Randomised controlled trial on testing an increased vertical dimension of occlusion prior to restorative treatment of tooth wear

Abstract

Background: Evaluation of a new vertical dimension of occlusion (VDO) in complex restorative treatments is considered a necessary step prior to placement of restorations.Objectives: This randomised controlled trial (RCT) aimed to assess the effects of using an evaluation of a VDO increase before restorative treatment in patients with moderate-to-severe tooth wear, on OHRQoL, freeway space (FWS) and interventions to restorations.Methods: Forty-two patients with tooth wear were included and randomly allocated to either a test phase with a Removable Appliance (RA) or no test phase. Restorative treatment consisted of restoration of all teeth using composite restorations in an increased VDO. OHIP-score, freeway space (FWS) and clinical acceptability of restorations were assessed at baseline and at recall appointments (1 month and 1 year).Intervention to restoration was scored in case of material chipping or when the abutment tooth had increased sensitivity that could be linked to occlusal overloading.ANCOVA analyses, Univariate Cox regression, t-tests and descriptive analyses were performed (p < .05).Results: Clinical follow-up after 1 year was completed for 41 patients. No significant effect of testing the VDO with a RA could be found on the OHIP-score (p = .14).Reduction of FWS in the RA group, compared to the control group, was significantly lower at 1 year (p = .01, 95% CI −1.09 to −0.15). No effect on early interventions to restorations was found (p = .94). Conclusion:This RCT showed that a removable appliance is not indicated to functionally test the increased VDO prior to restorative treatment in patients with tooth wear.

Predictive modelling of freeway space utilising clinical history, normalised muscle activity, dental occlusion, and mandibular movement analysis

“…Constricted mandibular range of motion can compromise freeway space, limiting the resting position and impacting occlusal stability and patient comfort. In cases of inadequate bimaxillary clearance, unstable unilateral chewing dynamics may result 33 . Explainability analyses indicated that AI performed better when considering phonetic expression, clenching muscle activity, and TMJ vibrations during lateral and anterior protrusion.…”

“…Persistent clenching and bruxism, leading to occlusal changes, tooth wear, and muscle tension, have an important influence on the vertical dimension at rest 33 . Some of these parafunctional habits are more prevalent in younger patients and often necessitate orthodontic intervention 35 .…”