Bite Off More Than You Can Chew- and Chew it Anyway!
Full mouth rehabilitation can be one of the most daunting and yet rewarding aspects of a comprehensive dental practice. There are several pre-operative and operative records that are extremely important, but arguably the bite record for the diagnostic wax-up, as well as the molar control bites the day of prep are the two most important records that will dictate whether the process will be smooth and predictable, or fraught with pitfalls and setbacks. 
Step 1: Deprogramming the Patient The first step in performing a predictable increased vertical bite relationship is to deprogram the patient for 2 weeks prior to performing the bite record. A quick splint fabricated in-office and worn at night by the patient is a simple, yet effective solution for a deprogrammer. As an added benefit, it is ideal to have the patient wear the Quick Splint to the office prior to taking the increased vertical bite record.
Step 2: Determining Vertical Dimension Increase The second step is to determine the amount of vertical dimension increase that is required. This is performed by determining the new length of the maxillary central (A Point), the new length of the mandibular central (B Point), and then determining the amount of desired overbite. A good rule of thumb is to not increase the overbite more than what the patient has in the pre-operative measurements. More ideal is to decrease the overbite compared to their pre-operative measurementsl
Step 3: Taking the Deprogrammed Bite Record Once the measurements have been determined, it is now time to take the deprogrammed bite record. A leaf gauge, set at the desired final vertical, can be a rather quick and easy way to perform an increased vertical bite record in most instances. However, when patients have preoperative pathway wear, it is more ideal to have a flat surface without a ramp, such as a composite ball bite would produce. With the composite ball set at the desired vertical, Futar-D is used in the posterior, and then the composite ball is replaced with Futar-D in the anterior segment. Futar-D from Kettenbach is the only Clinical Mastery approved bite registration to be utilized for centric relation or increased vertical bite records.
Step 4: Placing the Mock-Up Once the prescribed wax-up is returned from the lab, it is now time to place the upper and lower mock-up in place by using the model reduction guides, stents, and siltech putty matrix. Confirming that the measurements of the mock-up match the wax-up, it is then time to check occlusion with articulating paper and verify there are no interferences in the mock-up. The bite must not have interferences because if they exist in the mock-up, then the bite records moving forward will be incorrect/inaccurate. Once the occlusion is confirmed, it is then time to perform Molar Control bites on the un-prepped molars with Futar-D.
Ensuring Accurate Diagnostic Mounting
Performed properly, the increased vertical bite will provide an accurate diagnostic mounting, allowing the mock-up to articulate correctly without interferences, which then provides the accuracy required to perform bite records throughout the preparation visit. #RockTheDrill
