Freeway space

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dentmech

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2-4mm is the normal fws accrdg.to the books but are there cases when you have to give the patient more fws?i have a patient that has 10mm. Esthetically the upper rim is good length and lower is just below corner of the lips.can anyone share some tips?lower ridge badly resorbed.
 
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Acrylicwookie

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What method are you using to establish VDO?
 
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dentmech

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I determine the VDR and deduct 3mm. From that amount i either choose to add or remove wax to upper or lower rims until i get 3 mm of FWS. But i also consider other things for esthetics say the upper incisal length should be 1-2 mm from the upper lip when the patient is relaxed so i establish that and lower rims height just to corner of lips,so im i getting it wrong? if im satisfied with upper rims length for esthetics should i just build the lower rim up to get 3 mm of freeway?
 
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Acrylicwookie

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My bad, I meant VDR. How are you getting your patient to VDR so you can figure out VDO? Also, I think there are a lot of factors that go into esthetics. However, I believe function comes far before esthetics and to me, 10mm FWS is too much and would cause them to be over closed and likely cause TMJ issues as well as the typical lip/cheek droop esthetic issues associated with overclosing. I establish the correct maxillary line of occlusion with a fox plane allowing 1-2mm of wax to show as the lip is at rest, then adjust lower rim to VDO (after deducting 3mm from VDR.) Then carve in a high smile line along with the other landmarks so I know if it will be a gummy smile based on tooth mould (and if it needs to change.) In my book, upper esthetics are far more important than lower so I would get the upper to your satisfaction and then build the lower to correct FWS. As long as there are no extenuating circumstances, the lowers should look just fine if you have the uppers looking good.
 
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dentmech

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For vdr im still trying which method is reliable, some patients are easy to follow instructions, some not so easy.
1.open half way, let lips lighty touch or
2. Wet lips, and gentle blow

What do you think about leaving lowers out when you take vdr does it change patients relaxed position?
 
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Acrylicwookie

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I always leave them out so there is no interference. Leaving them in also makes you risk continuing someone else's mistake. Kind of weird how many techniques there are to get into vdr. I've never heard of either of those. I have tried several and really like having them take a drink of water to wet their mouths, then have them touch the tip of their tongue to the roof of their mouth just posterior to the incisive papilla (I point it out to them cause no one knows what that is.) Then have them gently swallow again causing a slight suction of the tongue and then relax with lips sealed. Swallowing causes the tongue to suction to the roof of the mouth allowing the mandible to hang, which is essentially what natural VDR is for someone with natural dentition. I demonstrate to them and then push up on my chin several times making my teeth audibly chatter to show that naturally they shouldn't touch. The only issue is it is a hard technique for someone with severe dry mouth so you have to do it quickly after that drink of water.
 
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dentmech

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I always leave them out so there is no interference. Leaving them in also makes you risk continuing someone else's mistake. Kind of weird how many techniques there are to get into vdr. I've never heard of either of those. I have tried several and really like having them take a drink of water to wet their mouths, then have them touch the tip of their tongue to the roof of their mouth just posterior to the incisive papilla (I point it out to them cause no one knows what that is.) Then have them gently swallow again causing a slight suction of the tongue and then relax with lips sealed. Swallowing causes the tongue to suction to the roof of the mouth allowing the mandible to hang, which is essentially what natural VDR is for someone with natural dentition. I demonstrate to them and then push up on my chin several times making my teeth audibly chatter to show that naturally they shouldn't touch. The only issue is it is a hard technique for someone with severe dry mouth so you have to do it quickly after that drink of water.
Great Tip Acrylicwookie! it is nice to know different tricks esp. for someone starting like me. i will try that on my next bite reg. Thanks
 
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