In this video I explain how to articulate a full mouth rehabilitation when preparing all the teeth at once. The posterior temporaries hold the vertical while a record is made in the anterior.
I think my biggest question is how do you reconcile removing so much tooth structure? I'm actually curious as that is a major mental obstacle for me. Thanks
I always try to be conservative in my preparations, while achiecing the resistance and retention form I need. This case was done seven years ago and I am now using more adhesive dental techniques and preparations.
Hello! I am a young dentist. I want to know how you determine the exact CR for a cases like this? I want to ask, is there any method to determine the exact registration impression for mouth rehabilitations
Thank you for your question. I use "one hand-chin point guidance" when guiding my patient into CR. I tell them to put their tongue backwards, which relaxes their jaw so I can guide it gently back into CR (a fully seated condylar position). I constantly check the CR at each visit so I confirm that the articulated casts match the mouth. Since, I'm restoring the whole mouth, I need a treatment position that is repeatable = CR. The initial diagnostic wax up is done in CR. I make multiple records from the day I prep the teeth because they should match, if I have captured the same CR position. All the best, good luck!
hello,great video i have two questions please 1)what is tour sequence when it comes to prepare teeth? 2)the second duralay record (maxillary preps facing mandibular temporaries),is made at wich step ?thank you in advance
Thank you for your inquire. 1) I believe in this case I prepped and temped the maxillary arch in a full morning appointment. Had the patient back to do the same thing for the mandibular arch. Once we were satisfied with the temps, had the patient back for full mouth impressions and jaw relations. 2) I made all the jaw relation records in the same appointment, usually on a different day than the prep day and usually the same day as final impressions. I start by keep the posterior temps on and taking anterior temps off, that way the vertical is maintained. Now that I have an anterior prep-prep record, I keep this in place and remove the posterior temps and record that dimension. Now I have records to articulate both prepped casts. Now, I want records to cross articulate the cast of the temporaries for the lab. I put all the temps back on (max and mand) and remove the maxillary anterior temp and make a record here. Now put the maxillary anterior temp back in and take off the maxillary posterior temps and make a record here against the mandibular temps. This now gives you records of the maxillary prep cast against the mandibular temporaries. Then, with all the temps back in place, make a record of maxillary temps against mandibular temps, if you need it and cannot hand articulate the temporaries casts.
Hello sir once v fabricate provisionals... v make final impressions of our prepared teeth both maxillary n mandibular....if v make a bite record with provisionals on n use same record to articulate our final casts with maxillary cast mounted using facebow transfer can it be done??? Ur view on this sir
Thank you for your question. Yes, I articulate the master casts using the bite record with the provisionals. One side of the povisionals is in the mouth, to hold the OVD, while the remove the other side to capture the space. And then, I switch it and make a record on the other side.
I did the wax up without prepping the cast. From the wax up, I duplicated the cast and make a vacu-form suck down and bonded composite in place over the existing dentition to help me visualize my restorative space requirements. It is an extra step and I do not currently cases this way. I just use a vacu-form or silicone of the wax up to visualize space requirements.
It was nice video ..thank you for sharing ..but I HV a question regarding the increase in vertical dimension.how do u determine how much vertical height can be increased without tmj dysfunction and do u communicate the height to the lab for the first time for wax up ? Thank you in advanced
Thank you for your questions. I only increase an amount necessary to give me restorative space for the needed restorations. Some room will be gained in just doing the tooth prep reductions. In the beginning, it's an arbitrary amount. I start with 2-4mm in the anterior and that has been sufficient for the cases I've done. Remember, 3mm opening in the anterior equals about 1mm in the posterior, based on the arch the jaw opens. To communicate this to the lab, I send them the acrylic lucia jig bite record in CR. This way, they are waxing the proposal to the height I want and in the patient's CR. Before treatment begins, a hard night guard can be made at this same opening for the patient to wear for a couple months to confirm their TMJ can handle this opening.
Good Morning, I did not do RCT on these teeth. He had some existing root canal treated teeth but I did not do any more for restorative reasons. I gained space by increasing the vertical.
