How to increment vertical dimension in a predictable way
Even when placing only a tooth colored composite resin restoration, esthetic principles need to fall into place in order to achieve a successful result that satisﬁes both clinical aspect as well as the harmonic facial aspect. Esthetic dentistry does not begin or end inside the mouth, teeth need to ﬁt into the entire framework of the face.
In this course we will:
- Include the concept studied during Level 1 and Level 2 about the physiology of occlusion. In addition , during this Level 3 , we will combine digital planning for a esthetic case taking into consideration how much vertical dimension should be increased based in facial harmony.
- We will plan a case starting from : facial analysis to establish the esthetic harmony , followed by taking the appropriate vertical dimension for the esthetics.
- We will integrate the data to manufacture a functional mock up for top and bottom, to transition in the next Level 4 to prep for permanent upper ceramics.
- In this course you will understand when to add and when to remove for a proper restorative phase.
- We will start the process for analysis for function (gathering of records, pictures), proceed with planning digital using NEMO , printing STL , manufacturing of matrixes for temporization, and mock up presentation.
- During the course we will emphasize on :
- Incisal display
- Gingival display
- Inﬂuence of the natural head posture and facial esthetics
- Diﬀerence between an emotional mock up versus a functional diagnostic wax up
- Students will learn the capability of 3D Data Integration from CBCT intraoral impressions, facial scans and pictures.
- Learn how to transfer the digital records for the smile design to the analog articulator
- We will go over the 3 diﬀerent alternatives of long term mock ups : transitional shells , palatal support, and matrix
- We will review equilibration and coronoplasty techniques brieﬂy for this speciﬁc mock up presentation ( Level 1 and Level 2 is more in depth).
This course is not a software course. The attendants will have the opportunity to see the entire process for data collection, case presentation , digital planning, designing, printing, to functional occlusal adjustments
The students will have hands on practices on how to :
- Manufacture matrixes from printed models
- Mount occlusal plane based on the pupil line or long axis of the face. When to use which landmark or reference? They will practice with Full Face pictures that will be provided for them printed ( as a handout) to mount the occlusal plane on an occlusal table. Practice is based in diﬀerent cases, and diﬀerent scenarios.
DAY 1 / 6TH MARCH
How each case starts.
- Facial Esthetics analysis
- Incisal display – borde incisal superior
- Occlusal plane :
- vertical dimension
- Occlusal plane compensations and considerations
- Caliper – to measure bites
Treat a patient from beginning to the end, going back to basics: retro engineering. Take a vertical dimension based in the facial esthetics needs Explain diﬀerent workﬂows: Taking bite ﬁrst to design mock up, or design mock up and take bite at the time of mock up presentation.
DEMO on live patient:
- Take pictures
- Digital Impressions ( generate STL’s)
- Nemo Design ( 1st Day afternoon) ( we need the projector to show design screen)
- Everyone will be tensing while Demo of the Smile design is going on
HANDS ON PRACTICE:
- Take bites on each other ( groups of 2) based on the facial esthetics of each participant
- Fill out handout with considerations when taking bite – for notes and review in group discussion
- Nemo Design will be ﬁnished and will be sent to print for 2nd Day of the course.
Day 2 / 7th March
- 1st day review main points
- Mock up presentation hands on Demo on Live patient
- How to drive the mock up ? towards a semi permanent case? Or as a transition to permanent crowns?
- Permanent cementation of mock up
- Go over cases that need crown lengthening, how to present the alternative and need for these procedures. Also go over mock ups guiding orthodontics .
- JAW Tracking
HANDS ON PRACTICE:
- Each attendant MUST bring their own models of their own mouth : good quality, no tags, or bubbles . Students will use their own models to make a dento gingival analysis
- Patient equilibration
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