Dentaltown April 2020 - 73

Fig. 7

on patients with worn teeth; we open the VDO for
prosthetic convenience. It is also important to know
that when we open a vertical, the dentition may
adapt, and slowly go back to the original vertical
over a six-month period.
The good news: If we have a stable occlusion, as
we've previously described, the patient will not even
be aware this adaptation process is occurring.

Fig. 8: Bonded "tops" designed virtually in Exocad.

When can opening the VDO be helpful?
* Worn dentition
We make the decision on how much to open the
vertical on an articulator with properly mounted models
in centric relation. It is rarely more then 2-3 millimeters
at the pin.
If we consider the patient in Figs. 2-4 (p. 71 and
facing page), we see a mouth with significant wear
and erosion. If we were to consider crowning these
teeth at the patient's present occlusion, it would result
in too much reduction, pulpal impingement, and
decreased retention and resistance form.
Additionally, as these patients wear their teeth,
they often end up with very little overjet and very
steep guidance angles that often interfere with the
envelop of function. In Fig. 5, notice when the vertical
is opened (on the arc), the lower incisors drop down
and back, creating decreased overbite and increased
overjet, lending itself to shallower guidance angles
that puts far less horizontal load on the front teeth.
We gain much-needed space on the posterior teeth
to add back what is missing. This gives us many options
to restore the posterior teeth. In our example, because of
the age of the patient and the desire to phase treatment,
we used bonded resin "tops" and simply added back the
tooth structure that was missing, allowing us to set up
an ideal occlusal relationship and focus our attention
on the final aesthetic restorations on the front teeth.
Figs. 6-9 show the virtual wax up with ideal anterior
relationships with posterior "topper design."

Fig. 9

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Dentaltown April 2020

Table of Contents for the Digital Edition of Dentaltown April 2020

Dentaltown April 2020 - Intro
Dentaltown April 2020 - Cover1
Dentaltown April 2020 - Cover2
Dentaltown April 2020 - 1
Dentaltown April 2020 - 2
Dentaltown April 2020 - 3
Dentaltown April 2020 - 4
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