Opening Vertical Dimension of Occlusion by Dr. Jim Furgurson
Kevin came in for a consultation in October 2014 with a chief concern of “I want to fix my smile”. In hindsight, my note from that day isn’t so bad. I recognized his conditions—class II, deep bite, severe attrition, failing restorations, yada yada yada. I even mentioned a full mouth rehab as a possibility…of course at that time he would HAVE to see an orthodontist first.
We saw him the following week for FMX/Comp Exam/Prophy. I referred him to endodontist for eval of a few teeth, took alginate impressions for study models, took some photos. According to my note, I reached out to a couple of mentors for advice. Then I referred him to ortho who recommended…believe it or not…comprehensive orthodontics!
Education & Training
Next time I saw Kevin was in May 2015 for recall and he had not moved forward with orthodontics. It was about the same time that I started to research a good curriculum to learn how to do a full mouth rehabilitation. At this point in my career, I had taken hundreds of hours of continuing education, including a lot of occlusion/restorative courses through Spear and Dawson. However, I lacked the knowledge and confidence to take on restoring a full mouth or arch. Through Dentaltown, I found Clinical Mastery Series and John Nosti, and signed up for my first CMS course “Mastering Full Mouth Rehabilitation” in October 2014.
In November, I used my new knowledge to deprogram and take new records (Facebow, CR bite at approximate new VDO, photos, PVS impressions) on Kevin. Working with mentors and a great lab (Gold Dust) we planned Kevin’s reconstruction. Given his severe attrition and need to restore vertical, orthodontics would have done little for Kevin. We planned and executed 20 units of Emax the following year. To be honest, I was terrified to open vertical and leave molars out of occlusion. I was shocked when it didn’t bother him and he didn’t die. In the years since then, we have restored one or 2 molars at a time and he’s doing great.
Ceramics by Gold Dust, Emax with micro cutbacks and layered porcelain, Shade A1
Hindsight 20/20 what would I have done differently?
- virginized all teeth–#8/9 especially
- Since this was my first FMR and not the most straightforward, I would have completed upper arch against interim mock up on lower, then completed lower. This allows you to focus on esthetics, then still have total control over occlusion, function, and perhaps a more seated condylar position.
- I would have used a lighter shade, maybe a BL4 or OM3