Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options

During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO.

Invasive cervical resorption: etiology, diagnosis, classification and treatment

BACKGROUND

Invasive cervical resorption (ICR) is not well understood by the professional, being misdiagnosed, leading to inappropriate treatment and unnecessary loss of tooth.

INTRODUCTION

ICR is defined as a localized process of resorption, which begins in the cervical area of the tooth, just below the epithelial junction and above the ridge crest in the area of the connective tissue insertion. Possible predisposing factors include external trauma, orthodontic movement, surgical procedures, periodontal disease and its treatments, endogenous bleaching, pressure generated by wind instruments and herpes virus infection. Different approaches have been suggested for the treatment of ICR, depending on the extent of the lesion and its location. However, in some cases due to the severity of the injury, there is no alternative but to tooth extraction, followed by restoration of the edentulous area.

AIM AND OBJECTIVE

Discuss etiology, diagnosis and classification of the ICR, as well as different treatment options. Also is presented a case in which extraction was carried out, installation of the implant and ceramic crown, subsequent to a treatment approach that resulted in failure in the short-term period.

CONCLUSION

Early diagnosis of the ICR is critical to proper treatment and favorable prognosis. Interdisciplinary treatment should be instituted as soon as possible, avoiding the loss of the affected tooth. In advanced cases, treatment involving the installation of osseointegrated implants should be considered the first choice of treatment.

CLINICAL SIGNIFICANCE

Early diagnosis of the ICR is critical do prevent unnecessary tooth loss, once the prognosis for advanced cases is doubtful.