Dentaltown June 2021 - 51

where the patient should be to get them out
of pain quickly.)
Figs. 5 and 6 show how Lorraine looked
in the TENS bite position: The posterior
opens and she positions forward and down.
Send the results to your lab to mount
on articulator using the TENS bite. Because
you're opening the vertical and likely bringing
the mandible forward, that will result in
posterior or full-arch spaces, so mounting
to the TENS bite will dictate how much
vertical change you'll need to make to get
this patient comfortable. Ask the lab to wax
up to occlusion-either just in the posterior
or a full arch. Because this patient came
forward and down in the posterior while her
anteriors maintained good overbite/overjet,
I did not include the lower anteriors in the
wax-up (Figs. 7 and 8).
If making a fixed orthotic: Using the
wax-up of the opened vertical, have the lab
fabricate a Siltec stent (Fig. 9) so you can
open the vertical with a temporary material
before doing anything permanent. I always
ask for a Siltec stent to fabricate provisionals,
as well as reduction guides, to help me when
prepping. (If making a removable orthotic,
you can skip this step.)
Because we were doing veneers on the
uppers, I had the lab wax up 10 uppers for
veneers as well (Fig. 10), so I could open up
the patient's smile by broadening the buccal
corridor and bringing out the bicuspids.
System 2: Fixed orthotic built
by you or team member
(aka " the middle " )
There are many times where I want to
do a fixed orthotic for a patient but don't
want to send it out to a lab. There could be
time constraints, the patients are eager to
get going, they've driven hours to see me so
we don't want another appointment if we
can get around it-whatever the reason, I
want to have them in an orthotic faster than
the typical lab turnaround time.
In these cases, I will use the TENS bite to
mount the models on an articulator myself,
or have someone on my team do this. Then
I add resin to the buccal cusps (if adding to
lower teeth) or lingual cusps (if adding to
upper teeth) and, before curing, close the
articulator down so the pin touches at zero,
then cure the resin. You may want to add
Vaseline to opposing teeth so you don't
get them stuck together.
Once partially cured, I open the
articulator and add additional resin
to create more ideal tooth shape, then
cure and trim (Figs. 11 and 12). Then
I make my own Siltec stents and we're
good to go (Fig. 13).
Remember to watch out for undercuts
or missing teeth! I learned that the hard
way on a patient who was not only missing
a tooth but also had severe undercuts on
a few teeth because of tipping and tooth
Fig. 12
Fig. 13
dentaltown.com \\ JUNE 2021 51
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Dentaltown June 2021

Table of Contents for the Digital Edition of Dentaltown June 2021

Dentaltown June 2021 - Intro
Dentaltown June 2021 - Cover1
Dentaltown June 2021 - Cover2
Dentaltown June 2021 - 1
Dentaltown June 2021 - 2
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