help with a case

[Penthus]

Long time lurker, first time poster. Wanting to see if the dental lab network has any good ideas. Received this case today and mounted it on a plasterless articulator. Doc says the pt has a max partial and wants a mand one as well but he doesn't have much room. I did not make the max partial and so far don't have a model with it in place either. Doc wants suggestions on extractions etc. to make to this work. It appears #13 is broken so it may be tighter than the picture indicates. It appears there are I-bars on #6,12,13. Would this be a good case for an all metal occlusal for #20-21 if not that entire side? Even with a metal occlusal it appears that #12 would have to be reduced a little. Any other suggestions I can bring to the table when I discuss this with him in person? I appreciate the time of anyone who bothers to post, thanks.

 

[rkm rdt]

open the bite

By adding acrylic to the pld until, the dr can retrain the mandible to improve the opening.

 

[Tayebdental]

I think the doctor has to open the bite for some room!!. As rkm said.

 

[AJEL]

If the Dr is up to it make a vinyl appliance and the Dr can open the case with add on materials, if the patient is in a hurry but still wants to try, I would put it on a Stratus and construct an acetal opener, sort of like a "snap on" for the patient to try for several months. In this way you could extend the anterior length in an aesthetic manner and allow muscle retraining, deprogramming.
Should you need to jump into an appliance with no further changes you really need to see the current partial, and I wouldn't (never) use a minimally functioning plastic thing to try as an articulation for any removable or any case requiring balancing.
You do nice pictures.
This was done to open bite 5mm anteriorly patient used 1 year and is now starting C&B but same idea for your case. Get the verticle to where it is comfortable & proper then build your case, If DDS or Pt not up to it well you tried.