ArticlePDF Available

A Simplified Method to Identify Patient Face Type for a Prosthodontic Treatment Plan

Authors:

Abstract and Figures

Objective: To describe the clinical, radiographic and instrumental procedures that enable easy recognition of brachyfacial patients, both edentulous and with teeth. Materials and methods: Through the use of different diagnostic exams (clinical, radiographic and cephalometric) the anatomical and clinical characteristics that distinguish brachyfacial individuals have been described in a way that even a general dentist can recognize them and implement the most appropriate prosthetic or implant therapy. Results: We feel that the described diagnostic exams are easy to apply and enable the general dentist - and not just the orthodontic specialist – to recognize patients with a high occlusal load. Conclusions: Our aim is to provide a diagnostic protocol that simply and safely makes it possible to recognize brachyfacial individuals and easily implement an orthodontic therapy that can limit possible damage caused by excessive bite forces.
Content may be subject to copyright.
Journal of Dental Health, Oral Disorders & Therapy


 | http://medcraveonline.com
 
to overload as individuals who present parafunctions [12-14].
However, patients with parafunctions do not necessarily present
load forces intense enough to cause damage to the periodontal
 
       
       
        
complications [15]. Considering the face form of the patient in
        
          
        
       

   
of the present study is to provide a diagnostic protocol that easily
       
   
        

Clinical Report
 
the strongest individual that the dentist can encounter and can
 
      
cephalometric.

         
         
patient presents a short lower face third, voluminous and tonic

        
          
see a reduced nose-chin distance, developed masseter muscles,
         

          
     
            



    
    
 



        


     
   
anatomical aspects even prior to performing actual cephalometric

         
        

      
          
       
(Figure 4 & 5).

1Department of Prosthodontics, University of Catania, Italy
2Department of Maxillo Facial Surgery, University of Rome,
Italy
3Private practice, Italy
*Corresponding author: Luca Ortensi, Department
of Prosthodontics, University of Catania, Via De

 
| 
Clinical Report

Introduction
 

         
stress- related complications. Biomechanical stress intensity
is directly related to force applied [1-3]. Many clinical studies


   
aspects crucial for the planning and prognosis of prosthetic
         
developed masticatory musculature, smaller anterior facial height
           
 
a longer anterior and shorter posterior facial height (long face)
   
      

          
Citation:

 2/5
Copyright:
©2017 Ortensi et al.
  Brachyfacial patient (front view): short lower face third,

       

   

  Latero-lateral X-ray showing the tangent drawn at the
        

Citation:

 3/5
Copyright:
©2017 Ortensi et al.


       
many authors have suggested measuring the various angles in
 

            
        
orthodontic diagnosis. Below the most important points and


Gonion (Go) and the menton (me) is the angle that expresses the
   
    
      
       
   

  

          
   
      
 
higher values, indicate a dolichofacial individual   
21]. Visually, the more the two lines tend towards parallelism,
         
musculature and reduced vertical dimension, thus identifying it
        


        

      
        
 
  
        
method to implement is that of measuring the gonial angle on the
latero-lateral X-ray, since the value of the angle is independent of

      


latero-lateral X-ray.

Citation:

 4/5
Copyright:
©2017 Ortensi et al.

Discussion
      
         
proven muscular force expressed during chewing cycles that
      
         
vastly applied in orthodontics with a change of therapeutic
        
       
particular for prosthodontics and implantology, this did not occur




their effects will vary depending on the type of patient suffering
 
his/her teeth will apply to the dentition – whether natural or
   
  
individual the parafunction is an aggravating circumstance of the
          
       
of the patient’s face into account, similarly to other diagnostic
elements when planning a more or less complex therapy.
         
       
 
        
    
  
 
of the cephalometric test proposed, with the mere purpose of


Conclusion
     
   
  




to measure the gonial angle on the latero-lateral X-ray.
Citation:

 5/5
Copyright:
©2017 Ortensi et al.
  
easily implementing an odontological therapy - in particular
        

needed to validate this promising protocol.
Acknowledgment
 
in preparing this manuscript.
Conict of Interest
None.
References
1.     
        


2. 
        

3.         

4.     
          

5. 

6. 
force measurements: a literature review. Eur J Dent 4(2): 223-232.
   

8. 


           
Histochemical study of the masseter muscle in patients with vertical

            
       
       

11.           

with different vertical cranio-facial morphology. Eur J Oral Sci
111(3): 183-188.
12.       
therapy and prosthodontic treatment in the management of
      

13.          
causes and its effects on dental implants–an updated review. J Oral

14.         

15.           
       

16.     
      

          


18. 

 

          

21.        
        
424.
22.             
       
      


23. 

       

24. 

... This x-ray examination enables the study of the hard and soft tissues of the patient's face; in particular, the relationship between the maxilla as well as the spatial position of the upper central incisor and the philtrum. It is also possible to identify the musculoskeletal classification with an appropriate and simple cephalometric analysis [17]. The study of the patient's latero-lateral radiography highlighted meso-facial musculoskeletal typology with reduced occlusal risk. ...
Article
Full-text available
The purpose of this article is to show how to implement an implant-supported prosthetic overdenture using a digital workflow. Esthetic previewing using a specific software, guided-surgery, construction of the prosthesis, and the esthetic finalization are described in this article. Patients suffering from severe loss of bone and soft tissue volume could benefit from the construction of an overdenture prosthesis as a feasible therapeutic choice for functional and esthetic issues of the patient.
Article
Full-text available
Introduction The determination of physiologic rest position of the mandible to the maxillae is of paramount importance in almost all fields of dentistry. The stability of vertical dimension at rest has been controversial if the rest position of mandible remains constant throughout life or not. Despite of several studies on the rest position of the mandible and facial vertical dimension, certain fundamental disagreements remain unresolved. The present study aims to compare the vertical dimension at rest, before and after extraction and after rehabilitation with complete denture. Material & methods This study was conducted in a total of ten randomly selected patients, who had some natural teeth present with one or more opposing posterior teeth with vertical occlusal stops but were advised for extraction because of poor prognosis. Digital lateral cephalograms were done and measurements recorded at three stages: prior to extraction of remaining natural teeth, post extraction and after complete denture rehabilitation. Results Vertical dimension at rest was found to be greatest in post rehabilitation followed by pre-extraction than post extraction state. The differences in changes were found to be statistically significant. Conclusion Vertical dimension at rest shows a decrease following extraction of natural teeth, the occlusal stops, and an increase on rehabilitation. It can be stated that vertical dimension at rest is not stable position and varies following extraction of natural teeth and rehabilitation.
Article
Full-text available
Maximum bite force is a useful indicator of the functional state of the masticatory system and the loading of the teeth, and its recordings can be performed in a relatively simple way in the clinic. However, because maximum bite-force levels vary with method, sex and age, it is important that the measurements are compared against the appropriate reference values. The level of bite force is a result of the combined action of the jaw elevator muscles modified by jaw biomechanics and reflex mechanisms. Pain limits the maximum bite force and may thus impede the measurements, but this factor may also be useful in treatment control. The maximum bite force increases with the number of teeth present. The number of occlusal tooth contacts is an important determinant for the maximally attainable bite force, explaining about 10% to 20% of the variation. The association between maximum bite force and the amount of occlusal contact is closest in the posterior region, and as a consequence, loss of molar support results in reduction of force. In contrast, malocclusions defined solely on the basis of molar and canine relationships have less influence on the level of bite force.
Article
Full-text available
Maximum voluntary bite force is an indicator of the functional state of the masticatory system and the level of maximum bite force results from the combined action of the jaw elevator muscles modified by jaw biomechanics and reflex mechanisms. The measurement of bite force can provide useful data for the evaluation of jaw muscle function and activity. It is also an adjunctive value in assessing the performance of dentures. Technological advances in signal detection and processing have improved the quality of the information extracted from bite force measurements. However, these measurements are difficult and the reliability of the result depends on a number of factors, such as presence of pain and temporomandibular disorders, gender, age, cranio-facial morphology, and occlusal factors. In addition to these physiological factors, recording devices and techniques are important factors in bite force measurement. Therefore, one should be careful when comparing the bite force values reported in the research.
Article
In thirty patients (24 women and 6 men) treated because of dysfunction of the masticatory system at the department of Stomatognathic Physiology, University of Gothenburg, bite force was registered before, during and after treatment had been completed. In the controls, thirty‐six dental students and trainee dental nurses, with no dysfunction of the masticatory system, bite force was registered on two occasions. Bite force was measured between the first molars on each side and between the central incisors. Also finger force was registered. The force measurements were made at five different levels, increasing from very weak to maximum force. Repeated tests of bite force in the control group, made at intervals of about 1 week, gave almost identical results. Bite force in the patient group was lower than in the control group at the first registration but increased with palliation of the symptoms during treatment. There was no significant difference in bite force between the affected and the unaffected side.
Article
I felt a need for a restatement of the objectives of so-called cephalometric analysis. The semantics of terms were discussed to familiarize the reader with survey, analysis, and synthesis as applied in this study.One thousand cases were studied in an effort to establish a knowledge of the most common orthodontic problems and the variation of more infrequently occurring problems.A system of five measurements from x-ray tracings was designed to provide a sensible method of informing the orthodontist of facial form and denture position. The five measurements were (1) the facial angle, (2) the XY axis angle, (3) the measure of contour, and (4 and 5) the relationship of the upper and lower incisors to the APo plane.These angles and measurements proved to be indicators of facial depth, facial height, and profile contour. Classification by assigning numerical limits of the denominators for chin location made for an easier and more informative communication of problems. Thus, the cephalometric x-ray was shown to provide a description, a comparison, a classification, and a communication of existing conditions. Certain classifications were thus proposed for future semantic purposes.The teeth were measured from the denture bases rather than to points outside the dental areas. The position of the lower incisor in relation to the APo plane was thought to be the key to communication of the problems with the anterior teeth. Thus, a line from point A to pogonion was described as the denture plane.Age changes in position of the lower incisor, facial contour, and lip relations were studied from a cross-sectional viewpoint. The average convexity decreased consistently from the deciduous dentition age to the full adult dentition age. At the same time, the lips became progressively more retracted in relation to the esthetic plane. However, the relationship of the lower incisor to the APo plane tended to be similar in the age samples studied.A system for deep structural analysis was proposed for those cases in which more detailed information is desired. This included the length and angulation of the cranial base, the location of the glenoid fossa and the condyle head, the angulation of the condyle neck to the cranial base, and the mandibular plane angle. The analysis of the nasopharynx was also employed in cases with cleft palate, speech, or breathing problems or other problems near the coronal suture complex area.I stressed the need for the concept that a survey or analysis was for the purpose of describing and understanding skeletal proportion and form. Treatment planning constitutes a separate subject embodying the factors of growth, tooth movement, and changes in function. That subject—cephalometric synthesis—should be dealt with separately.
Article
Occlusal and incisal tooth wear were evaluated for the purpose of assessing their prevalence, severity and distribution in a selected Swedish high-wear patient sample and in a young adult Saudi non-patient population. Furthermore, an attempt was made to investigate, by means of a questionnaire and a clinical examination, the association of various factors with wear; any observed associations were further analyzed with reference to possible cause and effect relationships. The scales used for evaluating the severity and the progression of wear provided high inter- and intra-observer concordances. The results revealed a high wear experience in the Saudi population compared to Western equivalents. Dietary, para-functional, anamnestic, occlusal and salivary factors exhibited certain correlations with wear. Progression of tooth wear was shown to be a slow process in the Swedish sample. The common element of a harsh desert terrain in the Saudi sample may constitute the dominant passive abrasive etiological factor in this population. While progression of wear seems to be of a "linear" nature in the Saudi population, it is postulated that wear in Western populations may, in addition to a "linear" deterioration, occur in "bursts", coinciding with the presence of certain causative factors. The results from this study also indicate that the effects of excessive function, including that of wear, on certain dentoalveolar morphological features are similar in modern man and his ancestors. On the basis of the findings, not only is the multifactorial etiology of occlusal tooth wear a reality, but so too is the complex interdependence of these factors in the prevalence, severity, distribution and progression of wear.