Recording the bite in worn dentition
When patients’ teeth are affected by wear process their main concern is, usually, esthetics. To enhance the smile and recreate ideal proportion in the anterior zone we need some space to recreate the function and then esthetics. Professor Jean Francois Lasserre from Bordeaux call it “the bio-functional esthetics”.
It it highly recommended that, in these cases, the vertical dimension be increased in order to reduce the biological cost of our treatment (Vailati F, Fradeani M, Koubi S).
This is why it is highly recommended to get all the needed data to let the technician wax-up the missed volume in the new free space which has been created by the new vertical dimension. The data you should collect, hence, is:
– face, smile, intraoral picture
– impression of both arches
– record of the face references with Ditramax device (www.ditramax.com)
– free hand composite shape modeling on the 2 central insisors (buccal and palatal) to set the length and the new incisal edge to create the new volume we are looking for. I can’t stress enough how this one step is the key factor to build the new full arch.
Same protocol is applied to the palatal anatomy on the 2 central incisors. Then it is very important to check the new space created in the posterior area to see if we have or not enough available space or if the final esthetic will be modified by the added occlusal veneer. If the smile line must not be modified then we will have to reduce the increase of the VDO. In this case a smile improvemente is expected which means a lengthening of the lateral corridor.
This is why we use the Luxabite (DMG) as an accurate bite registration. The practitioner has to inject a small quantity on the occlusal surface in order to remove and replace it without fracture. The setting time must be minimum of 2 min in order to have the complete curing of the resin.
Also, the accuracy and the esthetic of the bis-acryl resin (luxatemp star, DMG) is very useful to communicate with the patient.
Every time a full mouth rehabilitation is needed, steps such as recording the bite, increasing the VDO (where, how much..) scare the dentist. This is why a simple protocol which is accessible to everyone has been presented in this simple article. Some tips and tricks using any kind of composite and one specific bite registration bis-acryl resin are the key for the success.
Once the project is edited and validated in the mouth thanks to the full mock up concept, a precise and guided dentistry can be performed in the mouth in order to work fast and being minimally invasive.
1. Koubi S, Gürel G, Margossian P, Massihi R, Tassery H. Le projet esthétique et fonctionnel: nouveau “GPS” de la dentisterie moderne. Rev Int de Proth Dent 2014, n°4 : 257-272.
2. Koubi S, Gurel G, Margossian P, Massihi R, Tassery H. Nouvelles perspectives dans le traitement de l’usure: les “Table Tops” Réalités Cliniques 2013. Vol. 24, n°4 : pp. 319-330
3. Vailati F, Belser U. Classification and treatment of anterior maxillary dentition affected by dental erosion: the ACE classification. Int J Periodontics Restorative Dent. 2010 Dec;30(6):559-71.