by Dr. John Nosti
In most dramatic alterations in occlusion – such as taking a patient from Class III to Class I – you should be concerned with how this can inherently lead to fracture. The patient may seem stable in temporaries, but it’s one of those situations where you should err on the side of caution.
Protect Patients Who Have Their Anterior Segments Changed From Class III to Cass I – Occlusal Jump
There are many contributing factors to ceramic porcelain fracture as a result of anterior segment restorations.
Primarily, you have the unsupported porcelain placed at the incisal edge over existing teeth. This preparation poses a risk during the restoration.
If the occlusal jump is 4mm or more and the overbite is 2mm or greater, there isn’t really a question of using a protective appliance. You’re looking at an increase in bite force at maximum intercuspation that can pose frustrating consequences if not dealt with properly.
This kind of occlusal change usually requires increasing vertical dimension. When you combine all of these factors, you face the inevitable outcome.
These are vast changes. Get ahead of the game by anticipating a patient’s likelihood to experience fracture.
As this is the final post in my ceramic porcelain fracture series, I hope you’ve achieved a greater understanding of how to deal with the preventable and protect patients. A predictable result is the primary goal when working to limit the percentage of fracture in your office.
Read the first five guidelines in Dr. Nosti’s ceramic porcelain fracture series. He discusses the best approach to occlusion for preventing fractures, why you must evaluate a patient’s past tendency to broken temporaries, protecting patients were anterior guidance is not achievable, dentistry in general, and the warning sign of an increasing diastema.