Can I change vertical dimension on processed case?

[Trey]

Everyone on this forum has been so helpful to me as new & young lab tech so I thank you all for that.

Here is my problem:

Processed a complete upper and lower for one of our doctors. It came back as a remake because the bite was COMPLETELY wrong. (doc/patient approved wax try-in). So we did a complete remake at no charge as we are still trying to please the doctor.

The new dentures were seated yesterday and he said the vertical dimension was too high..but again..the doc and patient approved the wax try in.

How can I proceed to reduce the vertical dimension?

Our thought was just a rebase with an articulator that can drop vertically.

Also, we are going to charge for whatever we have to do this time..

 

[cdtwade]

Everyone on this forum has been so helpful to me as new & young lab tech so I thank you all for that.

Here is my problem:

Processed a complete upper and lower for one of our doctors. It came back as a remake because the bite was COMPLETELY wrong. (doc/patient approved wax try-in). So we did a complete remake at no charge as we are still trying to please the doctor.

The new dentures were seated yesterday and he said the vertical dimension was too high..but again..the doc and patient approved the wax try in.

How can I proceed to reduce the vertical dimension?

Our thought was just a rebase with an articulator that can drop vertically.

Also, we are going to charge for whatever we have to do this time..

I do not mean to be sarcastic but I would find another "Doc" to work with, unless you can teach/assist him or her in how to take a CJR.

 

[Trey]

Haha, yeah.. To give him credit this is a very difficult patient. We were there when he took the bite for the remake and this patient wouldn't bite down the same way twice. She almost seems like she is not all there. I'm not trying to make excuses for him but we are in a small town and he puts out a TON of work so we're going to keep working with him..

 

[JohnWilson]

Do you remount your cases after processing to check for processing error and equillibrate as necessary?

Many variables can effect the final delivery of a removable prosthetic however the clients skill is the #1 factor. Often times clients move forward to complete a case thinking it will "improve" after processing when all the while the ill fitting case at try in is worse when the model is not blocked out and processed.

 

[Trey]

Thank you John, yes we equillibrate prior to finalizing. Apparently this is not a minor vert. dimension issue but major. The patient has very little ridge so there is a lot of acrylic over the ridge to adjust. Our thought is to just do a rebase and drop the vertical.

 

[cdtwade]

Cut off all lower teeth and put another wax rim on it. Get a tracing device from Blue Dolphin if that doesn't work. Sorry about get rid of the Doctor. Some times I act like those grumpy old lab techs I used to work with thirty years ago! Sometimes, LOL!!

 

[Trey]

Cut off all lower teeth and put another wax rim on it. Get a tracing device from Blue Dolphin if that doesn't work. Sorry about get rid of the Doctor. Some times I act like those grumpy old lab techs I used to work with thirty years ago! Sometimes, LOL!!

Haha no problem! The lower denture already sits pretty low on the ridge so I can't really reduce it much. Can I do the same thing on the upper? Cut off the teeth, take a new bite for vertical and reset to that?

 

[JohnWilson]

Look at the bright side he didn't miss the midline

 

[Doris A]

Haha no problem! The lower denture already sits pretty low on the ridge so I can't really reduce it much. Can I do the same thing on the upper? Cut off the teeth, take a new bite for vertical and reset to that?

It depends on the smile line, if you cut the teeth off and raise them up too much they won't show any teeth. If they're hanging down too far now, yes you can do that....About the bite, tell the Doc to have the patient swallow when he's taking the bite...when you swallow, you bite into centric every time!

 

[Doris A]

Also, since the Doctor and patient approved the set up, don't do it for free! The Dr should have had the patient sign off on it, if he didn't, that's his fault not yours! You've already done it once for nothing, don't do it twice!!!

 

[dmonwaxa]

First off how much is the bite off,,,,,,May I suggest: Chairside,,,,The patient is currently wearing dentures, I hope. Using the VDO from those, as a reference,,,,record that VDO, to do so make a mark(dot) on the nose and chin (use tattoo ink so the patient has a lasting memory....joke) measure and record in mm. Meanwhile,,,,, in the lab, cut away the teeth for a Max rebase. Set the cutaway arch on a new LC base or use the old denture base if room permits. You can ballpark the new estimated VDO,,,for example reduce 2-3mm. Since this will be set in occlusion to the lower the doc can reestablish proper VDO using the marks as a reference. Hopefully the modified dentures are going to be out of occlusion, then using a boley guage or ruler have the patient maintain the desired opening, then doc can inject registration material. Done another way would be to inject registration material and have the patient "gently close" until the desired VDO is achieved. Back at the lab,,,reset teeth an rewax to the new bite,,,process or have another try in before processing. Better safe than sorry. Just MHO. Best wishes with the case.

 

[rich green]

First off how much is the bite off,,,,,,May I suggest: Chairside,,,,The patient is currently wearing dentures, I hope. Using the VDO from those, as a reference,,,,record that VDO, to do so make a mark(dot) on the nose and chin (use tattoo ink so the patient has a lasting memory....joke) measure and record in mm. Meanwhile,,,,, in the lab, cut away the teeth for a Max rebase. Set the cutaway arch on a new LC base or use the old denture base if room permits. You can ballpark the new estimated VDO,,,for example reduce 2-3mm. Since this will be set in occlusion to the lower the doc can reestablish proper VDO using the marks as a reference. Hopefully the modified dentures are going to be out of occlusion, then using a boley guage or ruler have the patient maintain the desired opening, then doc can inject registration material. Done another way would be to inject registration material and have the patient "gently close" until the desired VDO is achieved. Back at the lab,,,reset teeth an rewax to the new bite,,,process or have another try in before processing. Better safe than sorry. Just MHO. Best wishes with the case.

good answer. this will work. Also if the patient has , as you say not much lower ridge and the teeth are already close, it sounds like the new bite might be correct and pt is merely accustomed to old bite. That knowledge won't help much but it might be an answer. good luck.

 

[kcdt]

Thank you John, yes we equillibrate prior to finalizing. Apparently this is not a minor vert. dimension issue but major. The patient has very little ridge so there is a lot of acrylic over the ridge to adjust. Our thought is to just do a rebase and drop the vertical.

You'd be better off separating teeth from base and rewaxing them in the proposed VDO.
Have dr take a check bite and remount/reset as needed.

 

[Trey]

You guys have all been very helpful. I really appreciate it.

Spoke with the doctor today and the patient never should have approved the bite for processing.. Her current upper denture is hidden behind her lip and the doc gave me her smile line, which I set teeth to, thus opening the bite. Patient should have said something at try-in. We are going to drop the vertical 5mm, reset in wax, try in and hopefully process.

 

[sas]

If there is enough vertical room cut the teeth out of the plate with a disk so that you will have an arch of teeth and a little acrylic. Grind the base down as close as you can get to the tissue surface. Place a small amount of wax on plate and loosely atta ch teeth. Have him reseat lower and soften upper wax. Have patient close to desired VD and CR, gently hand maneuvering the teeth to occlusion. When correct remove and chill wax. Reseat and test bite by several methods. Wax in case and either reattach to plate or reprocess entire plate. Patient can check this out before reprocess. This works great if you can get the teeth out of the plate without tearing up plate. You can always take a wash if necessary. This is slam dunk if you get good at this you can use a little acrylic instead of wax to reconnect the teeth to plate. Than you could finish up the case in nothing flat if time was short.

 

[Trey]

If there is enough vertical room cut the teeth out of the plate with a disk so that you will have an arch of teeth and a little acrylic. Grind the base down as close as you can get to the tissue surface. Place a small amount of wax on plate and loosely atta ch teeth. Have him reseat lower and soften upper wax. Have patient close to desired VD and CR, gently hand maneuvering the teeth to occlusion. When correct remove and chill wax. Reseat and test bite by several methods. Wax in case and either reattach to plate or reprocess entire plate. Patient can check this out before reprocess. This works great if you can get the teeth out of the plate without tearing up plate. You can always take a wash if necessary. This is slam dunk if you get good at this you can use a little acrylic instead of wax to reconnect the teeth to plate. Than you could finish up the case in nothing flat if time was short.

Thats the plan! Thanks for the help!

 

[Flipperlady]

Everyone on this forum has been so helpful to me as new & young lab tech so I thank you all for that.

Here is my problem:

Processed a complete upper and lower for one of our doctors. It came back as a remake because the bite was COMPLETELY wrong. (doc/patient approved wax try-in). So we did a complete remake at no charge as we are still trying to please the doctor.

The new dentures were seated yesterday and he said the vertical dimension was too high..but again..the doc and patient approved the wax try in.

How can I proceed to reduce the vertical dimension?

Our thought was just a rebase with an articulator that can drop vertically.

Also, we are going to charge for whatever we have to do this time..

Old thread now but had to say it's more complicated than you think. The easy answer is to remake lower denture ( get your new bite after teeth are removed) and pray it works as the upper anteriors will probably need to be pushed up as well. You can try to save teeth but remove all the lowers, get the new bite and make sure anteriors are correct which means at some point all of the teeth are removed and reset. You might also want to recheck the shade and size of teeth at this point as well. Btw you are reprocessing on original bases as well.

 

[Wade Bognuda]

Everyone on this forum has been so helpful to me as new & young lab tech so I thank you all for that.

Here is my problem:

Processed a complete upper and lower for one of our doctors. It came back as a remake because the bite was COMPLETELY wrong. (doc/patient approved wax try-in). So we did a complete remake at no charge as we are still trying to please the doctor.

The new dentures were seated yesterday and he said the vertical dimension was too high..but again..the doc and patient approved the wax try in.

How can I proceed to reduce the vertical dimension?

Our thought was just a rebase with an articulator that can drop vertically.

Also, we are going to charge for whatever we have to do this time..

Grindamania.

 

[Denture Dude]

I knew a guy who bought a mini bandsaw for an account that was a repeat offender. No one else in town would do his work anymore. He would bandsaw all the teeth off and start anew. Not sure if he has all his fingers still.