Restorative space part 3
Restorative space - horizontal components
Lack of restorative space can be managed by crown lengthening with/without (endo, Post and core , crowns), increasing OVD, orthodontics /orthognathic surgery
It is important to evaluate the occlusal vertical dimension before starting to plan for surgery or giving the options to the patient.
Patient may not be able to adapt to the increased of OVD; there are some contraindications for some major surgeries.
When the increase of OVD is not possible, consider other options like crown lengthening, orthodontic treatment, orthognathic surgery, etc in dentate patient; bone reduction in edentulous patient.
Abduo and Lyons (2012) Clinical considerations for increasing OVD: a review
- OVD for dentate – mainly determined by remaining dentition – loss of tooth structure
- Consequences of increasing OVD: hyperactivity of masticatory muscles, elevation in occlusal forces, bruxism and TMDs; symptoms may be transitory
- Original OVD for dentate can be preserved by dentoalveolar compensatory action – extrusion of worn teeth
- Increasing OVD should be determined on basis of dental restorative needs + esthetic demands
- Minimal increase in OVD should be applied, 5mm max increase in OVD justified to provide adequate occlusal space for restorative material and to improve anterior esthetics
- Should increase OVD with fixed vs removable appliance for predictable pt adaptation
- Increase OVD with TMD patients with removable appliances to control TMD symptoms
Vertical components of restorative space ( Inter-arch Distance)
Already been discussed in previous posts
Horizontal components of restorative space
Inter-implant Distance
The distance between adjacent implants within the same arch.
- 1.5 mm between natural tooth and implant
- 3.0 mm between implants
Ridge Width
Crest of ridge width in a facial-lingual or buccal-lingual direction.
Space Requirements:
1-2 mm gap between the implant and buccal bone in anterior, 1mm posterior
Tongue space, cheek and lips support should be consider as an important horizontal restorative space especially with removable prostheses
