Gaining Vertical Dimension for the Deep Bite Restorative Patient

Abstract

The value of utilizing an orthodontic specialist in treating these patients cannot be overemphasized, but it should be borne in mind that the ultimate responsibility for the entire treatment belongs to the referring restorative dentist. Therefore, the restorative dentist must give to the orthodontist a detailed description as to where he wants the teeth to be positioned. At the same time, he should respect and appreciate the limitations of orthodontic treatment. Each case should be discussed in detail before and during treatment so that both orthodontist and restorative dentist know and understand the goals and limitations of the other. Although the authors utilized a modified Crozat technique, they feel that other appliances may produce comparable results. 5 It is suggested that the operator use any appliance which works well in his hands and yields the desired results. Often this requires modifications of basic techniques because of unique problems found in adults. Frequently in discussions of complete prosthetics, mention has been made about the problem of encroachment on freeway space to a point where the patient is uncomfortable and complains of tired muscles, teeth colliding, and so on. However, the authors have not encountered this problem in the treatment of Class II deep bite patients, although the vertical dimension has, in some instances, been increased several millimeters in the anterior region. These patients may not encounter discomfort due to the increased vertical dimension for two possible reasons: first, they are biting on soft acrylic splints or bite planes; secondly, the extended treatment periods necessary for tooth movement allow the patient to accommodate gradually. Once these patients were orthodontically treated and the restoration completed, there was little need for a long retention period, except for some severely rotated anterior teeth. It is felt that the cusp-to-fossa arrangement of the occlusion acts to retain the posterior teeth, while the lips, tongue, and cheeks act to retain the anterior teeth —this may be termed functional retention.