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Dental Tribune Middle East & Africa No. 4, 2016

Dental Tribune Middle East & Africa Edition | 4/2016 17 RESTORATIVE to place prototypes on all the teeth and then to spend time reassess- ing occlusal planes, aes- thetic concerns and of course occlusal scheme and comfort of the pa- tient. The long term success of the final restoration is directly proportional to the skill and time in preparing and plan- ning prototypes and their adjustments. It is easy to lose vertical dimension, occlusal stability and ideal sealing of the condyle in the fossaifthisstageishurried. If increasing vertical dimension then either the timing of the preparation and prototypes is changed to accom- modate all initial procedures in one week or full occlusal contactsneedtobere-establishedonposteriorteethdur- ingtheintervalbetweenfittingoftheanteriorprototypes andthefinalsegmentsoftheposteriors. Impressions/JawRelationship Oncethepatienthasconfirmedthattheyarehappywith theaestheticappearance,issymptomfree,havinganide- alocclusalschemewithmultiplecontactsonallteethand the condyles in RAP with smooth shallow anterior guidance the next stage of treatment is to take impres- sions and jaw registrations. This can bedoneinseveralways. A similar sequencing of events can occur as anterior prototypes are re- moved,retractioncordsplaced,teeth re-prepared, sealed and impressions, jaw registrations and facebow recod- ings made with the posterior proto- types maintaining occlusal contacts, vertical dimension and a stable RAP position. Alternately there are times when the full arch needs to be delivered to the patient at one go. This may be the case when anterior and pos- terior teeth are linked together in bridgework; there are limited num- ber of appointments; patients are travelling long distances or vertical dimension is being increased on the fullyadjustablearticulator.Thisthen requires the use of duralay bonnets or copings on all teeth and the use of ◊Page16 Figure14:Facebowrecording Figure15:Cadiaxrecording Figure 17: Restorations on the fully-adjustablearticulator ÿPage 18 Figure11:Initialpresentationshowingwornupperdentition Figure12:Hopeless teethremoved Figure16:Cadiaxrecording Figure 18: Upper arch on the fully-adjustable articulator Figure13:Prototypesplaced Dental Tribune Middle East & Africa Edition | 4/201617

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