On June 11, a small seminar by Dr. Yoon Pil-sang Yoon was held as a change of pace from the usual meeting of the directors to discuss current issues of the hospital. The topic of the seminar was Minish full-mouth treatment methodology for patients with severely worn teeth. Dr. Yoon spoke about the diagnostic criteria and treatment plans that should be considered in the treatment of severely worn full-mouths.
Dr. Yoon says that it is essential to analyze facial changes, not just the teeth, when deciding on a treatment direction. The distance between the upper and lower jaw, medically referred to as the vertical dimension (VD), is the most important evaluation factor in analyzing facial changes.
For example, if your teeth are worn down a lot, this height will decrease, causing your face to lose shape and your ability to chew food. It can also reduce the stability of your prosthetic treatment. Therefore, when treating the entire mouth, the question of whether to regain this height or maintain the current state is central to the treatment plan.
Based on Turner’s paper, Dr. Yoon explained the treatment method in three parts. The first is to restore the lost facial length, the second is to maintain the current length and secure the treatment space, and the third is to analyze the patient’s chewing condition and facial shape to determine the treatment range based on the minimum length change. Each method should be applied flexibly depending on the patient’s oral condition.
The first patient Dr. Yun presented as a case study had severe decay in her front teeth, and her front teeth didn’t fit together when she closed her mouth. Dr. Yun decided to treat this patient while maintaining the height of his face. He performed a one-day procedure and applied a Minish bridge to the front teeth. To help the patient find a comfortable chewing position, Dr. Yoon utilized the Leaf Gauge, which is used to diagnose and adjust the jaw joint and bite.
Dr. Yoon says that while they succeeded in preserving the patient’s teeth and allowing her to chew comfortably, there were some morphological shortcomings in the molars. “When you focus on preserving the teeth, there are inevitably limitations in the form, and we need to keep trying to overcome them,” he adds.
In the second case, the height of the face itself had been reduced due to chronic wear and tear. In this case, the treatment plan was designed to restore the height, and the diagnosis and treatment design were digitally implemented using the “two-stage approach” developed by Dr. Hobo in Japan. This is a step-by-step treatment in which the incisors and molars are designed based on different reference points to suit the patient’s mastication habits.
“This is an example of anatomical cusp geometry while still satisfying the authoring function,” Dr. Yun said, adding, “Professional use of a digital occluder increases the precision and predictability of restoration.” He also shared the virtual articulator settings.
The presentation was followed by a discussion. The balance between recreating the occlusal surface and preserving the existing tooth was discussed in the first case. There was also a debate about the adhesion problem when applying minisheets to corroded teeth. Concerns about the potential for poor bonding in corroded dentin were addressed, with the consensus being that “it is necessary to remove the sclerotic dentin by prolonged phosphoric acid etching after preparation.” The importance of staff training to reduce bond failure was also emphasized.
“It’s important to look deeply into each patient with a diagnostic focus,” said Dr. Yoon, “and we will continue to share various clinical experiences.” The small seminars will be held regularly, once a month, to share concerns and insights from the clinic.
