Vertical dimension occlusion can be opened
Vertical can be opened to almost anything that appears esthetic and works with speech. Must open anterior at same time as posterior to avoid headaches, muscle fatigue, and para-function. Prep, temp, and restore via a SDA theory. Then do molars last.
Steps
Accurate pre-op casts and make custom incisal guide from protrusive and eccentric
Arbitrary facebow mounting Kois
Determine incisal length maxillary teeth you want just photograph
Crown lengthening or ortho needed?
Composite mock up of anterior centrals and of mandibular centrals
Make a set of extra oral measurement of that VDO
Get a AMPSA that opens to that height and have wear 1 week and over night into office in morning take CR bite at that height
Lab
Wax up SDA premolars forward at new height(Make suck down of this and prep guide if needed=shouldn’t)
Make vent holes in suck down
Draw with black marker on facial where max or mand frenum help line up
Patient prep date
Seat initial reduction guide if needed.
Place bis-acylic in suck down and set on teeth. Can use as reduction guide
Check chewing envelope by sitting up and have chew on gum with 200-micron articulating paper in anterior. All non CR contacts eliminated and noted on wax up. End of phase 1 here
Prep and temp
Inject with tip in incisal edge and also inject around margins on teeth
Evaluate seating by any excess bis-acryl on palate or unprepared teeth
Add flowable patches before oxygen inhibition layer removed.
Check chewing envelope again by sitting up and have chew on gum with
200-micron articulating paper in anterior. All non CR contacts
eliminated and noted on wax up. End of phase 1 here
Repeat opposite arch. Wear for three weeks.