Mastering Full Mouth Rehabilitation: Key Steps to a Seamless Process
Full mouth rehabilitation can feel like a monumental challenge, but the rewards it brings to both patients and dental practitioners are truly worth it. While there are many essential pre-operative and operative records, two stand out as key players: the bite record for the diagnostic wax-up and the molar control bites on the day of prep. These are critical in ensuring a smooth, predictable process—without them, the journey can quickly become riddled with challenges.
Step 1: Deprogramming the Patient
The first step toward achieving a predictable increase in vertical bite is deprogramming the patient. A simple, in-office fabricated splint, worn by the patient at night for two weeks, can work wonders. This “Quick Splint” isn’t just easy to make—it helps prepare the patient’s muscles and jaw for a more accurate bite record. Ideally, the patient should wear the Quick Splint in the office before you take the increased vertical bite record, providing the best foundation for success.
Step 2: Determining Vertical Dimension Increase
Now it’s time to figure out how much vertical dimension needs to increase. You’ll do this by measuring the new length of the maxillary and mandibular centrals and determining the desired overbite. A useful rule of thumb: don’t increase the overbite more than what the patient already has pre-operatively. In fact, decreasing the overbite compared to the original measurements is often the most ideal scenario.
Step 3: Taking the Deprogrammed Bite Record
With the vertical increase calculated, it’s time to take the deprogrammed bite record. A leaf gauge, set to the final vertical position, is a quick and effective tool for most cases. However, for patients with pre-existing pathway wear, using a flat surface without a ramp (such as a composite ball bite) is preferred. By setting the composite ball at the desired vertical, you can use Futar-D in the posterior and replace the ball with Futar-D in the anterior segment for the best bite record. Remember: Futar-D from Kettenbach is the only Clinical Mastery-approved bite registration material to use for both centric relation and increased vertical bite records.
Step 4: Placing the Mock-Up
Once the lab returns the wax-up, it’s time to place the upper and lower mock-ups. Use model reduction guides, stents, and siltech putty matrices to ensure the mock-up fits perfectly. After confirming that the measurements match the wax-up, check the occlusion with articulating paper to ensure there are no interferences in the mock-up. If any interferences are present, the bite records will be compromised later. Once the occlusion checks out, perform molar control bites on the un-prepped molars with Futar-D.
Ensuring Accurate Diagnostic Mounting
When done properly, the increased vertical bite will allow for an accurate diagnostic mounting. This ensures the mock-up articulates without interference, setting the stage for flawless bite records during the preparation visit and beyond.
Bite off more than you can chew—and with the right approach, chew it anyway! Full mouth rehabilitation doesn’t have to be overwhelming if you follow these key steps and use the right materials. By staying organized and precise, you’ll ensure a smooth, successful process for both you and your patients.
LEARN MORE ABOUT CMS FULL MOUTH RECONSTRUCTION LIVE PATIENT COURSE
