Dentist needs to increase the bite

[mr-b]

Good morning,
Trying to challenge this case.
Patient has severe attrition, bite collapsed.
The cast guy recommend this design.
My target to increase the VDO 4mm
What do you think about this design
Thanks

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[CoolHandLuke]

why? pt should stop screwing around and do a conversion to all on 4.

what you have there if you design 4mm tall teeth on it, is going to cause every single one of the existing natural teeth to fail in time.

 

[JMN]

Good morning,
Trying to challenge this case.
Patient has severe attrition, bite collapsed.
The cast guy recommend this design.
My target to increase the VDO 4mm
What do you think about this design
Thanks

Sent from my SM-N900W8 using Tapatalk

What's the opposing?
Was the cause of his bite 'collapsing' found, fixed, and it's now stable somehow? Otherwise, jeepers that's gonna be an expensive and rough road to a denture.

Edit: Jumping straight into that, in purely my opinion, will be a mistake. Has there been a bite opening appliance made and complied with to see if the patient can tollerate that much opening at once? I'd start with a nightguard and toothshade acrylic or injected opener for day use. But I know you don't get to prescribe, just follow.

 

[mr-b]

I hope this make the idea more clear

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[Affinity]

Opening 4mm on a brass clacker?

 

[Flipperlady]

I would be tempted to try a flexible partial on this case. The tech would have to grind away most of the metal to get anterior teeth in and 4mm opening is a huge jump for a bite like that. Either use an acrylic partial as a temp that can be opened bit by bit or try a flexible partial because of the thinness .

 

[Flipperlady]

why? pt should stop screwing around and do a conversion to all on 4.

what you have there if you design 4mm tall teeth on it, is going to cause every single one of the existing natural teeth to fail in time.

Problem is not everyone can afford something like that.

 

[CoolHandLuke]

Problem is not everyone can afford something like that.

not yet.

 

[mr-b]

I am not sure but I'll try to do set up with the existing bite and to see if it is doable.
I'll cut the mesh

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[Flipperlady]

I suppose you could process teeth on with tooth color acrylic, that's not my specialty and the ones I've ever seen looked bulky and ugly. The mesh over the teeth though, in theory it can work, but I'm guessing the patient won't tolerate it unless you work up to it.

 

[TheLabGuy]

I would of suggested a nightguard type of material...act as a transitional appliance at desired vdo. A mesh on the occlusion is a nice theory, but I don't see it lasting long before the patient is biting into that mesh without getting those muscles relaxed enough...hence why you use a transitional appliance. Also, once the patient and Doc feel the transitional appliance has worked it's magic, then I'd design a partial with metal occlusals. You won't ever correct those biting forces, all you can do is manage what's currently left over in my opinion.

 

[droberts]

why? pt should stop screwing around and do a conversion to all on 4.

what you have there if you design 4mm tall teeth on it, is going to cause every single one of the existing natural teeth to fail in time.

FYI. You cannot suggest an AO4 until you know how much bone, high smile etc. Don't put the cart before the horse!

Mesh over occlusion. Will not last.
The main problem I can see. All clinicians start with treatment plans on the maxillary arch to possibly correct the bite etc. Take a good look and the mand.
Its a roller coaster? Put them in a bite splint, increasing vertical if possible.
Then restore the mand first, or at least with a temp on it to restore the max arch.

 

[kimba]

I have a client who does a fair number of cases like this over the years, and insists on that type of frame design. They always come back in in a year or so for fresh acrylic. I have stopped trying to talk him around, and send the invoice each time. You can lead a horse to water......

 

[grantoz]

i would probably forward this case to someone else i couldnt in all honesty take money for that case .we all know it will come back time and time again and that no one will want to pay for the redo.

 

[mr-b]

Mish has beet cut, noraml bite set up. Case deliver today. Thanks

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