Posterior Dysfunction – Conservative Function & Esthetic Treatment

This series of videos follows a patient with pain, worn and damaged teeth, and an unattractive smile with Posterior Dysfunction through conservative functional and esthetic treatment. This treatment included RedAddibration and composite restorations. It emphasizes the use of the DATA Appliance in providing this treatment and creating what is now referred to as a “Stable Biomechanical Foundation”. It is important to understand that this patient had a complete evaluation before it was possible to know that this treatment was appropriate. Details of this evaluation and the planning that preceded this treatment may be viewed on the “Posterior Dysfunction – Evaluation and Treatment Planning” video series.

As previously described in the main introduction in this “Case Examples” section, it is important to understand that some of the terminology has been changed since these videos were produced. The term “Occlusal Dysfunction” was used in these videos for what is now referred to as “Posterior Dysfunction”. The term “Kois Deprogrammer” was used for what is now referred to as a “DATA Appliance”. The term “Equilibration” has been replaced with “RedAddibration”. It would also be helpful to read Dr. Hegyi’s article “A Classification System for the Management of Biomechanical Factors in Dentistry”, located in the “Online Media Library” section of this site prior to viewing these videos.


Posterior Dysfunction Treatment 1 – RedAddibration Treatment Expectations: Dr Hegyi and his patient review the process of RedAddibration treatment and expectations . prior to treatment.


Posterior Dysfunction Treatment 2 – RedAddibration – Gross Elimination of Posterior Interferences: In this live, unedited clinical video, Dr. Hegyi begins the process of RedAddibration with the gross elimination of posterior tooth interferences to physiologic closure of the mandible.


Posterior Dysfunction Treatment 3 – RedAddibration – Refinement of Posterior Tooth Contacts : In this chapter, Dr. Hegyi refines posterior tooth functional closure contacts to a higher degree of precision.


Posterior Dysfunction Treatment 4 – Elimination of Excursive Interferences: In this, the second phase of the reductive portion of RedAddibration, Dr. Hegyi demonstrates the elimination of working, balancing (non-working), and protrusive interferences to all excursive jaw movements.


Posterior Dysfunction Treatment 5 – Harmonizing Anterior Guidance with the Envelope of Function: Dr. Hegyi demonstrates the final phase of the reductive phase of RedAddibration – harmonizing anterior guidance with the required envelope of function. The importance of this element cannot be over emphasized, especially when restorations are made that alter the functioning surfaces of the anterior teeth (the incisal edge and lingual contours of the upper anterior teeth and the incisal edge and facial surfaces of the lower anterior teeth). Although the materials and methodology of this element have been refined since the time this video was produced, the principles of Lundeen and Gibbs – that incisors should only contact at the completion of a chewing cycle (i.e. in maximum intercuspation) – are still important to demonstrate and understand.


Posterior Dysfunction Treatment 6 – Initial Patient Response to RedAddibration: Dr. Hegyi’s patient describes her initial sense of change immediately following the reductive phase of RedAddibration. At this point, with the exception of some anterior teeth (yet to be restored), the patient has equal intensity, simultaneous, axially directed contact of all her teeth coinciding with the most physiologic activity of the masticatory muscles and the condyles fully seated.


Posterior Dysfunction Treatment 7 – Post Reductive Reshaping Response and Additive Reshaping Preview: Dr. Hegyi’s patient describes the affect of the reductive reshaping on her occlusion, comfort, and parafunctional activity. In addition the additive portion of her RedAddibration is previewed. It should be noted that in some cases, no addition is required to meet the requirements of a stable occlusion and biomechanical harmony. In many cases, there is a need for the direct bonding of composite to the lingual surfaces of upper anterior teeth to create stops and assist in anterior guidance. In this case, there was also a need to replace missing tooth structure and improve esthetics.


Posterior Dysfunction Treatment 8-Post Additive Reshaping Functional/Esthetic Refinement and Review: With the patient’s anterior composite restorations functionally and esthetically refined, her RedAddibration is complete. At this point, all the requirements of biomechanical harmony are met. Dr. Hegyi and his patient demonstrate and discuss the results of her treatment and additional long-term treatment and management considerations.
Dr. Hegyi also describes and demonstrates critical design features of the lingual aspect of the upper anterior teeth. These contours literally define the Available Envelope of Function and impact on both functional and parafunctional jaw activities.
Also worth noting is the fact that although the patient’s composite “Veneer” restorations were only intended to last a “few years”, they have been in place and unmodified for more than ten years.