Darin O'Bryan, D.D.S. When trying to tackle (the Super Bowl has just happened and, of course, I am using football references) multiple anterior restorations a systematic approach will make for efficient and predictable results. In this multi part blog I want to walk through the thought process as well as the techniques used to make for an efficient appointment.
This patient originally presented with a chief complaint on her upper teeth. She had multiple crowns and a long spanning bridge. Extensive caries and periodontal disease made salvaging the maxillary teeth impossible. So the teeth were extracted, grafts were placed and an immediate denture was placed. Due to the urgency of the maxillary and the patient was not ready to discuss the lower teeth. After she was out of pain she then wanted to correct the esthetics of the lower teeth. This led to a challenge since the maxillary denture was already fabricated and the occlusal plane was made to the roller coaster (sorry couldn’t come up with a good foot ball analogy) occlusal scheme she had.
First and foremost we need a wax up. This will allow us to determine the best occlusal plane. The benefit with having an upper denture is we can always reset the teeth once we have a good mandibular plane established. We used the wax up to visualize how we needed to level the curve of Spee and Wilson. To get and accurate wax up we need a good impression and bite record with a horizontal marker placed in the bite record. For this I just use a stick from a cotton applicator. Once the wax up is done the model is duplicated in stone and a plastic vacuform matrix is made. This will be used to transfer the information to the mouth.
Now that the final outcome is designed it is time to start preparing teeth. This will be the topic of the next blog.
