Dentaltown December 2024 - 37

Knowing that we would do a fullmouth
rehabilitation on the patient,
we had to consider how to manage
the bite. We decided that we would
use centric relation (CR) and we
will increase the occlusal vertical
dimension.
We then had to decide how to open
the vertical-either through direct
or indirect restoration. Because of
the patient's limited finances, it was
decided that we would go with direct
restorations. Later, the patient could
convert these to indirect cohesive
ceramics. With the vertical dimension
of occlusion already established with
the composites, it would allow the
patient to do a few crowns to convert
the case.
With this treatment plan in mind,
we decided upon the execution of the
case. This could be done using a stent
or injection molding with a nanocomposite.
The rationale for going
with the stent was that the patient
bruxes, and using a nanocomposite
showed significantly less wear at
bearing cusps versus any other type
of composites.1
Medical precautions: Based on his
medical history, we asked the patient
to visit his primary care doctor to ask
about possible GERD and to request a
sleep study.
For the diagnostic wax-up, we
mounted the printed cast on the Panadent
articular with the CR bite registration
taken from the deprogrammer.
From the dentofacial analysis we
knew the right cuspid was -2 mm. We
wanted to lengthen teeth #8 and #9
an additional 2 mm. This would make
them 10 mm in length total, which is
within the normal range for central
length.
Figs. 7a -b
To prepare the model, we had to
reduce the enamel slightly on the buccal
of tooth #2 and the distal buccal of
tooth #14 so that the incisal distance
from teeth #8 and #9 from the wax-up
plate was 10 mm (Fig. 6).
Teeth #6-#11 were waxed up to
the plate with the exception of teeth
#7 and #10, which we made 0.5 mm
shorter to the plate for aesthetic
appearance (Figs. 7a-7b).
Buccally and lingually, 0.2 mm of
wax was added to replace the missing
enamel and for composite strength.
To develop the maxillary posterior
plane, we lengthened teeth #2-#5, and
Fig. 5
#12-#15 to level to the wax-up plane,
adding an additional 0.5 mm-1 mm
of wax to the posterior teeth (Figs. 8a
and 8b) and 0.2 mm wax was added on
all maxillary posterior teeth labially
and lingually to strengthen the composite.
This replaced missing enamel
and helped develop full contour of the
posterior teeth.
We saw from the patient's dental
facial analysis that his mandibular
lip dynamic was high at 5.3 mm. We
didn't want to lengthen the lower
anterior teeth too much since he was
showing his lower teeth already, but
we wanted to lengthen them enough to
Fig. 6
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Dentaltown December 2024

Table of Contents for the Digital Edition of Dentaltown December 2024

Dentaltown December 2024 - Intro
Dentaltown December 2024 - Cover1
Dentaltown December 2024 - Cover2
Dentaltown December 2024 - 1
Dentaltown December 2024 - 2
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