Hypothesis Aim of the study Materials and methods IMPLEMENTATION OF FUNCTIONAL DESIGN, USING THE OCCLUSAL CONCEPT “SEQUENTIAL DISOCCLUSION WITH CANINE DOMINANce” IN AESTHETIC RESTORATIVE THERAPY, BY DIRECT METHOD State University of Medicine and Pharmacy “Nicolae Testimitanu”, Moldova Valeriu Fala (1,2,4),Igor Cazacu (2,3,4),Vitalie Gribenco (9),Vitalie Pântea (9),Radu Bolun (1,4),Eva Piehslinger (7,8),Rudolf Slavicek (2),Markus Greven (2,5,6,7) (1) Department of Continuing Education, State University of Medicine and Pharmacy “Nicolae Testemitanu, Moldova (2) Vienna School of Interdisciplinary Dentistry - VieSID (3) Orthodontics Department, State University of Medicine and Pharmacy “Nicolae Testemitanu, Moldova (4) Private Office, Moldova (5) Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics, Kanagawa Dental College (6) Private Office, Germany (7) Medical University of Vienna (8) Bernhard-Gottlieb Universitätszahnklinik (9) Prosthodontics Department, State University of Medicine and Pharmacy “Nicolae Testemitanu, Moldova Hypothesis Direct method in aesthetic restorative therapy can be combined with the occlusal concept “VieSID - Sequential Disocclusion with ´Canine Dominance” for treating patients with bruxism, tooth grinding, tooth wear and other disorders of the masticatory organ. Aim of the study Aim: Implementation of functional design, using the occlusal concept “VieSID - sequential occlusion with canine dominance with canine dominance” in aesthetic restorative therapy, by direct method. Materials and methods Fig. 2a Dental arches in static occlusion and laterotrusion after the fixation of the gold crowns, where the mesio-vestibular cusp of the first superior molar, induces the disocclusion of the rest of the occlusal elements of the 1st and 2nd molar. A group of 83 patients (37 men, 46 women - age between 21-58 yrs.) have been included in the study, to whom the aesthetic restorative therapy, through the direct method was applied by implementing the functional design, using the occlusal concept “VieSID - Sequential Disocclusion with a Canine Dominance”. The patients were examined by standard interview (anamnesis), clinical exam and paraclinical exam (panoramic X-Rays, CT, mounted casts in the fully adjustable articulator, by the aid of kinematic facebow-tranfer, condylography, with the recording of “true hinge axis” and the individual condylar trajectories). After the end of the treatment and also after 4 years, the patients were re-examined in order to re-assess the maintainance of the occlusal rehabilitation treatment results. Fig. 2b The template model of diagnostic wax-up, which guides the procedure of functionally aesthetically directed restoration of the teeth 45, 44 and the view of functionally directed restored teeth. Clinical Case Fig. 2c The dental hemiarch from the right and left, in static occlusion and laterotrusion, where the vestibular cusp of the 45 tooth moves on the slope of the vestibular cusp of the 15 tooth, inducing the molar disocclusion and the vestibular cusp of 35 tooth moves on the slope of the vestibular cusp of 25 tooth, enableing the molar disocclusion. Fig.1a Condition of the teeth in the maximum intercuspation position Fig.1b Ratio between the front teeth Fig. 1c Panoramic X-Ray, Lateral Cephalometrics Fig. 2d The functionally aesthetically directed restoration of the superior frontal teeth, on the basis of the concept of “VieSID - Sequential Occlusion with Canine Dominance”, in accordance with the principles of dento-facial aesthetics. Fig. 3a Post-Tx: Protrusion/Retrusion. Free mandibular movements Fig. 3b Post-Tx: Cephalometry and the analysis of occlusal parameters, one month after the directed individualized complex treatment. Fig. 1d Mounted diagnostic study casts in the “Reference SL”-Articulator, with the aid of anatomic facebow-transfer. Fig. 1e Protrusion/Retrusion. Graphical recordings done by means of condylography “Cadiax®” Fig. 1f Opening/Closing movement of the mandible. Fig. 3c Post-Tx: The control of quantity and quality of occlusal contacts. Diagnostic study casts, mounted in fully adjusted articulator with the aid of kinematic facebow-transfer. Fig. 3d Post-Tx: Verification of the quality of functional occlusal contacts and trajectories at the level of the second premolars on the right: - static occlusion and laterotrusion, where the vestibular cusp of the tooth 45, slides on the slope of the vestibular cusp of the tooth 15, producing molar disocclusion Fig. 3e Post-Tx: Verification of the quality of the functional occlusal contacts and trajectories, at the level of the first premolars on the right: - static occlusion, laterotrusion, where the vestibular cusp of the 44 tooth slides on the pathway of the vestibular cusp of the tooth 14, producing the disocclusion of molars and second premolar. Fig. 3f Post-Tx: Verification of the quality of the functional occlusal contacts and trajectories at the level of canines from the left: - static occlusion and laterotrusion, where the cusp of the tooth 33, slides on the lingual surface of tooth 23, producing molar and premolar disocclusion. Fig. 1g Free movements of the mandible. Quantitative and qualitative evaluation of the trajectories of condylar excursions. Fig. 1h Cephalometry and the analysis of occlusal parameters before occlusal rehabilitation. Fig. 3g Post-Tx: Execution of maximum protrusive mandible movements within fully adjusted articulator. Verification of the quality of the static and functional occlusal contacts and trajectories in protrusion from frontal view, posterior view. Fig. 3h Post-Tx: quality of functional occlusal contacts and trajectories of the dental arches on diagnostic study casts. Fig. 1i Muscle relaxation splint adjusted to the height of +10mm, in accordance with the values of the incisal pin in articulator (frontal view). Fig. 1j Diagnostic wax-up of the first molars – “occlusion key/key to occlusion”, in “Reference SL”-Articulator, in accordance with the occlusal plane values – 4 degrees (lateral view). Fig. 4 Post-Tx: Panoramic X-Ray before en-osseous implant insertion and after the implant-prosthodontical treatment at the level of teeth 27, 47. Fig. 5a Post-Tx Results of the direct individualized complex treatment, after 4 years from finalization. Occlusal view. Fig. 1k Completed diagnostic wax-up modelling of molars, using the occlusal concept “VieSID - Sequential Occlusion with Canine Dominance”. Fig. 5 b-e Post-Tx: Results of the direct individualized complex treatment, after 4 years from finalization. View of the frontal teeth in the maximum intercuspation position. Dental arches in maximum intercuspation from the lateral right view, frontal view, and lateral left view. Results Monitoring the patient records, after 4 years, by means of clinical and paraclinical examination, we observed stability of the following parameter: No occurence of signs and symptoms of dysfunction. Maintenance of the morphological aspect of the teeth. Maintenance of the quality of the functional occlusal contacts and trajectories. Confirmation of maintenance of the occlusal parameters in articulator simulation. Morphological and functional preservation of the stomatognathic system. Fig. 1k Draftof the gold crown-restoration plaster models and the final wax –up of the reorganized functionally aesthetically directed occlusion, based on the concept of “VieSID - Sequential Occlusion with Canine Dominance” Conclusion Direct restoration method can be utilized in patients with bruxism, tooth grinding, tooth wear and other disorders of the masticatory organ under maximum preservation of healthy tooth substance applying the occlusal concept “VieSID - Sequential Disocclusion with a Canine Dominance” to restore the healthy function of masticatory organ. Protrusion/Retrusion. Graphical recordings done by means with the “Cadiax®” condylograph Mediotrusion. Evaluation of the routes of condylar excursions on the left and right.