A case report is presented of a patient with: multiple carious lesions presenting periodontal recessions; tooth loss; tooth wear; and severe myopathy in the area of the masticatory muscles (mylohyoid muscle on the right; masseter muscle, superficial part on both sides), atlanto-occipital region (deep neck muscles), shoulder and neck muscles, as well as an Angle class II classifcation with a tendency to anterior and lateral open bite. Given advanced periodontal attachment loss (especially in the maxillary posterior region), periodontal surgery (root top resection 15 – right maxillary second premolar ), and implantological and functional pretreatment using an occlusal splint combined with physiotherapy were carried out. Initially, an interdisciplinary approach was applied, and orthodontic measures (intrusion and gap closure of the anterior mandible) were carried out. The splint treatment was performed at the beginning of orthodontic treatment until the muscles were symptom free, as well as after completion with subsequent adjustment of the splint. After the completion of the splint treatment, the jaw position was stabilized using CAD/CAM long-term provisionals based on the existing Angle Class II classification in centric jaw relation and reduced vertical dimension of occlusion. After a 6-month adaptation period, the jaw position thus maintained was successively transferred to indirectly manufactured dentures. In the posterior region, minimally invasively prepared partial crowns (occlusal onlays) made of lithium-disilicate ceramic were used. In the anterior region, veneers were fabricated using the sandwich technique, comprising pressed ceramic and feldspathic ceramic.
Keywords: Angle class II, division 1, implant, walking bleach, sandwich technique, lowering of the vertical dimension of occlusion (VDO), orthodontic gap closure, compensatory supraeruption of the mandibular anterior teeth, myopathy, cervical spine, syndrome, loss of VDO
