PROSTHODONTICS-Clinical Cases in Prosthodontics, 1ed (2011)

Case 36

235

Case 36

Management of cleidocranial dysplasia I—treatment of
an adolescent patient

CASE STORY Figure 4: Maxillary occlusal view.
A 17-year-old male patient presents with a chief
complaint of “I don’t like the way my teeth look,
and I would like to have a nice smile.” The
patient is accompanied by his mother (see Case
37) and has been diagnosed with cleidocranial
dysplasia (CCD). The patient has received only
palliative and emergency care for his dental
condition and no formal management plan has
been pursued for the treatment of CCD.

Figure 5: Mandibular occlusal view.

Figures 1, 2, and 3: Right, left, and maximum LEARNING GOALS AND OBJECTIVES
intercuspation. „ To recognize signs of CCD
„ To discuss treatment approaches for a young
Clinical Cases in Prosthodontics, Leila Jahangiri, Marjan Moghadam,
Mijin Choi, and Michael Ferguson, © 2011 Blackwell Publishing Ltd. patient with CCD
236 Clinical Cases in Prosthodontics „ To understand the advantages and

disadvantages of various treatment options
„ To manage CCD dental treatment with a

multidisciplinary approach

Medical History CLEIDOCRANIAL DYSPLASIA I
• Cleidocranial dysplasia • Supernumerary teeth
• Poor anterior aesthetics
Dental History • Plaque accumulation
• Palliative treatment including extraction of mobile • Deficiency in speech
Radiographic Findings
primary teeth
Figure 6: Panoramic radiograph.
Medications and Allergies
• No medications Charting
• No known drug allergies (See Fig. 7.)
Diagnosis
Review of Systems • Cleidocranial dysplasia
• Vital signs: • Deficient aesthetics

᭺ Blood pressure: 120/78
᭺ Heart rate: 70 beats/minute
᭺ Respiration rate: 16 breaths/minute

Significant Soft Tissue Examination Findings
• No significant findings

Significant Clinical Findings/Problem List
• Anterior open bite
• Bilateral posterior cross-bite
• Underdeveloped maxilla, class III malocclusion
• Retention of primary teeth

Figure 7: Dental charting of erupted teeth.

Clinical Cases in Prosthodontics 237

CASE 36 bonded attachments are placed to facilitate the
eruption and alignment of the permanent incisors.
Clinical Decision-Making Determining Factors • During the second stage of this approach, which
occurs during the dental age of 10–11, the remaining
• Cleidocranial dysplasia (CCD) is an autosomal deciduous and supernumerary teeth are removed.
dominant condition that is genetically inherited. The The unerupted premolars and canines are exposed
patient presented here has inherited this condition and brought into proper position by forced eruption.
from his mother (see Case 37). The genetic The posterior teeth provide anchorage during stage
condition affects bone growth, often causing aplasia one, and the anterior teeth as well as the first
(defective development) or hypoplasia (incomplete or molars provide anchorage during stage two (Becker,
underdevelopment) of bones undergoing Lustmann et al. 1997; Becker, Shteyer et al. 1997).
intramembranous ossification. The general • Other approaches to treatment of patients with CCD
appearance of a person presenting with CCD is include the Toronto-Melbourne approach and the
typically frontal, parietal, and occipital bossing; Belfast-Hamburg approach. In the former approach,
underdevelopment of the maxilla; and a the deciduous teeth are initially removed and
brachycephalic appearance of the skull. The clavicles exposure of unerupted permanent teeth is delayed
are among the bones commonly affected by this until after the permanent first molars have
condition (Gonzalez Lopez, Ortiz Solalinde et al. spontaneously erupted. This approach requires
2004; Angle and Rebellato 2005; Bratu 2005), several small surgeries. In the latter approach, all
surgery is limited to one session where all
• Dental findings in patients with CCD may include deciduous and supernumerary teeth are removed
class III jaw relationship, underdeveloped maxilla, and all permanent teeth are exposed and allowed to
overretention of deciduous teeth, failure or delayed erupt either spontaneously or with the aid of
eruption of permanent teeth, multiple supernumerary orthodontic appliances (Becker, Lustmann et al.
teeth, and cyst formation. Because dental 1997; Becker, Shteyer et al. 1997).
complications have a direct effect on the patient’s • Early intervention is key in management of patients
quality of life, CCD patients are often in extensive with cleidocranial dysplasia. Our patient was unable
dental treatment that includes multiple disciplines to receive the care he needed at the more typical
(Golan, Baumert et al. 2004; Angle and Rebellato age of 10–12. He presented for treatment at the age
2005; Bratu 2005). of 17. As the patient ages, the success rate of
treatment can decrease. Some factors that
• Typical treatment of patients with CCD involves a contribute to the decrease in predictability in
combination of oral surgery and orthodontics treatment outcomes with increased age include
followed by prosthetic treatment as needed. There obstruction by advanced development of
are several approaches to the staging of the surgical supernumerary teeth, increased displacement of
and orthodontic treatments. One of the most permanent teeth, poor root development of
common approaches, known as the Jerusalem permanent teeth, ankylosis of teeth that require
approach, requires the removal of deciduous and movement, and the closure of the apices of teeth
supernumerary teeth and active eruption of the requiring active eruption (Jensen and Kreiborg 1990).
permanent dentition. More specifically, during the
first stage of treatment, which occurs typically
around the dental age of 7–8, the anterior deciduous
teeth and supernumerary teeth are surgically
removed. The permanent incisors are exposed and

238 Clinical Cases in Prosthodontics

CLEIDOCRANIAL DYSPLASIA I

Questions

1. Cleidocranial dysplasia is 5. A staged orthodontics treatment approach is
A. A congenital disorder one in which the anterior permanent dentition is
B. An acquired disorder guided into proper occlusion and followed by the
C. A disorder affecting the elderly posterior permanent dentition. According to
D. A disorder affecting only the oral/dental Daskalogiannakis et al., what is the main advan-
tage of a two-stage approach to the treatment of
structures patients with cleidocranial dysplasia?

2. Management of CCD involves a multidisciplinary A. Shortened treatment time
approach due to complexity of the patient presen-
tation. Team members usually include the ortho- B. Ability to maintain the patient’s existing occlusal
dontist, oral and maxillofacial surgeon, and the vertical dimension
restorative dentist. At what point should the
restorative dentist become involved in treatment C. Ability to avoid maxillofacial surgery
of these patients?
A. From the outset because the restorative D. There is no advantage to this treatment
modality versus the others.
treatment plan can help guide surgical and
orthodontic treatment 6. The RUNX2 gene on the short arm of chromo-
B. After the first series of extractions where the some 6 had been found to be the master gene in
permanent dentition is exposed the formation of bone and dental tissues. It is a
C. After the completion of the surgical and defect on this gene that causes cleidocranial
orthodontic phases dysplasia. How can this information be used in the
D. There is usually no need for restorative treatment of patients suffering from cleidocranial
treatment if the surgical and orthodontic phases dysplasia?
are executed properly.
A. Genetic testing is not needed because
3. Dental features of cleidocranial dysplasia include manifestation of signs are early enough that
all of the following except they do not evade diagnosis.
A. Cyst formation of unerupted teeth
B. Retention of deciduous teeth B. Genetic testing should be reserved for patients
C. Missing secondary dentition with a familial history of cleidocranial dysplasia.
D. Delayed eruption of secondary dentition
C. Genetic diagnosis of these patients can lead to
4. The physical features of cleidocranial dysplasia early detection and early intervention.
include all of the following except
A. Missing clavicles D. Genetic testing is too invasive: the risks do not
B. Tall and lanky stature outweigh the benefits.
C. Frontal bossing
D. Underdeveloped maxilla 7. Early intervention in management of patients
with cleidocranial dysplasia is key. Which of the
following is the reason for this?

A. The patient will not remember the trauma of the
surgical procedures.

B. Due to incomplete growth of facial bones,
treatment outcomes are more favorable.

C. Lack of closure of tooth apices allows for more
successful active eruption.

D. All of the above

Clinical Cases in Prosthodontics 239

CASE 36

8. In patients with CCD, the deciduous dentition
often requires extraction followed by orthodontic
intervention for active eruption of permanent
dentition into occlusion. Why is this necessary?
A. Removal of deciduous teeth does not

necessarily lead to eruption of permanent
dentition in CCD patients.
B. To ensure proper bone formation after eruption
of permanent dentition is achieved
C. To ensure proper alignment of the permanent
dentition after extraction of the deciduous
dentition
D. To ensure development of soft tissues
surrounding the permanent teeth

5. B (Daskalogiannakis, Piedade et al. 2006) ANSWERS
6. C (Golan, Baumert et al. 2003) 1. A (Angle and Rebellato 2005)
7. C (Jensen and Kreiborg 1990) 2. A (Angle and Rebellato 2005)
8. A (Angle and Rebellato 2005) 3. C (Angle and Rebellato 2005)
4. B (Daskalogiannakis, Piedade et al. 2006)

The authors would like to acknowledge and thank Dr. Bratu, D. P. (2005). “Oral Manifestation in Cleidocranial
Tonino Ciocca and Dr. Mohammad Alavi for clinical Dysplasia.” TMJ 55(4): 379–385.
case photographs taken at New York University
College of Dentistry. Daskalogiannakis, J., L. Piedade et al. (2006). “Cleidocranial
dysplasia: 2 generations of management.” J Can Dent
References Assoc 72(4): 337–342.

Angle, A. D. and J. Rebellato (2005). “Dental team Golan, I., U. Baumert et al. (2003). “Dentomaxillofacial
management for a patient with cleidocranial dysostosis.” variability of cleidocranial dysplasia: clinicoradiological
Am J Orthod Dentofacial Orthop 128(1): 110–117. presentation and systematic review.” Dentomaxillofac
Radiol 32(6): 347–354.
Becker, A., J. Lustmann et al. (1997). “Cleidocranial
dysplasia: Part 1—General principles of the orthodontic and Golan, I., U. Baumert et al. (2004). “Early craniofacial
surgical treatment modality.” Am J Orthod Dentofacial signs of cleidocranial dysplasia.” Int J Paediatr Dent
Orthop 111(1): 28–33. 14(1): 49–53.

Becker, A., A. Shteyer et al. (1997). “Cleidocranial dysplasia: Gonzalez Lopez, B. S., C. Ortiz Solalinde et al. (2004).
Part 2—Treatment protocol for the orthodontic and surgical “Cleido cranial dysplasia: report of a family.” J Oral Sci
modality.” Am J Orthod Dentofacial Orthop 111(2): 46(4): 259–266.
173–183.
Jensen, B. L. and S. Kreiborg (1990). “Development of the
dentition in cleidocranial dysplasia.” J Oral Pathol Med
19(2): 89–93.

240 Clinical Cases in Prosthodontics

Case 37

241

Case 37

Management of cleidocranial dysplasia II—
treatment of an adult patient

CASE STORY Figure 5: Maxillary occlusal view.
A 49-year-old female patient presents with a chief
complaint of “I want to be able to smile without
feeling self-conscious.” The patient is diagnosed
with cleidocranial dysplasia (CCD). Her dental
treatment has typically involved extraction of
mobile or carious teeth and replacement of
missing teeth with removable prostheses. See
Case 36 for presentation of this patient’s son.

Figure 6: Mandibular occlusal view.

Figures 1, 2, and 3: Right, left, and maximum LEARNING GOALS AND OBJECTIVES
intercuspation. „ To recognize signs of cleidocranial dysplasia

(CCD)
„ To discuss treatment approaches for an adult

patient with CCD
„ To understand the advantages and

disadvantages of various treatment options
„ To manage CCD dental treatment with a

multidisciplinary approach

Figure 4: Panoramic radiograph. Medical History
• Cleidocranial dysplasia
Clinical Cases in Prosthodontics, Leila Jahangiri, Marjan Moghadam,
Mijin Choi, and Michael Ferguson, © 2011 Blackwell Publishing Ltd. Dental History
242 Clinical Cases in Prosthodontics • Extraction of mobile or nonrestorable teeth
• Endodontic therapy of mandibular left canine
• Removable partial dentures
• Full coverage metal-ceramic restorations

Medications and Allergies CLEIDOCRANIAL DYSPLASIA II
• Birth control pills
• No known drug allergies Diagnosis
• Cleidocranial dysplasia
Review of Systems • Partial edentulism
• Vital signs: • Periradicular periodontitis
• Anterior and posterior cross articulation
᭺ Blood pressure: 122/80 • Localized severe periodontal disease
᭺ Heart rate: 72 beats/minute
᭺ Respiration rate: 16 breaths/minute Clinical Decision-Making Determining Factors
• Cleidocranial dysplasia (cleido refers to the collar
Soft Tissue Examination Findings
• No significant findings bone, cranial refers to the head, and dysplasia refers
to abnormal forming) is an autosomal dominant
Charting condition that is often genetically inherited. The
(See Fig. 7.) patient presented in this case story did not inherit
the condition from either parent. It is reported that
Significant Clinical Findings/Problem List of all cleidocranial dysplasia cases, the majority are
• Partial edentulism genetically inherited, but up to one-third can be
• Reverse articulation—left posterior spontaneous genetic mutations. This patient has
• Reverse articulation—anterior, involving maxillary also passed CCD on to her son (see Case 36). It is
transmitted as an autosomal dominant trait. CCD is
right lateral incisor (7) caused by mutation in the runX2 gene on
• Periodontal disease, including but not limited to chromosome 6p21. The genetic condition affects
bone growth, often causing aplasia (defective
furcation involvement of maxillary primary left and development) or hypoplasia (incomplete or
right second molars (A and J) underdevelopment) of bones undergoing
• Class II mobility of mandibular right first intramembranous ossification. The general
molar (30) appearance of a person presenting with CCD is
• Periapical pathology and pain of mandibular left frontal, parietal, and occipital bossing;
canine (22) underdevelopment of the maxilla; and a
brachycephalic appearance of the skull. The clavicles

2A 78 9 J 14
30 T 18
27 26 25 24 23 22

Figure 7: Dental charting.

Clinical Cases in Prosthodontics 243

CASE 37 replacement of missing teeth with removable or
implant prostheses (Jensen and Kreiborg 1990).
are among the bones commonly affected by this • The patient presented here did not have access to
condition (Gonzalez Lopez, Ortiz Solalinde et al. proper medical care at an early age and was not
2004; Angle and Rebellato 2005; Bratu 2005). diagnosed with CCD until her midtwenties. The
• Dental problems are typically the most significant treatment that she received was geared toward
problems in CCD patients and may include class III management of emergencies via extractions and
jaw relationship, underdeveloped maxilla, endodontic therapy rather than a more
overretention of deciduous teeth, delayed eruption comprehensive treatment plan. The patient was
of permanent teeth, failure of eruption of permanent unable to receive this type of treatment at the more
dentition, multiple supernumerary teeth, and cyst typical age of 10–12 years. She presents for
formation. Because dental complications have a treatment at the age of 49. The patient’s age
direct effect on their quality of life, CCD patients are presents a great challenge in treatment planning and
often involved in extensive dental treatment that management. There is a paucity of evidence and
includes multiple disciplines (Golan, Baumert et al. sufficient number of case reports with data on
2004; Angle and Rebellato 2005; Bratu 2005). treatment of these patients with osseointegrated
• Typical treatment of patients with CCD involves an implants. The limitations with implant options
aggressive combination of oral surgery and include presence of unerupted teeth in the
orthodontics followed by prosthetic treatment as underlying bone, as well as osseointegration
needed, starting at a young age before the complete outcome with aplastic and hypoplastic alveolar bone
development of the roots of permanent teeth (See (Petropoulos, Balshi et al. 2004).
Case 36). Treatment of adult patients typically
involves restoration of defective teeth and

Questions 3. If early access to comprehensive treatment is
limited, the patient with CCD usually receives
1. What is the greatest challenge to orthodontic palliative dental care typically consisting of extrac-
treatment of an adult patient with CCD? tion of mobile or carious teeth. The most detrimen-
A. Lack of adequate number of teeth for anchorage tal result of receiving only palliative treatment can
B. Poor quality of bone leading to periodontal be

disease in adulthood A. Psychological strain for the CCD patient
C. Poor quality of bone leading to increased rate of
B. Supraeruption of impacted teeth
tooth mobility
D. High caries rate leading to tooth loss C. Fewer treatment options due to loss of key
abutment teeth
2. One of the most significant challenges involved
with treatment of an adult patient with CCD is D. Continued growth of the mandible leading to
A. Inadequate/delayed healing due to worsening of prognathism in the adult

the CCD condition with age
B. Poor bone quality leading to failure of abutment

teeth used for fixed or removable prostheses
C. Adult onset chronic periodontal disease
D. Difficult recovery after extensive surgical

procedures

244 Clinical Cases in Prosthodontics

CLEIDOCRANIAL DYSPLASIA II

4. After consultation with different dental disci- 6. The use of dental implants may be controversial
plines and considering the difficulties of extracting for CCD patients because
the mandibular right premolars (28 and 29), the
treatment plan for the patient’s mandibular arch A. Permanent teeth may be difficult to extract due
includes extraction of right first molar (30) due to to malformed teeth.
hopeless periodontal prognosis. Considering the
patient’s age and the condition of the remaining B. Permanent teeth may be difficult to extract due
teeth, what type of prosthesis is recommended for to their deep unerupted positions.
replacement of the missing teeth in the mandible?
C. Extraction of teeth may lead to inadequate bony
A. Implant placement in the mandibular left region ridges for implant placement.
and provision of an implant-retained removable
partial denture D. All of the above

B. Conventional fixed partial dentures

C. Removal of mandibular teeth and fabrication of
implant-retained fixed partial dentures

D. Removable complete denture after extraction of
all remaining teeth

5. The treatment plan for the patient’s maxillary
arch has been determined with the input of the
periodontist. It is determined that all of the
remaining maxillary teeth will be maintained. The
prosthetic treatment plan includes a removable
partial denture. What is the prime concern about
fabrication of the removable partial denture for this
patient?

A. High caries risk of the remaining abutment teeth

B. Long-term prognosis of remaining abutment
teeth

C. Eruption of the impacted supernumerary under
pressure of the removable partial denture

D. Intrusion of abutment teeth due to poor quality
of supporting bone

4. A (Butterworth 1999) ANSWERS
5. B (Stewart, Rudd et al. 1983) 1. A (Kuroda, Yanagita et al. 2007)
6. D (The National Craniofacial Association) 2. D (Angle and Rebellato 2005)
3. C (Butterworth 1999)

Clinical Cases in Prosthodontics 245

CASE 37

The authors would like to acknowledge and thank Dr. Gonzalez Lopez, B. S., C. Ortiz Solalinde et al. (2004).
Tonino Ciocca and Dr. Mohammad Alavi for clinical “Cleido cranial dysplasia: report of a family.” J Oral Sci
case photographs and treatment performed at New 46(4): 259–266.
York University College of Dentistry.
Jensen, B. L. and S. Kreiborg (1990). “Development of the
References dentition in cleidocranial dysplasia.” J Oral Pathol Med
19(2): 89–93.
Angle, A. D. and J. Rebellato (2005). “Dental team
management for a patient with cleidocranial dysostosis.” Kuroda, S., T. Yanagita et al. (2007). “Titanium screw
Am J Orthod Dentofacial Orthop 128(1): 110–117. anchorage for traction of many impacted teeth in a patient
with cleidocranial dysplasia.” Am J Orthod Dentofacial
Bratu, D. P. (2005). “Oral manifestation in cleidocranial Orthop 131(5): 666–669.
dysplasia.” TMJ 55(4): 379–385.
Petropoulos, V. C., T. J. Balshi et al. (2004). “Treatment of a
Butterworth, C. (1999). “Cleidocranial dysplasia: modern patient with cleidocranial dysplasia using osseointegrated
concepts of treatment and a report of an orthodontic implants: a patient report.” Int J Oral Maxillofac Implants
resistant case requiring a restorative solution.” Dent 19(2): 282–287.
Update 26(10): 458–462.
Stewart, K. L., K. D. Rudd et al. (1983). Clinical removable
Golan, I., U. Baumert et al. (2004). “Early craniofacial signs of partial prosthodontics. St. Louis, Mosby.
cleidocranial dysplasia.” Int J Paediatr Dent 14(1): 49–53.
The National Craniofacial Association: http://www.faces-
cranio.org/Disord/CCD.htm

246 Clinical Cases in Prosthodontics

Index

Page numbers followed by f denote photographs. significant soft tissue findings, 93
social history, 93
A partial coverage restorations (case 15), 98–102
Abrasion, tooth wear from, 139 answers, 102
Abutment tooth, crown-to-root ratio for, 169 case story, 98, 98f, 99f
Acquiring information, 4–6 clinical decision-making determining factors,
The Aesthetic Zone, 87
American College of Prosthodontists (ACP), 29 99–100
American Dental Association clinical findings/problem list, 99
dental history, 99
Center for Evidence-Based Dentistry, 5, 6 diagnosis, 99
on clinical recommendations, 4 learning goals and objectives, 99
on Evidence-Based Practice, 3 medical history, 99
on systematic review, 4 medications and allergies, 99
AMSTAR, 6 photographs
Ankylosis of teeth in cleidocranial dysplasia, 238
Anterior-posterior spread, 187 central and lateral incisors after removal of
Anterior teeth rehabilitation existing restorations, 98f
combination of complete and partial coverage
final restorations, 99f
restorations (case 14), 92–96 lingual view of prepared teeth, 99f
answers, 95 preparations, 99f
case story, 92, 92f pretreatment, central and lateral incisors,
clinical decision-making determining factors,
98f
93 pretreatment maxillary occlusal view, 98f
clinical findings/problem list, 93 pretreatment presentation, 98f
dental history, 93 questions, 100–101
diagnosis, 93 review of systems, 99
learning goals and objectives, 93 significant extraoral findings, 99
medical history, 93 significant soft tissue findings, 99
medications and allergies, 93 social history, 99
photographs requiring orthodontic extrusion (case 16),

final restorations, 92f 104–107
pretreatment front view, 92f answers, 107
pretreatment incisal display, 92f case story, 104, 104f
tooth preparation competed: lateral incisors clinical decision-making determining factors,

for PLV, central incisors for full-coverage 105
crowns, 92f dental history, 104
questions, 94–95 diagnosis, 105
review of systems, 93 learning goals and objectives, 104
significant extraoral findings, 93 medical history, 104
medications and allergies, 104

247

INDEX Caries
in chronic methamphetamine users, 232
photographs plaque buildup and, 225
orthodontic treatment, 104f as sequela to xerostomia, 169
posttreatment presentation, 104f
pretreatment presentation, 104f CASP (Critical Appraisal Skills Programme), 6
CBVT (cone beam volumetric tomography), 193
questions, 106–107 CCD. See Cleidocranial dysplasia (CCD)
review of systems, 104 Cementable fixed prostheses, implant-supported
significant clinical findings/problem list, 105
significant soft tissue examination findings, 105 (case 31), 206–210
social history, 104 Center for Evidence-Based Dentistry, American Dental
Application of knowledge, 6
Appraisal of evidence/information, 6 Association, 5, 6
Asking the “right” question, 3–4 Central incisor. See Fractured central incisor
Assessment, 6 Centre for Evidence-Based Dentistry, 6
Attrition, tooth wear and, 139, 148 Ceramic crown

B combination of complete and partial coverage
Belfast-Hamburg approach, to cleidocranial dysplasia restorations (case 14), 92–96

treatment, 238 for fractured central incisor, 86–88
Biomechanical characteristics of natural tooth, 213 shade selection and color matching, 88
Bleaching, 87–88 Cleidocranial dysplasia (CCD)
Bone grafts, for residual ridge enhancement, 30 inheritance of, 238, 243
Bone loss, with tooth-implant connected prostheses, treatment of an adolescent patient (case 36),

213, 214 236–240
Bone type classification, 17 answers, 240
Bulimia (case 34), 224–228 case story, 236, 236f
charting, 237f
answers, 228 clinical decision-making determining factors,
case story, 224, 224f
charting, 225f 238
clinical decision-making determining factors-226, 225 dental history, 237
clinical findings/problem list, 224–225 diagnosis, 237
diagnosis, 225 learning goals and objectives, 236
learning goals and objectives, 224 medical history, 237
medical history, 224 medications and allergies, 237
medications and allergies, 224 photographs
photographs
mandibular occlusal, 236f
full mouth radiographs, 226f maxillary occlusal, 236f
panoramic radiograph, 226f right, left, and maximum intercuspation), 236f
preop left side, 224f questions, 239–240
preop presentation, 224f radiographic findings, 237f
preop right side, 224f review of systems, 237
questions, 226–228 significant soft tissue examination findings, 237
radiographic findings, 226f treatment of an adult patient (case 37), 242–246
social history, 224 answers, 245
case story, 242, 242f
C charting, 243f
Candidiasis, 24, 126 clinical decision-making determining factors,
Canine transposition. See Maxillary canine
243–244
transposition (case 18) dental history, 242–243
Cantilever length, 187 diagnosis, 243
Cardiovascular disease, association with periodontal learning goals and objectives, 242
medical history, 242
disease, 169 medications and allergies, 243

248 Clinical Cases in Prosthodontics

photographs INDEX
mandibular occlusal, 242f
maxillary occlusal, 242f preop maxilla, 110f
panoramic radiograph, 242f preop presentation, 110f
right, left, and maximum intercuspation, 242f preop right side, 110f
questions, 113–114
questions, 244–245 radiographic findings, 112f
review of systems, 243 review of systems, 111
significant clinical findings/problem list, 243 significant intraoral examination findings, 111
significant soft tissue examination findings, 243 Crown. See Ceramic crown
Clinical recommendation, ADA position on, 4 Crown height, increasing, 105
Cochrane Library, 5 Crown-to-root ratio for abutment tooth, 169
Cohort studies, 5, 5f CT (computed tomography), 193
Color matching
for ceramic crowns, 88 D
for porcelain laminate veneer (PLV), 75, 81, 88 Dentures
Combination syndrome, patient with (case 3), 22–26
answers, 26 conventional complete denture prostheses (case 1),
case story, 22, 22f 10–14
charting, 23f
clinical decision-making determining factors, 23–24 implant-retained removable partial denture prosthesis
clinical findings/problem list, 23 (case 6), 40–44
dental history, 23
diagnosis, 23 implant-supported fixed complete denture
learning goals and objectives, 23 prostheses (case 27), 180–183
medical history, 23
medications and allergies, 23 overdenture
photographs ectodermal dysplasia (case 8), 54–58
final artificial tooth arrangement and try-in, 22f edentulous patient with two-implant-retained
preop, 22f mandibular overdenture (case 2), 16–20
preop maxilla, 22f
questions, 24–25 10-year probability of survival for fixed partial
review of systems, 23 dentures, 148
significant soft tissue examination findings, 23
social history, 23 Discoloration, reasons for, 87
syndrome characteristics, 24 “Dowel Dilemma,” application of PICO format to, 4,
Computed tomography (CT), 193
Cone beam volumetric tomography (CBVT), 193 5–6
Critical Appraisal Skills Programme (CASP), 6 Dry mouth, 126, 230, 232
Crowding, multidisciplinary approach to severe
E
(case 17), 110–115 EBP. See Evidence-Based Practice (EBP)
answers, 114 Ectodermal dysplasia (ED)
case story, 110, 110f
charting, 111, 111f hypohidrotic, 55
clinical decision-making determining factors, 112 implant-retained removable prostheses (case 9),
clinical findings/problem list, 111
diagnosis, 112 60–64
learning goals and objectives, 111 answers, 64
medical history, 111 case story, 60, 60f–61f
photographs clinical decision-making determining factors,

preop left side, 110f 61–62, 62f
preop mandible, 110f clinical findings/problem list, 61
dental history, 61
diagnosis, 61
learning goals and objectives, 61
medical history, 61
photographs

computerized tomography, 61f
front view, 60f
implants placed in the mandible, 62f
mandibular arch during treatment, 62f

Clinical Cases in Prosthodontics 249

INDEX preop maxilla, 54f
preop mounted diagnostic casts, 54f
mandibular occlusal view, 61f preop presentation, 54f
maxillary and mandibular prostheses, 62f questions, 57
maxillary occlusal view, 60f radiographic findings, 55, 55f
panoramic radiograph, 61f Rapp-Hodgkins anhidrotic, 61
posttreatment front view, 62f Edentulous patient. See also Full mouth rehabilitation;
side view, 60f
surgical placement of implants, 62f Partially edentulous patient
questions, 63 classification system, American College of
radiographic findings, 61f
multidisciplinary approach (case 10), 66–71 Prosthodontists (ACP), 29
answers, 70 with conventional complete denture prostheses
case story, 66, 66f
clinical decision-making determining factors, 67–68 (case 1), 10–14
clinical findings/problem list, 67 answers, 14
dental history, 67 case story, 10, 10f
diagnosis, 67 clinical decision-making determining factors, 11–12
learning goals and objectives, 66 clinical findings/problem list, 11
medical history, 66 dental history, 10
photographs diagnosis, 11
before and after change in vertical dimension of extraoral examination, 11
learning goals and objectives, 10
occlusion, 69f medical history, 10
cephalometric radiograph—lateral view, 67 medications and allergies, 10
diagnostic casts, 69f photographs
diagnostic wax-up, 68f
frontal view, 67f completed dentures, 12f
full mouth series radiographs, 68f preop, 10f
intraoral guides, 68f questions, 12–13
maxillary and mandibular occlusal views, 67 review of systems, 10
panoramic radiograph, 67 social history, 10–11
preprosthetic treatment left and right MI, 66f soft tissue examination, 11
preprosthetic treatment maximum with severely atrophic mandible (case 4), 28–32
answers, 32
intercuspation (MI), 66f case story, 28, 28f
provisional restorations, 69f clinical decision-making determining factors, 29–30
questions, 69–70 dental history, 28
radiographic findings, 67, 67f–68f diagnosis, 29
overdenture prostheses (case 8), 54–58 learning goals and objectives, 28
answers, 57 medical history, 28
case story, 54, 54f medications and allergies, 28
clinical decision-making determining factors, 55–56 photographs
clinical findings/problem list, 55 panoramic radiograph, 29f
dental history, 55 pretreatment mandible, lateral view, 28f
diagnosis, 55 pretreatment mandible, occlusal view, 28f
learning goals and objectives, 55 questions, 30–31
medical history, 55 radiographs, 29f
photographs review of systems, 28
panoramic radiograph, 55f significant clinical findings/problem list, 28
periapical radiographs, 55f significant soft tissue examination findings, 28
postop, left side, 56f social history, 28
postop, right side, 56f with two-implant-retained mandibular overdenture
postop presentation, 56f
preop mandible, 54f (case 2), 16–20
answers, 20
250 Clinical Cases in Prosthodontics

case history, 16, 16f INDEX
case story, 16
clinical decision-making determining factors, 17 radiographs of mandibular left posterior
clinical findings/problem list, 17 dentition, 167f
dental history, 16
diagnosis, 17 questions, 169–171
learning goals and objectives, 16 review of systems, 168
medical history, 16 significant extraoral examination findings, 168
medications and allergies, 16 significant soft tissue examination findings, 168
photographs social history, 168
retreatment, success rate after, 175
postop, 18f survival rate after treatment followed by coronal
preop, 16f
questions, 18–19 restoration, 175
review of systems, 17 Erosion, tooth wear from, 139, 156
significant soft tissue examination findings, 17 Evidence-Based Dentistry (journal), 6
social history, 17 Evidence-Based Practice (EBP), 3–6
Endodontics
implant therapy versus endodontic therapy (case 24), description of, 3
process steps
160–164
answers, 163 step 1 (Ask), 3–4
case story, 160, 160f step 2 (Acquire), 4–6
clinical decision-making determining factors, step 3 (Appraise), 6
step 4 (Apply), 6
161–162 step 5 (Assess), 6
clinical findings/problem list, 161 therapy question, evidence structure for, 4, 5f
diagnosis, 161 Exostoses, 148
learning goals and objectives, 161 Extractions, prognostic indicators for strategic in full
medical history, 161
photographs mouth rehabilitation (case 26), 174–178
Extrusion. See Orthodontic extrusion
panoramic radiograph, 161f
preop left side, 160f F
preop maxilla with existing provisional, 160f Ferrule, defined, 162
preop presentation, 160f Florid cemento-osseous dysplasia (FCOD) (case 5),
preop right side, 160f
questions, 162–163 34–38
radiographic findings, 161f answers, 38
management of endodontically treated teeth case story, 34, 34f–35f
clinical decision-making determining factors, 36
(case 25), 166–172 clinical findings/problem list, 36
answers, 172 dental history, 36
case story, 166, 166f diagnosis, 36
charting, 168f learning goals and objectives, 36
clinical decision-making determining factors, medical history, 36
photographs
168–169
clinical findings/problem list, 168 maxillary and mandibular occlusal views, 35f
dental history, 167 maxillary prosthesis, 36f
diagnosis, 168 panoramic radiograph, 35f
learning goals and objectives, 167 patient profile throughout treatment, 36f
medical history, 167 periapical radiographs, 35f
medications and allergies, 168 posttreatment front view, 36f
photographs pretreatment front view, 34f
pretreatment maximum intercuspation, 34f
preop full mouth radiographs, 167f pretreatment side view, 34f, 35f
preop panoramic radiograph, 166f prosthesis remounted, 36f
questions, 37
radiographic findings, 35f, 36

Clinical Cases in Prosthodontics 251

INDEX learning goals and objectives, 87
medical history, 87
Fractured central incisor medications and allergies, 87
mild (case 11), 74–78 photographs
answers, 77
case story, 74, 74f core buildup and preparation of fractured teeth;
clinical decision-making determining factors, 75–76 finish line is a deep chamfer, 86f
clinical findings/problem list, 75
dental history, 75 final restorations, 86f
diagnosis, 75 pretreatment fractured right lateral and central
extraoral examination, 75
learning goals and objectives, 75 incisors, 86f
medical history, 75 provisional restorations, 86f
medications and allergies, 75 questions, 88–89
photographs review of systems, 87
porcelain laminate veneer, 74f significant extraoral findings, 87
porcelain laminate veneer intraoral, 74f significant soft tissue findings, 87
porcelain laminate veneer on the master cast, social history, 87
74f Fricative sounds, 11, 120
prepared right central incisor, 74f Full mouth rehabilitation
pretreatment view, 74f combination of implant and tooth-supported
questions, 76–77
review of systems, 75 fixed and removable prostheses (case 33),
social history, 75 218–222
soft tissue examination, 75 answers, 221
moderate (case 12), 80–84 case story, 218, 218f
answers, 83 clinical decision-making determining factors,
case study, 80, 80f 219–220
clinical decision-making determining factors, 81 clinical findings/ problem list, 219
dental history, 80–81 dental history, 219
diagnosis, 81 diagnosis, 219
learning goals and objectives, 80 learning goals and objectives, 219
medical history, 80 medical history, 219
medications and allergies, 81 photographs
photographs final prostheses, 220f
bonding surface should be equal to or exceed impression copings in place, 220f
the amount of tooth structure being maxillary milled bars, 220f
replaced, 80f panoramic radiograph, 219f
final restoration, 80f posttreatment front view, 220f
preop class IV fracture maxillary right central pretreatment left and right sides, 218f
incisor, 80f pretreatment occlusal and front views,
questions, 82–83 218f
review of systems, 81 questions, 220–221
significant extraoral findings, 81 radiographic findings, 219, 219f
significant soft tissue findings, 81 combination of implant and tooth-supported fixed
social history, 81 prostheses (case 32), 212–216
severe (case 13), 86–90 answers, 215
answers, 89 case story, 212, 212f
case story, 86, 86f clinical decision-making determining factors,
clinical decision-making determining factors, 87–88 213–214
clinical findings/problem list, 87 clinical findings/problem list, 213
dental history, 87 dental history, 212
diagnosis, 87 diagnosis, 213
learning goals and objectives, 212
252 Clinical Cases in Prosthodontics medical history, 212

photographs INDEX
abutment try-in, 214f
diagnostic wax-up, 214f radiographic findings, 201
maxillary and mandibular master casts, 214f implant-supported prostheses (case 28), 186–190
periapical radiographs, 213f
posttreatment front view, 214f answers, 190
pretreatment front view, 212f case story, 186, 186f
pretreatment left and right views, 212f clinical decision-making determining factors,
provisional prostheses, 214f
187–188
questions, 214–215 clinical findings/problem list, 187
radiographic findings, 213, 213f dental history, 186
implant-supported, cementable fixed prostheses diagnosis, 187
learning goals and objectives, 186
(case 31), 206–210 medical history, 186
answers, 209 photographs
case story, 206, 206f
clinical decision-making determining factors, 207 postop mandible, 188f
clinical findings/problem list, 207 postop maxilla, 188f
dental history, 206 postop presentation, 188f
diagnosis, 207 preop mandible, 186f
learning goals and objectives, 206 preop maxilla, 186f
medical history, 206 preop panoramic radiograph, 187f
photographs preop presentation, 186f
questions, 188–189
full mouth series of radiographs, 207f radiographic findings, 187f
maxillary and mandibular abutments in place, implant-supported prostheses (case 29), 192–197
answers, 196
208f case story, 192, 192f
metal try-in, maxillary, front, and mandibular clinical decision-making determining factors,

views, 208f 193–195
posttreatment front view, 208f dental history, 192
pretreatment front view, 206f diagnosis, 193
pretreatment mandibular occlusal view, 206f learning goals and objectives, 192
pretreatment maxillary occlusal view, 206f medical history, 192
questions, 208–209 medications and allergies, 192
radiographic findings, 207f photographs
implant-supported, screw-retained prostheses
mandibular definitive cast with index, 194f
(case 30), 200–203 mandibular diagnostic arrangement with index,
answers, 202
case story, 200, 200f 194f
clinical decision-making determining factors, mandibular impression copings splinted with

201–202 autopolymerizing acrylic resin material, 194f
clinical findings/problem list, 201 maxillary definitive cast with index, 194f
dental history, 200–201 maxillary diagnostic arrangement with index,
diagnosis, 201
learning goals and objectives, 200 193f
medical history, 200 maxillary impression copings splinted with
photographs
autopolymerizing acrylic resin material, 194f
posttreatment left and right side views, 201f postsurgical panoramic radiograph, 193f
posttreatment mandibular occlusal view, 201f postsurgical presentation of mandible, 192f
posttreatment maxillary occlusal view, 201f postsurgical presentation of maxilla, 192f
pretreatment front view, 200f questions, 195–196
pretreatment left and right, 200f radiograph, 193f
questions, 202 review of systems, 193
significant clinical findings/problem lis, 193
significant soft tissue examination findings, 193
social history, 193

Clinical Cases in Prosthodontics 253

INDEX significant soft tissue examination findings, 41
social history, 41
prognostic indicators for strategic extractions Implant-retained removable prostheses
(case 26), 174–178 ectodermal dysplasia (ED) (case 9), 60–64
partial denture (IRRPD) prosthesis (case 6), 40–44
answers, 177 Implant-supported fixed complete denture prostheses
case story, 174, 174f
clinical decision-making determining factors, (case 27), 180–183
answers, 183
175 case story, 180, 180f
clinical findings/problem list, 175 clinical decision-making determining factors, 181
dental history, 175 clinical findings/problem list, 181
diagnosis, 175 dental history, 181
learning goals and objectives, 175 diagnosis, 181
medical history, 175 learning goals and objectives, 180
photographs medical history, 181
photographs
postop presentation, 175f
preop mandible, 174f mandibular prosthesis intaglio surface, 181f
preop maxilla, 174f mandibular prosthesis intraoral view, 181f
preop presentation, 174f panoramic radiograph, 180f
questions, 176–177 posttreatment intraoral front view, 181f
radiographic findings, 175f pretreatment front intraoral view, 180f
Furcated teeth, retention rates for, 175 pretreatment front view, 180f
questions, 182
G radiographic findings, 180f, 181
Golden proportion rule, 120 social history, 181
Gold restorations, wear of, 140, 148 Implant-supported prostheses
Guidelines, 5, 5f cementable fixed prostheses (case 31), 206–210
combination of implant and tooth-supported
H
Hydrogen peroxide gel, 87 fixed and removable prostheses (case 33),
218–222
I combination of implant and tooth-supported fixed
Implant-retained removable partial denture (IRRPD) prostheses (case 32), 212–216
fixed complete denture prostheses (case 27),
prosthesis (case 6), 40–44 180–183
answers, 44 full mouth rehabilitation (case 28), 186–190
case story, 40, 40f full mouth rehabilitation (case 29), 192–197
charting, 41f screw-retained prostheses (case 30), 200–203
clinical decision-making determining factors, 41–42, Implant therapy versus endodontic therapy (case 24),
160–164
42f answers, 163
dental history, 41 case story, 160, 160f
diagnosis, 41 clinical decision-making determining factors,
learning goals and objectives, 41 161–162
medical history, 41 clinical findings/problem list, 161
medications and allergies, 41 diagnosis, 161
photographs learning goals and objectives, 161
medical history, 161
design of removable partial denture, 42f photographs
implant-retained removable partial denture, 40f panoramic radiograph, 161f
posttreatment maxilla with implant-retained preop left side, 160f
preop maxilla with existing provisional, 160f
removable partial denture, 40f
posttreatment smile, 40f
removable partial denture framework, 42f
questions, 43–44
review of systems, 41
significant clinical findings/problem list, 41

254 Clinical Cases in Prosthodontics

preop presentation, 160f INDEX
preop right side, 160f
questions, 162–163 Metamerism, 81, 93
radiographic findings, 161f Methamphetamine abuse, oral manifestations of
Impression, accuracy of, 194
IRRPDs (implant-retained removable partial dentures) (case 35), 230–233
answers, 233
(case 6), 40–44 case story, 230, 230f
clinical decision-making determining factors,
J
Jerusalem approach, to cleidocranial dysplasia 231–232
clinical findings/problem list, 231
treatment, 238 dental history, 230
Journal of Evidence-Based Dental Practice, 6 diagnosis, 231
learning goals and objectives, 230
M medical history, 230
Malocclusion photographs

pseudo-class III, 139 preop left side, 230f
worn dentition resulting from (case 21), 138–143 preop mandible, 230f
Mandible, severely atrophic (case 4), 28–32 preop maxilla, 230f
Mandibular growth, 62 preop presentation, 230f
Mandibular overdenture, two-implant-retained (case 2), preop right side, 230f
provisionalization, 232f
16–20 provisionals left side, 232f
Maxilla provisionals right side, 232f
questions, 232
canine transposition (case 18), 118–122 radiographic findings, 231f
milled-bar retained implant-supported fixed Mobility, of osseointegrated implants, 213

prosthesis (case 33), 186–190 N
restoration of completely edentulous (case 28), Natural tooth, biomechanical characteristics of, 213
Nicotine replacement therapy, 169
186–190 Nystatin, 24
Maxillary canine transposition (case 18), 118–122
O
answers, 122 Oral hygiene, 225–226, 232
case story, 118, 118f Orthodontic extrusion
charting, 119f
clinical decision-making determining factors, 120 case 16, 104–107
clinical findings/problem list, 120 contraindications for, 105
dental history, 118–119 indications for, 105
diagnosis, 120 Osseointegration, bone type and, 17
extraoral examination, 119 Overdenture
learning goals and objectives, 118 ectodermal dysplasia (case 8), 54–58
medical history, 118 edentulous patient with two-implant-retained
medications and allergies, 119
photographs mandibular overdenture (case 2), 16–20

postop presentation, 118f P
preop mandible, 118f Partial coverage restorations, anterior teeth
preop maxilla, 118f
preop presentation, 118f rehabilitation with
questions, 121 case 14, 92–96
review of systems, 119 case 15, 98–102
social history, 119 Partially edentulous patient
soft tissue examination, 119 with fixed and removable prostheses (case 7), 46–50
Maxillary growth, 62
Maxillary occlusal splint, 140 answers, 50
Medical Subject Heading (MeSH) database, 6 case story, 46, 46f

Clinical Cases in Prosthodontics 255

INDEX photographs
preop full mouth radiographs, 131f
charting, 47f preop mandible, 130f
clinical decision-making determining factors, 47–48 preop maxilla, 130f
clinical findings/problem list, 47 preop presentation, 130f
dental history, 46–47
diagnosis, 47 questions, 133–134
learning goals and objectives, 46 significant clinical findings/problem list, 132
medical history, 46 strategic extractions, prognostic indicators for in full
medications and allergies, 47
photographs mouth rehabilitation (case 26), 174–178
Phonetics
preop mandible, 46f
preop maxilla, 46f fricative sounds, 11, 120
preop presentation, 46f sibilant sounds, 11, 120
questions, 49–50 PICO format, 4
review of systems, 47 Plaque, 225–226
significant soft tissue examination findings, 47 Porcelain laminate veneer (PLV)
social history, 47 color matching/shade selection, 75, 81, 88, 100
with implant-retained removable partial denture combination of complete and partial coverage

prosthesis (case 6), 40–44 restorations (case 14), 92–96
answers, 44 for management of fractured central incisor-mild
case story, 40, 40f
charting, 41f (case 11), 74–77
clinical decision-making determining factors, for management of fractured central incisor-

41–42, 42f moderate (case 12), 8083
dental history, 41 postinsertion management of, 75, 100
diagnosis, 41 for replacement of composite veneer restorations on
learning goals and objectives, 41
medical history, 41 anterior teeth (case 15), 98–102
medications and allergies, 41 Posterior support, loss of (case 19), 124–128
photographs
answers, 128
design of removable partial denture, 42f case story, 124, 124f
implant-retained removable partial denture, 40f charting, 125f
posttreatment maxilla with implant-retained clinical decision-making determining factors, 126
clinical findings/problem list, 125
removable partial denture, 40f dental history, 124
posttreatment smile, 40f diagnosis, 126
removable partial denture framework, 42f extraoral examination, 125
questions, 43–44 learning goals and objectives, 124
review of systems, 41 medical history, 124
significant clinical findings/problem list, 41 medications and allergies, 125
significant soft tissue examination findings, 41 photographs
social history, 41
management of consequences (case 20), 130–135 caries, into furcation area of molar, periapical
answers, 135 pathology, and root resorption on premolar,
case story, 130, 130f 126f
charting, 132f
clinical decision-making determining factors, panoramic radiograph, 125f
periapical pathology and root fracture, 126f
132–133 preop left side, 124f
dental history, 131 preop presentation, 124f
diagnosis, 132 preop right side, 124f
learning goals and objectives, 131 questions, 127
medical history, 131 radiographic findings, 125f, 126f
medications and allergies, 131 review of systems, 125
social history, 125
256 Clinical Cases in Prosthodontics Preload, 181

PRISMA (Preferred Reporting Items for Systemic INDEX
Reviews and Meta-Analyses) Statement, 6
Transposition. See Maxillary canine transposition
PubMed, 5, 6 (case 18)

R V
Randomized control trials, 5, 5f Validity, 6
Regurgitation, self-induced, 156 Vertical dimension of occlusion (VDO), 11, 140,
Removable partial denture (RPD) prosthesis
147–148
critical steps in fabricating, 48 Vestibuloplasty, 30
implant-retained (case 6), 40–44 Vomiting, self-induced, 156, 225
Research design, 4, 4t, 5f
Residual ridge resorption, 30 W
Retracted tongue position, 29–30 “Walking” bleach technique, 87
Retruded tongue position, 29–30 Worn dentition

S generalized severe wear (case 23), 154–158
Salivary flow, decreased, 126, 156, 232 answers, 158
Screw-retained prostheses, implant-supported case story, 154, 154f
charting, 155f
(case 30), 200–203 clinical decision-making determining factors,
Searching for information, 4–6. 156–157
Secondary literature, 6 dental history, 155
Shade selection diagnosis, 156
learning goals and objectives, 155
ceramic dental restoration, 88 medical history, 155
for porcelain laminate veneer (PLV), 75, 81, 100 medications and allergies, 155
Sibilant sounds, 11, 120 photographs
Smile, percentage of maxillary incisors displayed in, bitewing radiographs, 156f
pretreatment maximum intercuspation, 154f
187 pretreatment occlusal view, 154f
Smoking questions, 157–158
review of systems, 155
association with implant failure, 181 significant clinical findings/problem list, 155
cessation, 169, 181 significant soft tissue examination findings,
Soft drinks, tooth wear and, 139, 154–157 155–156
Supernumerary teeth in cleidocranial dysplasia, social history, 155

238 localized severe wear (case 22), 146–151
Superoxyl, 87 answers, 150
Systematic reviews, 4, 5f case story, 146, 146f
clinical decision-making determining factors,
T 147–148
Therapy question, evidence structure for, 4, 5f clinical findings/problem list, 147
Tongue position, retracted/retruded, 29–30 dental history, 147
Tooth wear diagnosis, 147
learning goals and objectives, 147
abrasion, 139 medical history, 147
attrition, 139, 148 photographs
erosion, 139, 156 postop, 148f
generalized severe wear (case 23), 154–158 postop laterotrusive, 149f
localized severe wear (case 22), 146–151 postop left, 149f
resulting from dental malocclusion (case 21), postop panoramic radiograph, 149f
postop right, 148f
138–143 preop frontal, 146f
soft drinks and, 139, 154–157
wear pattern, 139–140, 156 Clinical Cases in Prosthodontics 257
Toronto-Melbourne approach, to cleidocranial dysplasia

treatment, 238

INDEX diagnosis, 139
learning goals and objectives, 139
preop full mouth radiographs, 148f medical history, 139
preop left, 146f photographs
preop mandible, 146f
preop maxilla, 146f diagnostic wax-up, 138f
preop right, 146f laterotrusive left, 140f
questions, 149–150 laterotrusive right, 140f
radiographic findings, 147, 148f postop mandible, 140f
significant soft tissue examination findings, postop maxilla, 140f
postop presentation, 140f
147 preop mandible, 138f
resulting from dental malocclusion (case 21), preop maxilla, 138f
preop presentation, 138f
138–143 questions, 141
answers, 142
case story, 138, 138f X
clinical decision-making determining factors, Xerostomia, 126, 169, 232

139–140
clinical findings/problem list, 139
dental history, 139

258 Clinical Cases in Prosthodontics