Treatment Planning Symposium 16th November Hybrid event: https://www.protrusive.co.uk/rx
Are you still afraid of raising the Vertical Dimension? You cannot break free from the shackles of single tooth Dentistry if you don’t get comfortable with vertical dimensions changes in Restorative Dentistry.
https://youtu.be/Nb-LTyzRKuUWatch PDP197 on YoutubeIn this episode, Dr. Jaz Gulati and Dr. Mahmoud Ibrahim simplify the complex topic of increasing vertical dimension.
What is a safe limit of increasing the vertical dimension?
They cover the essentials of joint health, muscle stability, and the importance of centric relation (does it actually matter?)
Protrusive Dental Pearl: Use Duralay copings for guide planes to ensure stable dentures with a single path of insertion. While eyeballing the prep can be challenging, he suggests requesting acrylic copings from the lab for precise preparation. He explains that technicians survey models to identify undercuts and determine the path of insertion, and instead of manual prepping, he advises using lab-created reduction copings and acrylic jigs to simplify and accurately guide the preparation process.
Need to Read it? Check out the Full Episode Transcript below!
Highlights of this episode:
This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.
AGD code: 180 Occlusion (Occlusal therapy)
This episode meets GDC Outcomes A and C.
Dentists will be able to:
Explore key clinical considerations and current research in restorative dentistry related to vertical dimension, enhancing your ability to make informed decisions.
Understand the relationship between joint position and vertical dimension, and how to assess and manage this relationship effectively.
Recall the guidelines for assessing the vertical dimension and the safe limit for this in dentate patients.
If you liked this, you will also like Functionally Generated Path Technique – Conforming to Funky Occlusions – PDP168
Click below for full episode transcript:Teaser: But it can also help you stage treatments, right? It's a great technique to learn because it allows you then to stage those more comprehensive cases. So one of the most useful things about opening vertical dimension is gaining space for your material without having to prep teeth that they're usually already quite worn. Now that is a huge benefit for anterior teeth, but also can come into play on back teeth.
Jaz’s Introduction:I used to be petrified of opening the bite, i.e any kind of treatment that would increase the patient’s vertical dimension would be way out of my comfort zone and it really made me worried like, is the patient going to adapt?
Are they going to get joint pain? Am I perhaps increasing the vertical dimension too much? And so for the first 18 months of my career, I was focusing on conformative dentistry. Not having to change the vertical dimension, just accepting the patient’s bite for what it is and working with it. You know, a filling here or a crown there.
And back then it mostly was small and large composites. I was still finding my feet, I wasn’t confident with indirect dentistry, and like I said, occlusion is confusing to all new grads. And I remember the first couple of cases where I started to think about this, whereby the only way I can solve this patient’s occlusion and give them what they want, be it denture or some new restorations, would involve opening the vertical dimension.
I was speaking to my principal and I said, okay, are you sure this is going to work? Is it going to be okay? What if the patient has pain? And I think a lot of you have also been through this and some of you may be in that place right now. Which is why with Dr. Mahmoud Ibrahim, we’ve created this episode specifically devoted to vertical dimension.
Look, this short episode, whilst we’re going to really make sure it packs a punch, is not going to allow you to open the vertical dimension, but it’s going to inspire you to think about it more. It’s going to give you some guidelines in terms of how much you can raise the vertical dimension. Is there a magic number?
And how is it measured? Which patient should we not be thinking about raising the vertical dimension? And which patients may need an occlusal appliance, and for how long, before we were to think about raising the vertical dimension for that patient.
Hello, Protruserati, I’m Jaz Gulati, and welcome back to your favorite dental podcast. It is Occlusion Month, it is September 2024, devoted to occlusion, and this episode we’ve got something for everyone. We’ve got something for the new grads, really reconnecting with those feelings I used to have as a new grad. And for those of you who have a little bit more experience, we’ll give you a few more ideas about me and Mahmoud record the vertical dimension to make sure we have to do as little adjustment as possible.
Dental PearlNow, every PDP episode, we give you a Protrusive Dental Pearl. This pearl is inspired from the last episode about digital dentures. It was a request we had in a YouTube comment. I’d mentioned these duralay copings for the guide plane. So know how we do dentures. We try to build in these guide planes to allow your denture to have one path of insertion. And that generally gives you a more stable denture, one with more retention and stability. But again, when I was a new grad, I had no idea about how to prep for a guide plane. But I’d like to share with you now how I do it currently.
And this is something that we can all do. And I think if you get your technician involved, it makes your life a little bit easier. I mean, yes, you can eyeball it. Because as long as you can remove that maximum bulbosity of a tooth, and you can really picture that path of insertion. And kind of like when you’re doing a bridge, you want the surfaces nice and parallel against each other.
But sometimes that’s tricky to do, which is why you can ask your lab to make some acrylic copings. So what’s happened is that the technician has surveyed the models, found out where the undercuts are, decided on the path of insertion along with your guidance, and instead of you just prepping the guide planes, you can ask for these reduction copings, whereby the technician has actually prepared the guide planes on the model, actually drilling the teeth on the model, and making this acrylic jig so that all you have to do is put the jig on the tooth, and it will highlight the exact area you need to prepare.
So those of you who are listening and commuting right now, if you’ve never done this before just visualize a little like a sleeve going on the tooth and now the belly of the tooth is exposed and you just get like a nice long carbide bur and shave that away until you’re flush against the coping.
If you’re watching on Protrusive Guidance app where you can get CPD as you know or on YouTube then you would have seen a visual for that. It’s a cool thing to do, especially when you have loads of guide planes to worry about. As always, as was the theme of the last episode, make sure you have a good relationship with your technician. Have a chat with them. Pick up the phone before you do this kind of work. Anyway, back to occlusion now. Enjoy the episode and I’ll catch you in the outro.
Main EpisodeDr. Mahmoud Ibrahim, my occlusion brother from another mother. How are you doing, my friend?
[Mahmoud]I’m good, man. How are you, Jaz? You good?
[Jaz]I’m all bunged up, as you know, with the kids getting one bug to the next bug. But the show must go on, as they say in Hollywood. And so will this educational podcast. Today we’re talking about the vertical dimension of occlusion. And I think it’s fair to say, Mahmoud, that this topic, podcast topic, when I suggest it, just scared us just a little bit, because it’s so vast, like, how do we even begin to tackle this topic?
So, what we did is we came up with some sensible topics that we think is realistic to cover in a podcast, that’s going to give a lot of value to everyone who makes, listens to this, and can take away enough nuggets to really improve their standard of dentistry. So we have a tough one. For the very few people, maybe they’ve just googled occlusal, vertical dimension occlusion, they’ve landed on our podcast, and then you, Protruserati, hello.
[Mahmoud]Hello, hello.
[Jaz]Just tell us about yourself, Mahmoud. Remind us about you as a clinician, what you stand for, your love of occlusion.
[Mahmoud]Ah, yeah, so,...