Establishing VDO Using Generic Ideals
This process is separate from the CBCT and tissue scans with radio-opaque markers that are needed for fabrication of a surgical guide. This is in addition, and is needed to establish VDO.
If a patient is edentulous, or mostly edentulous, an intraoral scan of temporarily cemented generic ideals provides a wealth of information to assist the lab in implant planning, abutment planning, and bridge design. It indicates the ideal location of the midline, ideal tooth length, the Fox plane, and more. It allows the doctor to determine the ideal placement of temps, and allows the lab to plan accordingly. It also gives the patient a nice preview of what is to come.
The intaglio surface of the generic ideals are modified until the desired results are achieved, then they are temporarily cemented for scanning. The lab is then able to align the records tissue scans to this bridge scan using natural gingival markers in the palate, vestibule, etc.
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Evaluate patient’s smile with dentures, and discuss tooth length with patient.
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Choose maxillary generic ideal arch size to match patient (small, medium, large)
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Hold maxillary generic arch in place while patient relaxes upper lip to determine tooth height.
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Place dentures, and compare tooth height with relaxed upper lip.
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Decide how much needs to be removed/added (if necessary) to generic arch for ideal length.
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Hold maxillary generic arch in place and check Fox occlusal plane.
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Modify generic arch as needed to achieve ideal tooth length and Fox occlusal plane.
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Place Core-Flo DC along the intaglio surface of the generic arch.
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Dry the patient’s gums, and place generic arch with ideal midline & Fox plane, then cure.
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Check stability. If it pops off then you’ll need to “super glue” it with PeriAcryl.
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Dry the intaglio surface of the generic bridge
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Apply PeriAcryl to intaglio surface of generic bridge
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Dry the patient’s gums, and place generic arch with ideal midline and Fox plane, then dry PeriAcryl.
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Place mandibular generic arch in ideal occlusion with maxillary generic arch.
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Have patient close bite to hold mandibular generic arch in place and analyze smile. Patient can protrude mandible several mm if needed to obtain ideal occlusion while maintaining long-term comfort.
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Decide how much needs to be removed/added (if necessary) to generic arch for ideal length.
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If PeriAcryl was required on the uppers you still want to start with Core-Flo DC on the lowers.
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Dry intaglio surface of mandibular ideal arch
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Apply Core-Flo DC to intaglio surface of generic arch (build up posteriors to account for any bone loss)
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Dry the patient’s gums.
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Place generical ideals with ideal midline and occlusion with uppers. Patient can protrude mandible several mm if needed to obtain ideal occlusion while maintaining long-term comfort.
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Cure Core-Flo DC using curing light.
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Apply PeriAcryl if needed (follow same steps as maxillary).
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Scan. Be sure to obtain maximum palatal and vestibular information in all scans to assist with alignment