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Advice on Bruxism patient
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<blockquote data-quote="Kreyer" data-source="post: 8480" data-attributes="member: 602"><p>Hello Tony,</p><p></p><p>Your first thought is right on to make a cast cr-co palate,. The problem with a bruxer is at what position do you restore them at. According to literature it is always best to restore at true centric relation and create a functional occlusal scheme from this position of the condyle to glenoid fossa. To treatment plan this I would duplicate the existing denture and convert the duplicate into a maxillary reprograming prosthesis. After duplicating the maxillary set-up a central bearing device for an intra-oral tracing on the maxillae and mandible. Remount to apex of tracing which is centric relation then with new established VDO/CR add occlusal contacts and anterior lingual ramp if necessary to create centric reference points for stops and ramp for disclusion if necessary. If you make all heavy contacts in anterior ramp this will help seat condyles if repositioning is needed. </p><p></p><p>After patient is comfortable and can function with new CR/VDO then start with your new maxillary complete denture with cast cr-co palate and mandibular RPD. To prevent wear and breakage of teeth I would do a Functionally Generated Path posterior occlusion. This can be done direct or indirect but should always be verified intra-orally. The FGP posteriors occlusal surface can be cast in gold or even cured in composite and then processed into denture. A less expensive route is to use a composite tooth for this procedure as well. I do like gold though for extreme cases.</p><p></p><p>It is difficult to go into every detail step but if you want more info I would be happy to provide.</p><p></p><p><img src="/forums/images/smilies/test/cheers.gif" class="smilie" loading="lazy" alt="Cheers" title="Cheers Cheers" data-shortname="Cheers" /> to you!</p><p></p><p>Robert</p></blockquote><p></p>
[QUOTE="Kreyer, post: 8480, member: 602"] Hello Tony, Your first thought is right on to make a cast cr-co palate,. The problem with a bruxer is at what position do you restore them at. According to literature it is always best to restore at true centric relation and create a functional occlusal scheme from this position of the condyle to glenoid fossa. To treatment plan this I would duplicate the existing denture and convert the duplicate into a maxillary reprograming prosthesis. After duplicating the maxillary set-up a central bearing device for an intra-oral tracing on the maxillae and mandible. Remount to apex of tracing which is centric relation then with new established VDO/CR add occlusal contacts and anterior lingual ramp if necessary to create centric reference points for stops and ramp for disclusion if necessary. If you make all heavy contacts in anterior ramp this will help seat condyles if repositioning is needed. After patient is comfortable and can function with new CR/VDO then start with your new maxillary complete denture with cast cr-co palate and mandibular RPD. To prevent wear and breakage of teeth I would do a Functionally Generated Path posterior occlusion. This can be done direct or indirect but should always be verified intra-orally. The FGP posteriors occlusal surface can be cast in gold or even cured in composite and then processed into denture. A less expensive route is to use a composite tooth for this procedure as well. I do like gold though for extreme cases. It is difficult to go into every detail step but if you want more info I would be happy to provide. Cheers to you! Robert [/QUOTE]
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