Hello

This patient was presented to me (See photos below). His main concern was at the time that some teeth needed crowns. The endodontist said that during endo there was pain in the upper front teeth (12-22).

When I first saw the patient I understood that this is a warn dentition case. I started examining the patient. He had no problems with jaw joints and muscles. There were some changes in the oclusion (wear, overeruption etc).

I made 2 treatment plans. One had ortho in it other was to raise the bite (upper anterior and lower posterior). Patient didn't want ortho so he chose the other option.

In that period of time he fractured tooth 27 (it was a rootcanal treated tooth). Also 38, 48 were extracted.

First I made a splint (Duralon). Then I raised the bite 13-33 (12-22 temp crowns; 13, 23, 34-37, 44-47 with composite bildups). I also made a relaxation splint (hard).

Everything was ok for 2 weeks. Then he started to have supracontacts on teeth 15, 13 and also pain (because of the overload). Every time I removed the contacts, after a week they were back. Then I noticed that the patient is chewing only with the right side. I asked to try to chew with the left side. The pain moved to the left side also and supracontact on 23. I don't know what to do. When the splint is in the mouth he feels ok. But he refuses to wear the splint in daytime (because af work). When I check the bite it looks ok (anterior guidance). But every little supracontact develops to pain. When I remove it, pain goes away. I cant adjust the bite for ever. Why doesn't it stabilize?

All the comments are welcome. And critics also.

Regards,

Martin

ps. Sorry for my english. I't is not my everyday language :)

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