"This 29 year-old male patient has been in my practice since the age of 12 and is congenitally missing a substantial number of teeth. Over the years, he had been referred to a number of Orthodontists, Prosthodontists and Oral Surgeons all of whom diagnosed treatments with very guarded prognosis. The idea of restoring this patient "Metal-free" seemed impossible but the patient wanted to try.

The first step was placing the patient on "TENS" equipment to determine his optimal neuromuscular bite position. It was decided to open his VDO 8 mm. His maxillary arch was prepped and temporized with custom temporaries in January 2001. Ovoid pontic sites were also created using a laser. All preparations were kept supragingival. At the same time, the unprepped lower arch was temporized with Luxatemp to create the planned occlusion and vertical dimension opening.

The patient tolerated the change in VDO very well without adverse symptoms. The final maxillary restorations (IPS Empress I with Vectris reinforcement) were placed one month later. Temporary prostheses will continue to be employed on the lower arch for an additional month at which time final IPS Empress restorations will be placed."

- Dr. Orin Harker

Figure 1 Worn centrals over closed congenitally missing laterals and bicuspids. Patient is Class III occlusion.   Figure 2 1:1 Before Preparation.   Figure 3 Before preparation. Occlusal view.               Figure 4 Preparation of six teeth. Front view.   Figure 5 Preparation of six teeth. Occlusal view.   Figure 6 Upper temporaries in place. Lower composite build up to stabilize occlusion until patient ready to finish lowers with IPS Empress crowns and veneers. Front view.               Figure 7 Lower dentition. Occlusal view before restoration.   Figure 8 Lower dentition. Occlusal composite build up to stabilize occlusion.   Figure 9 1:1 Final IPS Empress I/Vectris reinforced restorations.               Figure 10 Full smile with upper temporary in place.   Figure 11 Full smile with upper IPS Empress I/Vectris reinforced bridges.   Figure 12 Occlusal view. Inserted IPS Empress I/Vectris reinforced bridges 1.1 to 1.3; 2.1 to 2.3; 1.6 single crown and 2.6 single crown.               Figure 13 Close up of upper IPS Empress I/Vectris reinforced bridges.   Figure 14 Full face before restoration. Note: overclosed rounded face with Class III occlusion.   Figure 15 Full face after restoration. Note how the slight overbite/overjet opened the bite and improved appearance. Patient extremely happy.                 Figure 16 Profile before restoration. Note the forward protrusion of the chin.   Figure 17 Profile after restoration. Note the normal profile and position of chin after opening bite.

Dr. Orin Harker graduated from the University of Alberta in 1979,recently celebrating 20 years of providing General Family Dentistry in Calgary, Alberta. He is a graduate of the Advanced Anterior Course, Occlusion Course and the Masters program at the Las Vegas Institute for Advanced Dental Studies.