Denture design Class 3 mandibular prognathism

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jesusdesinger10

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Hello! I am going to be designing a denture for a patient that is in severe class 3. Are there any recommendations on tooth placement? I can't decide which is a better option, to angle the anterior teeth edge to edge or to bulk them out. I've been looking at articles and they are saying I need to design it in crossbite and have the anterior teeth edge to edge but I've seen others do it where there is a slight overlap for esthetics. Any suggestions will help, it's certainly a difficult case.
 
Flipperlady

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It's really up to what the pt wants, that and was the bite severely worn down making the prog worse. If so I would explain why and step by step if the bite is opened and you are able to get end on end or better at that point (in wax). I remember seeing just a case like that on a young school teacher that was livid her under bite was now opened and set end on end. I wouldn't assume and also have significant other in the room for try in.
 
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It's really up to what the pt wants, that and was the bite severely worn down making the prog worse. If so I would explain why and step by step if the bite is opened and you are able to get end on end or better at that point (in wax). I remember seeing just a case like that on a young school teacher that was livid her under bite was now opened and set end on end. I wouldn't assume and also have significant other in the room for try in.
Thank you for your expertise. It definitely appeared to be worn down. I have two bites to work off of. I am designing this case, fully digital and am planning on making him two sets. One with his original vertical correcting the edge to edge and the other manipulated based off measurements from the VDO gauge. My fear is that when he occludes it will cause the upper denture to loose retention.
 
Flipperlady

Flipperlady

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Thank you for your expertise. It definitely appeared to be worn down. I have two bites to work off of. I am designing this case, fully digital and am planning on making him two sets. One with his original vertical correcting the edge to edge and the other manipulated based off measurements from the VDO gauge. My fear is that when he occludes it will cause the upper denture to loose retention.
I don't envy having to make this case as a finished denture without try ins, and even with try in in wax it would be a hard one. This will be on the dentist to get it right and communicate with you.
 
Doris A

Doris A

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I don't envy having to make this case as a finished denture without try ins, and even with try in in wax it would be a hard one. This will be on the dentist to get it right and communicate with you.
We just finalized a Turbyfill F/F. When it went out for hydrocast the max teeth were 15mm off of the ridge and she still wasn't end to end by 5mm. When it came back to finalize it was reset into class 1, so it's now 21mm off of the ridge. It went for try in and came back to finish. We'll see how it goes.
 
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I don't envy having to make this case as a finished denture without try ins, and even with try in in wax it would be a hard one. This will be on the dentist to get it right and communicate with you.
Yes ,it leaves me with same thoughts. Thank you for your honest opinion. My main concern is the patient NOT leaving with a better outcome than what they originally had or else it's a failure. I'll go home and cry for a couple days. Then get back on the horse.
 
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