to be effective, sufficient retention and stability should be derived from coverage of the occlusal and incisal surfaces of the teeth. In the absence of most or all of the posterior teeth, the effectiveness of the device could become compromised as the incisal portions of the anterior teeth are typically not conducive to adequately retaining and stabilizing the device. This clinical report describes an approach to improving the retention and stability of an occlusal device for a patient with shortened dental arches by use of the patient’s existing extracoronal attachments. (J Prosthet Dent 2011;105:213-216)
Porcelain fracture of fixed dental restorations has been reported in several clinical studies.1-3 Goodacre et al4 reviewed the literature pertaining to clinical complications in fixed prosthodontics and showed porcelain fracture to occur in 2% to 7% of the various restorations studied. In a recent summary of occlusal concepts in fixed prosthodontics, Pokorny et al5 alluded to these findings and indicated that although Goodacre et al4 did not link occlusion directly as a causative factor, complications involving porcelain fracture in the studies reviewed may have actually been indirectly associated with occlusal or parafunctional factors. Occlusal devices have been recommended for management of patients reporting bruxism or exhibiting signs of this parafunctional habit.6,7 These devices are also advocated for patients with multiple restorations to protect against the possibility of damage to restorative materials by occlusal forces.7,8 The effectiveness of occlusal devices has been subject to controversy; however, their application has shown merit in reducing hyperactivity of the muscles of mastication in subjects with bruxism or temoporomandibular joint (TMJ) dysfunction.9-11 Although occlusal devices do not stop bruxism, they have
been found helpful in redistributing the load borne by the teeth and masticatory system.12,13 A commonly encountered clinical presentation is that of subjects with shortened dental arches (SDAs), in which most or all of the posterior teeth are missing.14 In this situation, the anterior occlusal load could increase, possibly resulting in effects similar to those occurring with distal migration of posterior teeth.15 Among these effects are occlusal wear and accelerated restorative material fatigue, the latter often resulting in ceramic fracture(s).16-18 Therefore, fabrication of a protective occlusal device for such patients may be warranted. Previously described methods of device fabrication6,19-22 produce a sufficiently retentive and stable device when multiple anterior and posterior teeth are present in the arch. This outcome, however, is less predictable with SDAs as the incisal portions of the anterior teeth are typically not conducive to adequately retaining and stabilizing the device. The purpose of this article is to describe a method for enhancing the retention and stability of an occlusal device in a patient with sleep bruxism and SDAs by use of the patient’s existing extracoronal attachments.
CLINICAL REPORT A 48-year-old woman in good general health presented with the chief complaint that she was concerned about the fractured porcelain of 2 anterior metal ceramic crowns (MCCs). Review of the patient’s dental history revealed that the patient was aware of a sleep bruxism habit, but that management of this condition had not been addressed in her past dental treatment. Clinical examination revealed that the patient had received extensive prosthodontic treatment, which included the fabrication of MCCs on all the maxillary and mandibular anterior teeth with extracoronal resilient attachments (ERA; Sterngold Dental, Attleboro, Mass) at the canines to retain maxillary and mandibular bilateral distal extension removable partial dentures. The patient was periodontally stable and exhibited good oral hygiene. The marginal adaptation of the MCCs was found to be adequate with no clinical or radiographic signs of recurrent caries. At least one point of occlusal contact existed between each opposing tooth when the mandible was manipulated into centric relation. The veneering porcelain of each restoration was intact except at the incisal aspect of the MCCs on the maxillary left and
Staff Prosthodontist, Department of Fixed Prosthodontics, Bneid Al-Qar Dental Center, Ministry of Health.
a
Al-Rowaieh
214
Volume 105 Issue 4
1 Exposure of metal framework at incisal aspect of metal ceramic crown on mandibular right canine.
mandibular right canines, where minor fractures had occurred (Fig. 1). The patient was satisfied with the esthetics of these restorations and did not express an interest in replacing them, but nevertheless was concerned about the prognosis of the anterior treatment and requested advice on preventive measures that could obviate further damage to the veneering porcelain. The patient was counseled on the possible effects of bruxism on the TMJ, teeth, and restorative materials. The idea of using a protective occlusal device during sleep was introduced and offered to the patient, who accepted the treatment plan. Difficulty was anticipated in gaining adequate retention and stability of the device if fabricated, so that it would simply be adapted to the incisal portions of the anterior teeth of either arch. A decision was made to fabricate the device on the maxillary teeth and to incorporate the ERA attachments within the device for improved retention and stability (Fig. 2). The affected porcelain incisal edges were adjusted and polished with a porcelain polishing system (Dialite; Brasseler USA, Savannah, Ga). ERA patrices were inserted onto the matrices at the maxillary canines, then impressions of the maxillary and mandibular arches were made with
2 Occlusal view of maxillary arch with ERA matrices, where sufficient retention and stability of device could be derived.
irreversible hydrocolloid impression material (Jeltrate Plus; Dentsply Intl, York, Pa) and poured in type III dental stone (Microstone; Whip Mix Corp, Louisville, Ky). Maxillary and mandibular record bases were fabricated with visible light-polymerized tray material (Triad VLC tray material; Dentsply Trubyte, York, Pa) and occlusion rims were prepared using wax (TruWax Baseplate Wax, Regular; Dentsply Intl). A centric relation record (CRR) was made using modeling plastic impression compound (Impression Compound; Kerr Corp, Orange, Calif ) and a facebow transfer record was obtained. The maxillary and mandibular casts were mounted/articulated in a semi-adjustable articulator (Model 2240; Whip Mix Corp). The occlusal vertical dimension (OVD) on the articulator was increased by 2 mm to allow for fabrication of the device. Two layers of wax (TruWax Baseplate Wax, Regular; Dentsply Intl) were adapted to the teeth and ERA attachments on the maxillary cast to develop a wax pattern of the device. The wax was applied so that it would fully encompass the ERA attachments with a uniform thickness of approximately 2 mm circumferentially. The occlusion was developed on the wax pattern to achieve multiple centric occlusal contacts and harmonious simulated mandibular excursive movements at
The Journal of Prosthetic Dentistry
the increased OVD. The wax pattern was then invested in type III dental stone (Microstone, Whip Mix Corp) and processed in heat-polymerized clear acrylic resin (Lucitone Clear Resin; Dentsply Intl) using conventional denture processing techniques.23 After recovery, the device was trimmed using an acrylic resin trimming bur (Brasseler E-Cutter H79E-050; Brasseler USA). The device was then inserted intraorally and its adaptation was evaluated using a silicone disclosing medium (Fit Checker; GC America, Inc, Alsip, Ill). Adjustment to the intaglio surface of the device was made using a No. 8 round bur (Brasseler USA) until the device was intimately adapted to the teeth. In preparation for the incorporation of the ERA patrices within the device, the spaces between the ERA matrices at the maxillary canines and the gingiva were blocked out with wax. The areas within the device that corresponded to the attachments were minimally relieved with a No. 8 round bur (Brasseler USA) to provide space for subsequent inclusion of the ERA patrices using acrylic resin. ERA fabrication patrices were inserted onto the matrices at the maxillary canines. Auto-polymerizing acrylic resin (Orthodontic Resin; Dentsply Caulk, Milford, Del) was carefully applied with a fine brush around the
Al-Rowaieh
215
April 2011
3 Intaglio surface of occlusal device after incorporation of ERA least retentive patrices.
patrices and into the intaglio surfaces of the attachment portions of the device. The device was inserted and the excess acrylic resin that extruded around the attachments was immediately eliminated using an explorer. The acrylic resin was allowed to completely polymerize as the device was stabilized by firm digital pressure to adequately engage the teeth and the ERA patrices. After assuring that satisfactory retention and stability of the device had been achieved, the occlusion was evaluated and adjusted using an acrylic resin trimming bur (Brasseler E-Cutter H79E-050; Brasseler USA) until the results obtained earlier on the articulator were met intraorally. The ERA fabrication patrices were then replaced with the least retentive ERA patrices (Fig. 3). The device was then carefully finished using dental laboratory pumice (Laboratory Pumice Med/Fine; Henry Schein, Inc, Melville, NY) and polishing compound (Acrilustre Polishing Compound; Buffalo Dental Mfg Co, Syosset, NY). Accurate placement of the device was re-verified (Fig. 4), and the patient was instructed on how to insert, remove, and clean the device.
DISCUSSION Bernhardt et al24 reported on the risk factors for high occlusal wear,
Al-Rowaieh
4 Left lateral view of occlusal device. Portions of device surrounding both attachments were finished with gradual reduction of contours toward gingiva to avoid tissue impingement.
which included bruxism and loss of molar contact. The patient described in this report both self-reported the occurrence of sleep bruxism and exhibited complete loss of posterior teeth, which possibly placed the anterior restorations at risk for damage by occlusal forces. The fabrication of a protective occlusal device was therefore recommended. The device was fabricated on the maxillary rather than the mandibular dental arch to avoid impingement on the tongue space.6,21 The use of a facebow and a CRR to articulate the casts in a semi-adjustable articulator was to assist in minimizing intraoral occlusal adjustment.22 A general examination and evaluation of the efficacy of the occlusal device should be performed at the patient’s recall appointments. If retention of the device decreases with time, the existing patrices can be easily replaced. If the matrices exhibit wear, then replacement with patrices with increased retentive values should be considered. The advantage of this technique is that it promotes retention and stability of the device, thereby enhancing its effectiveness and preventing dislodgment, aspiration and swallowing of the device during parafunction. Disadvantages of the presented technique are the additional cost due to
inclusion of the ERA patrices and the need for periodic maintenance and replacement. In the situation reported in this article, however, the benefits outweigh the disadvantages.
SUMMARY In the presence of extracoronal attachments, the method described in this article effectively increases the retention and stability of an occlusal device that is fabricated on a shortened dental arch.
REFERENCES 1. Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: length of service and reasons for replacement. J Prosthet Dent 1986;56:416-21. 2. Libby G, Arcuri MR, LaVelle WE, Hebl L. Longevity of fixed partial dentures. J Prosthet Dent 1997;78:127-31. 3. Kinsel RP, Lin D. Retrospective analysis of porcelain failures of metal ceramic crowns and fixed partial dentures supported by 729 implants in 152 patients: patientspecific and implant-specific predictors of ceramic failure. J Prosthet Dent 2009;101:388-94. 4. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications in fixed prosthodontics. J Prosthet Dent 2003;90:31-41. 5. Pokorny PH, Wiens JP, Litvak H. Occlusion for fixed prosthodontics: a historical perspective of the gnathological influence. J Prosthet Dent 2008;99:299-313. 6. Askinas SW. Fabrication of an occlusal splint. J Prosthet Dent 1972;28:549-51.
216
Volume 105 Issue 4 7. Christensen GJ. Treating bruxism and clenching. J Am Dent Assoc 2000;131:233-5. 8. Donovan TE. Factors essential for successful all-ceramic restorations. J Am Dent Assoc 2008;139:14S-18S. 9. Beard CC, Clayton JA. Effects of occlusal splint therapy on TMJ dysfunction. J Prosthet Dent 1980;44:324-35. 10.Sheikholeslam A, Holmgren K, Riise C. A clinical and electromyographic study of the long-term effects of an occlusal splint on the temporal and masseter muscles in patients with functional disorders and nocturnal bruxism. J Oral Rehabil 1986;13:137-45. 11.Hiyama S, Ono T, Ishiwata Y, Kato Y, Kuroda T. First night effect of an interocclusal appliance on nocturnal masticatory muscle activity. J Oral Rehabil 2003;30:139-45. 12.Kydd WL, Daly C. Duration of nocturnal tooth contacts during bruxing. J Prosthet Dent 1985;53:717-21.
13.Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69:293-7. 14.Käyser AF. Shortened dental arches and oral function. J Oral Rehabil 1981;8:457-62. 15.Witter DJ, van Elteren P, Käyser AF. Migration of teeth in shortened dental arches. J Oral Rehabil 1987;14:321-9. 16.Creugers NH, Käyser AF, van’t Hof MA. A meta-analysis of durability data on conventional fixed bridges. Community Dent Oral Epidemiol 1994;22:448-52. 17.Lehner C, Studer S, Brodbeck U, Schärer P. Short-term results of IPS-Empress full-porcelain crowns. J Prosthodont 1997;6:20-30. 18.Shirakura A, Lee H, Geminiani A, Ercoli C, Feng C. The influence of veneering porcelain thickness of all-ceramic and metal ceramic crowns on failure resistance after cyclic loading. J Prosthet Dent 2009;101:119-27. 19.Shulman J. A technique for bite plane construction. J Prosthet Dent 1973;29:334-9.
20.Becker CM, Kaiser DA, Lemm RB. A simplified technique for fabrication of night guards. J Prosthet Dent 1974;32:582-9. 21.Kass CA, Tregaskes JN. Occlusal splint fabrication. J Prosthet Dent 1978;40:461-3. 22.Lundeen TF. Occlusal splint fabrication. J Prosthet Dent 1979;42:588-91. 23.Zarb GA , Bolender CL. Prosthodontic treatment for edentulous patients. 12th ed. St. Louis: Elsevier; 2004. p. 392-99. 24.Bernhardt O, Gesch D, Splieth C, Schwahn C, Mack F, Kocher T, et al. Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP). Int J Prosthodont 2004;17:333-9. Corresponding author: Dr Saleh A. Al-Rowaieh PO Box 14939 Faiha 72707 KUWAIT Fax: +965-22547109 E-mail: [email protected] Copyright © 2011 by the Editorial Council for The Journal of Prosthetic Dentistry.
Access to The Journal of Prosthetic Dentistry Online is reserved for print subscribers! Full-text access to The Journal of Prosthetic Dentistry Online is available for all print subscribers. To activate your individual online subscription, please visit The Journal of Prosthetic Dentistry Online. Point your browser to http://www.journals. elsevierhealth.com/periodicals/ympr/home, follow the prompts to activate online access here, and follow the instructions. To activate your account, you will need your subscriber account number, which you can find on your mailing label (note: the number of digits in your subscriber account number varies from 6 to 10). See the example below in which the subscriber account number has been circled. Sample mailing label
This is your subscription account number
*********AUTO**SCH 3-DIGIT 001 1 V97-3 J010 12345678-9 J. H. DOE 531 MAIN ST CENTER CITY, NY 10001-001
Personal subscriptions to The Journal of Prosthetic Dentistry Online are for individual use only and may not be transferred. Use of The Journal of Prosthetic Dentistry Online is subject to agreement to the terms and conditions as indicated online.
The Journal of Prosthetic Dentistry
Al-Rowaieh
Porcelain fracture of fixed dental restorations has been reported in several clinical studies.1-3 Goodacre et al4 reviewed the literature pertaining to clinical complications in fixed prosthodontics and showed porcelain fracture to occur in 2% to 7% of the various restorations studied. In a recent summary of occlusal concepts in fixed prosthodontics, Pokorny et al5 alluded to these findings and indicated that although Goodacre et al4 did not link occlusion directly as a causative factor, complications involving porcelain fracture in the studies reviewed may have actually been indirectly associated with occlusal or parafunctional factors. Occlusal devices have been recommended for management of patients reporting bruxism or exhibiting signs of this parafunctional habit.6,7 These devices are also advocated for patients with multiple restorations to protect against the possibility of damage to restorative materials by occlusal forces.7,8 The effectiveness of occlusal devices has been subject to controversy; however, their application has shown merit in reducing hyperactivity of the muscles of mastication in subjects with bruxism or temoporomandibular joint (TMJ) dysfunction.9-11 Although occlusal devices do not stop bruxism, they have
been found helpful in redistributing the load borne by the teeth and masticatory system.12,13 A commonly encountered clinical presentation is that of subjects with shortened dental arches (SDAs), in which most or all of the posterior teeth are missing.14 In this situation, the anterior occlusal load could increase, possibly resulting in effects similar to those occurring with distal migration of posterior teeth.15 Among these effects are occlusal wear and accelerated restorative material fatigue, the latter often resulting in ceramic fracture(s).16-18 Therefore, fabrication of a protective occlusal device for such patients may be warranted. Previously described methods of device fabrication6,19-22 produce a sufficiently retentive and stable device when multiple anterior and posterior teeth are present in the arch. This outcome, however, is less predictable with SDAs as the incisal portions of the anterior teeth are typically not conducive to adequately retaining and stabilizing the device. The purpose of this article is to describe a method for enhancing the retention and stability of an occlusal device in a patient with sleep bruxism and SDAs by use of the patient’s existing extracoronal attachments.
CLINICAL REPORT A 48-year-old woman in good general health presented with the chief complaint that she was concerned about the fractured porcelain of 2 anterior metal ceramic crowns (MCCs). Review of the patient’s dental history revealed that the patient was aware of a sleep bruxism habit, but that management of this condition had not been addressed in her past dental treatment. Clinical examination revealed that the patient had received extensive prosthodontic treatment, which included the fabrication of MCCs on all the maxillary and mandibular anterior teeth with extracoronal resilient attachments (ERA; Sterngold Dental, Attleboro, Mass) at the canines to retain maxillary and mandibular bilateral distal extension removable partial dentures. The patient was periodontally stable and exhibited good oral hygiene. The marginal adaptation of the MCCs was found to be adequate with no clinical or radiographic signs of recurrent caries. At least one point of occlusal contact existed between each opposing tooth when the mandible was manipulated into centric relation. The veneering porcelain of each restoration was intact except at the incisal aspect of the MCCs on the maxillary left and
Staff Prosthodontist, Department of Fixed Prosthodontics, Bneid Al-Qar Dental Center, Ministry of Health.
a
Al-Rowaieh
214
Volume 105 Issue 4
1 Exposure of metal framework at incisal aspect of metal ceramic crown on mandibular right canine.
mandibular right canines, where minor fractures had occurred (Fig. 1). The patient was satisfied with the esthetics of these restorations and did not express an interest in replacing them, but nevertheless was concerned about the prognosis of the anterior treatment and requested advice on preventive measures that could obviate further damage to the veneering porcelain. The patient was counseled on the possible effects of bruxism on the TMJ, teeth, and restorative materials. The idea of using a protective occlusal device during sleep was introduced and offered to the patient, who accepted the treatment plan. Difficulty was anticipated in gaining adequate retention and stability of the device if fabricated, so that it would simply be adapted to the incisal portions of the anterior teeth of either arch. A decision was made to fabricate the device on the maxillary teeth and to incorporate the ERA attachments within the device for improved retention and stability (Fig. 2). The affected porcelain incisal edges were adjusted and polished with a porcelain polishing system (Dialite; Brasseler USA, Savannah, Ga). ERA patrices were inserted onto the matrices at the maxillary canines, then impressions of the maxillary and mandibular arches were made with
2 Occlusal view of maxillary arch with ERA matrices, where sufficient retention and stability of device could be derived.
irreversible hydrocolloid impression material (Jeltrate Plus; Dentsply Intl, York, Pa) and poured in type III dental stone (Microstone; Whip Mix Corp, Louisville, Ky). Maxillary and mandibular record bases were fabricated with visible light-polymerized tray material (Triad VLC tray material; Dentsply Trubyte, York, Pa) and occlusion rims were prepared using wax (TruWax Baseplate Wax, Regular; Dentsply Intl). A centric relation record (CRR) was made using modeling plastic impression compound (Impression Compound; Kerr Corp, Orange, Calif ) and a facebow transfer record was obtained. The maxillary and mandibular casts were mounted/articulated in a semi-adjustable articulator (Model 2240; Whip Mix Corp). The occlusal vertical dimension (OVD) on the articulator was increased by 2 mm to allow for fabrication of the device. Two layers of wax (TruWax Baseplate Wax, Regular; Dentsply Intl) were adapted to the teeth and ERA attachments on the maxillary cast to develop a wax pattern of the device. The wax was applied so that it would fully encompass the ERA attachments with a uniform thickness of approximately 2 mm circumferentially. The occlusion was developed on the wax pattern to achieve multiple centric occlusal contacts and harmonious simulated mandibular excursive movements at
The Journal of Prosthetic Dentistry
the increased OVD. The wax pattern was then invested in type III dental stone (Microstone, Whip Mix Corp) and processed in heat-polymerized clear acrylic resin (Lucitone Clear Resin; Dentsply Intl) using conventional denture processing techniques.23 After recovery, the device was trimmed using an acrylic resin trimming bur (Brasseler E-Cutter H79E-050; Brasseler USA). The device was then inserted intraorally and its adaptation was evaluated using a silicone disclosing medium (Fit Checker; GC America, Inc, Alsip, Ill). Adjustment to the intaglio surface of the device was made using a No. 8 round bur (Brasseler USA) until the device was intimately adapted to the teeth. In preparation for the incorporation of the ERA patrices within the device, the spaces between the ERA matrices at the maxillary canines and the gingiva were blocked out with wax. The areas within the device that corresponded to the attachments were minimally relieved with a No. 8 round bur (Brasseler USA) to provide space for subsequent inclusion of the ERA patrices using acrylic resin. ERA fabrication patrices were inserted onto the matrices at the maxillary canines. Auto-polymerizing acrylic resin (Orthodontic Resin; Dentsply Caulk, Milford, Del) was carefully applied with a fine brush around the
Al-Rowaieh
215
April 2011
3 Intaglio surface of occlusal device after incorporation of ERA least retentive patrices.
patrices and into the intaglio surfaces of the attachment portions of the device. The device was inserted and the excess acrylic resin that extruded around the attachments was immediately eliminated using an explorer. The acrylic resin was allowed to completely polymerize as the device was stabilized by firm digital pressure to adequately engage the teeth and the ERA patrices. After assuring that satisfactory retention and stability of the device had been achieved, the occlusion was evaluated and adjusted using an acrylic resin trimming bur (Brasseler E-Cutter H79E-050; Brasseler USA) until the results obtained earlier on the articulator were met intraorally. The ERA fabrication patrices were then replaced with the least retentive ERA patrices (Fig. 3). The device was then carefully finished using dental laboratory pumice (Laboratory Pumice Med/Fine; Henry Schein, Inc, Melville, NY) and polishing compound (Acrilustre Polishing Compound; Buffalo Dental Mfg Co, Syosset, NY). Accurate placement of the device was re-verified (Fig. 4), and the patient was instructed on how to insert, remove, and clean the device.
DISCUSSION Bernhardt et al24 reported on the risk factors for high occlusal wear,
Al-Rowaieh
4 Left lateral view of occlusal device. Portions of device surrounding both attachments were finished with gradual reduction of contours toward gingiva to avoid tissue impingement.
which included bruxism and loss of molar contact. The patient described in this report both self-reported the occurrence of sleep bruxism and exhibited complete loss of posterior teeth, which possibly placed the anterior restorations at risk for damage by occlusal forces. The fabrication of a protective occlusal device was therefore recommended. The device was fabricated on the maxillary rather than the mandibular dental arch to avoid impingement on the tongue space.6,21 The use of a facebow and a CRR to articulate the casts in a semi-adjustable articulator was to assist in minimizing intraoral occlusal adjustment.22 A general examination and evaluation of the efficacy of the occlusal device should be performed at the patient’s recall appointments. If retention of the device decreases with time, the existing patrices can be easily replaced. If the matrices exhibit wear, then replacement with patrices with increased retentive values should be considered. The advantage of this technique is that it promotes retention and stability of the device, thereby enhancing its effectiveness and preventing dislodgment, aspiration and swallowing of the device during parafunction. Disadvantages of the presented technique are the additional cost due to
inclusion of the ERA patrices and the need for periodic maintenance and replacement. In the situation reported in this article, however, the benefits outweigh the disadvantages.
SUMMARY In the presence of extracoronal attachments, the method described in this article effectively increases the retention and stability of an occlusal device that is fabricated on a shortened dental arch.
REFERENCES 1. Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: length of service and reasons for replacement. J Prosthet Dent 1986;56:416-21. 2. Libby G, Arcuri MR, LaVelle WE, Hebl L. Longevity of fixed partial dentures. J Prosthet Dent 1997;78:127-31. 3. Kinsel RP, Lin D. Retrospective analysis of porcelain failures of metal ceramic crowns and fixed partial dentures supported by 729 implants in 152 patients: patientspecific and implant-specific predictors of ceramic failure. J Prosthet Dent 2009;101:388-94. 4. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications in fixed prosthodontics. J Prosthet Dent 2003;90:31-41. 5. Pokorny PH, Wiens JP, Litvak H. Occlusion for fixed prosthodontics: a historical perspective of the gnathological influence. J Prosthet Dent 2008;99:299-313. 6. Askinas SW. Fabrication of an occlusal splint. J Prosthet Dent 1972;28:549-51.
216
Volume 105 Issue 4 7. Christensen GJ. Treating bruxism and clenching. J Am Dent Assoc 2000;131:233-5. 8. Donovan TE. Factors essential for successful all-ceramic restorations. J Am Dent Assoc 2008;139:14S-18S. 9. Beard CC, Clayton JA. Effects of occlusal splint therapy on TMJ dysfunction. J Prosthet Dent 1980;44:324-35. 10.Sheikholeslam A, Holmgren K, Riise C. A clinical and electromyographic study of the long-term effects of an occlusal splint on the temporal and masseter muscles in patients with functional disorders and nocturnal bruxism. J Oral Rehabil 1986;13:137-45. 11.Hiyama S, Ono T, Ishiwata Y, Kato Y, Kuroda T. First night effect of an interocclusal appliance on nocturnal masticatory muscle activity. J Oral Rehabil 2003;30:139-45. 12.Kydd WL, Daly C. Duration of nocturnal tooth contacts during bruxing. J Prosthet Dent 1985;53:717-21.
13.Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69:293-7. 14.Käyser AF. Shortened dental arches and oral function. J Oral Rehabil 1981;8:457-62. 15.Witter DJ, van Elteren P, Käyser AF. Migration of teeth in shortened dental arches. J Oral Rehabil 1987;14:321-9. 16.Creugers NH, Käyser AF, van’t Hof MA. A meta-analysis of durability data on conventional fixed bridges. Community Dent Oral Epidemiol 1994;22:448-52. 17.Lehner C, Studer S, Brodbeck U, Schärer P. Short-term results of IPS-Empress full-porcelain crowns. J Prosthodont 1997;6:20-30. 18.Shirakura A, Lee H, Geminiani A, Ercoli C, Feng C. The influence of veneering porcelain thickness of all-ceramic and metal ceramic crowns on failure resistance after cyclic loading. J Prosthet Dent 2009;101:119-27. 19.Shulman J. A technique for bite plane construction. J Prosthet Dent 1973;29:334-9.
20.Becker CM, Kaiser DA, Lemm RB. A simplified technique for fabrication of night guards. J Prosthet Dent 1974;32:582-9. 21.Kass CA, Tregaskes JN. Occlusal splint fabrication. J Prosthet Dent 1978;40:461-3. 22.Lundeen TF. Occlusal splint fabrication. J Prosthet Dent 1979;42:588-91. 23.Zarb GA , Bolender CL. Prosthodontic treatment for edentulous patients. 12th ed. St. Louis: Elsevier; 2004. p. 392-99. 24.Bernhardt O, Gesch D, Splieth C, Schwahn C, Mack F, Kocher T, et al. Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP). Int J Prosthodont 2004;17:333-9. Corresponding author: Dr Saleh A. Al-Rowaieh PO Box 14939 Faiha 72707 KUWAIT Fax: +965-22547109 E-mail: [email protected] Copyright © 2011 by the Editorial Council for The Journal of Prosthetic Dentistry.
Access to The Journal of Prosthetic Dentistry Online is reserved for print subscribers! Full-text access to The Journal of Prosthetic Dentistry Online is available for all print subscribers. To activate your individual online subscription, please visit The Journal of Prosthetic Dentistry Online. Point your browser to http://www.journals. elsevierhealth.com/periodicals/ympr/home, follow the prompts to activate online access here, and follow the instructions. To activate your account, you will need your subscriber account number, which you can find on your mailing label (note: the number of digits in your subscriber account number varies from 6 to 10). See the example below in which the subscriber account number has been circled. Sample mailing label
This is your subscription account number
*********AUTO**SCH 3-DIGIT 001 1 V97-3 J010 12345678-9 J. H. DOE 531 MAIN ST CENTER CITY, NY 10001-001
Personal subscriptions to The Journal of Prosthetic Dentistry Online are for individual use only and may not be transferred. Use of The Journal of Prosthetic Dentistry Online is subject to agreement to the terms and conditions as indicated online.
The Journal of Prosthetic Dentistry
Al-Rowaieh