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Den-Mat Guest Editorial: A Conservative Approach to Restoring Anterior Guidance By: David Ouellet, DDS

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The patient came to my office with a desire to improve his smile. His dental exam and history revealed a Class II overbite (Fig. 1) with a night grinding problem that resulted in sleeplessness and headaches. Per Dr. Gelb’s and Dr. Sphal’s philosophies, the treatment plan required mandibular repositioning and vertical opening to decompress the posterior TMJ space. A simple way to accomplish this was to fabricate a fixed appliance to hold open his bite. Inter-arch, orthodontic elastics were used to supra-erupt his posterior teeth (Fig. 2a). A reverse anterior maxillary incline plane was used to reposition his mandible forward to achieve a better anterior incisal position (Figs. 2b–f). Wearing this Ricanator with a reverse incline plane for one year stabilized his bite, and his frequent headaches and TMD symptoms were corrected. The vertical was opened 4mm and his centric occlusion is much improved forward toward a Class I (Fig. 3).

The remaining restorative (anterior guidance) and esthetic changes were accomplished with little to no tooth reduction and no anesthetic with Cerinate® Porcelain Veneers (Fig. 4). The only preparation done was the removal of the old composites on teeth 8 and 9 and a slight labial reduction of lower teeth to create an inter-arch space for the veneers. It is important to note the severe wear on the anterior teeth before the treatment (Figs. 2b–f).

Cerinate Porcelain Veneers Nos. 4–13 and 22–27 were bonded with Tenure® Uni-Bond® A & B and Ultra-Bond® (Figs. 5a, 5b, 5c). The beauty of this procedure was the restorative goal achieved, in a conservative manner, to restore proper occlusion and eliminate related symptoms.

Patient’s comments, “…I now smile with pride. I am completely satisfied with the experience and results. My headaches are gone and I no longer grind my teeth. The procedure was painless and not at all uncomfortable. I am glad it did not involve surgery and would recommend it to anyone in a similar situation.”

David Ouellet, DDS, is a native of Boston and graduate of Georgetown University Dental School. He has conducted clinical research for placement and evaluation of composite resin and is a consultant for Den-Mat Corp. David has published numerous clinical and research oriented papers and is an accredited member of the American Academy of Cosmetic Dentistry. David is in private practice, where he specializes in adhesive cosmetic dentistry. He has conducted lectures and hands-on workshops on aesthetic materials and techniques throughout the United States and overseas. You can contact Dr. Ouellet at drO123@aol.com or (805) 925-8767.

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