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Thank you. I have been posting more on tiktok and Instagram. I agree, I need to do better at posting!

Thank you for your questions. I did this case many years ago but I believe I just used the mandibular clear matrix to bond in a composite mock up so the occlusion would be at the appropriate OVD when I prep and temped the maxillary arch.

I always try to be conservative in my preparations, while achiecing the resistance and retention form I need. This case was done seven years ago and I am now using more adhesive dental techniques and preparations.

Thank you for your question. Yes, I articulate the master casts using the bite record with the provisionals. One side of the povisionals is in the mouth, to hold the OVD, while the remove the other side to capture the space. And then, I switch it and make a record on the other side.

Thank you for the kind words, message me about what more information I can provide.

Thank you for your questions. Without knowing all the details of your case, it is hard to say for certain. For deep bite cases, we usually want to provide more space and we can use orthodontics or open the bite using full mouth restorations. Onlays and veneers does sound like one way of achieving this. Orthodontics maybe another option to consider with your dentist.

@@derekgatta7239 Thanks a lot. When vertical space increment is tried, is it possible to get a position without TMJ or jaw pain. Why I am asking is that currently I am under this treatment with blue material for increasing height on back teeth but getting jaw pain. My dentist told its trail and error till a position without pain is achieved. Just want to know whether I am on right track of treatment while increasing The VD space.

Thank you for your great question! Due to timing, we started the case before the implants went in. At first there was no occlusion on the left, until I delivered the implant bridge. At that preliminary stage, there was only occlusion on the right and #11. You are correct! I want the shimstock to be able to drag through for anterior occlusion and they really only engage heavy anterior forces in protrusion. I want them to have that freedom and not feel "lock in".

Thank you for your questions. At that time, I was bonding in my restorations using Ivoclar Multi-link resin cement.

Thank you for your question! The temporaries are for patient convenience and they also help me to test the change in vertical and esthetics. I want the temps to be as close to the finals as possible. I don't want big changes made between the temps and finals.

@@derekgatta7239 thank you so much sir for your proper answer

Thank you for your question. I usually make three temps per arch (2 posterior and an anterior). I'll prep a sextant and make temp while the mock up composite is still maintaining the vertical. Then I prep the remainder while the new temp is holding the vertical. Hope that provides some clarity, all the best!

@@derekgatta7239 With mock up composite, should I just hold the increased vdo with composite in the central fossa of the lowers (much like orthodontists)? Or we can make a device? In that case, what's the name of the device and the lab that would fabricate it, any recommendations?

Thank you for your question. If you cannot hand articulate your casts, then you need some way to relating the vertical dimension to the articulator. Record bases are ideal for this and yes it may take another appointment and a lab cost. Some people may try to fake it with a stiff wax or registration material but I think you will be disappointed on delivery with an inaccurate restoration.

Thank you for your inquire. 1) I believe in this case I prepped and temped the maxillary arch in a full morning appointment. Had the patient back to do the same thing for the mandibular arch. Once we were satisfied with the temps, had the patient back for full mouth impressions and jaw relations. 2) I made all the jaw relation records in the same appointment, usually on a different day than the prep day and usually the same day as final impressions. I start by keep the posterior temps on and taking anterior temps off, that way the vertical is maintained. Now that I have an anterior prep-prep record, I keep this in place and remove the posterior temps and record that dimension. Now I have records to articulate both prepped casts. Now, I want records to cross articulate the cast of the temporaries for the lab. I put all the temps back on (max and mand) and remove the maxillary anterior temp and make a record here. Now put the maxillary anterior temp back in and take off the maxillary posterior temps and make a record here against the mandibular temps. This now gives you records of the maxillary prep cast against the mandibular temporaries. Then, with all the temps back in place, make a record of maxillary temps against mandibular temps, if you need it and cannot hand articulate the temporaries casts.

I did the wax up without prepping the cast. From the wax up, I duplicated the cast and make a vacu-form suck down and bonded composite in place over the existing dentition to help me visualize my restorative space requirements. It is an extra step and I do not currently cases this way. I just use a vacu-form or silicone of the wax up to visualize space requirements.

Thank you for your question. If a tooth or teeth are not symptomatic, I do not pursue RCT. In this case, I was able to gain space from crown lengthening. I will do elective RCT if I need it to retain a core, but did not need it in this case.

Thanks for the prompt reply. Can I share pics of impression of my teeth. If you can advise if I need rct before full mouth rehabilitation. If you can share your whats app no.

@@vinayjoshi3684 just send to dgatta@gmail.com

Dr Gatta please write your Instagram and Facebook add. Nice presentation tone on UA-cam

You can make it shorter if you prefer. Just confirm with your lab that the material they pick has appropriate height for strength. For maxillary restorations, I do worry about having space between the gingiva and the restoration because air escape could alter the speech.

Hey Mike, I would check with your lab and see what they are using for your cases. I would recommend a calibrated semi-adjustable that is interchangeable. It is better than a barn door hinge articulator. Should produce a more accurate product requiring less chair-side adjusting. I'm using the Panadent right now that I like.

@@derekgatta7239 Hi Derek, I was looking at the Sam 2 articulator. Sam 3 is just too crazy pricey! The name "Panadent" reminded me that was what I used back in dental school 3 years ago. Thank you!

Thank you for your question! You can use a Luca jig or leaf gauge to prevent the front teeth from touching and guiding the patient's jaw back into CR. While the anterior is held open about 2-3mm, I use a full arch PVS bite registration material, which can then be used to articulate the casts.

Thank you for your question. I use "one hand-chin point guidance" when guiding my patient into CR. I tell them to put their tongue backwards, which relaxes their jaw so I can guide it gently back into CR (a fully seated condylar position). I constantly check the CR at each visit so I confirm that the articulated casts match the mouth. Since, I'm restoring the whole mouth, I need a treatment position that is repeatable = CR. The initial diagnostic wax up is done in CR. I make multiple records from the day I prep the teeth because they should match, if I have captured the same CR position. All the best, good luck!

dgatta@gmail.com

Derek Gatta Thanks

Amazon: Hu-Friedy Chu Proportion Gauge!

hahaha so you're going to create your own gingiva..? I love it! ♡

@@derekgatta7239 Thank you!

@@juleslund1515 I’m a DDS. Not sure I understand the question.

Hey thank you for the kind words! Generally when the term copy mill is used, people are referring to an implant supported restoration that has Titanium or Zirconia preps with individual crowns cemented over them. For a wax up, I the provisional scanned then make changes digitally and then the lab will mill a cheap PMMA provisional so I can check the esthetics/phonetics. That can take several attempts. We do before the final expensive restoration is fabricated so we know the patient has approved of the set up. If not using the digital mode, I use to do a denture wax set up that I can screw into the implants and check esthetics/phonetics just like doing conventional dentures. Take care!

Thank you for your questions. I only increase an amount necessary to give me restorative space for the needed restorations. Some room will be gained in just doing the tooth prep reductions. In the beginning, it's an arbitrary amount. I start with 2-4mm in the anterior and that has been sufficient for the cases I've done. Remember, 3mm opening in the anterior equals about 1mm in the posterior, based on the arch the jaw opens. To communicate this to the lab, I send them the acrylic lucia jig bite record in CR. This way, they are waxing the proposal to the height I want and in the patient's CR. Before treatment begins, a hard night guard can be made at this same opening for the patient to wear for a couple months to confirm their TMJ can handle this opening.

Thanx for the prompt reply .it really helpful to clear my doubt ...would love to see a video of how you take the Lucia jig record ..thank you again

That is a good idea! Thank you for the suggestion!

@@derekgatta7239 sir hv u perform rct on these tooth or all are vital crowns?

Good Morning, I did not do RCT on these teeth. He had some existing root canal treated teeth but I did not do any more for restorative reasons. I gained space by increasing the vertical.

Saeed Jaman: great question. To articulate the maxillary cast, I made a face bow record while the patient was wearing the trial denture and put the poured up master implant cast in the denture while it was on the articulator. The mandible was articulated against the maxilla and the stone duplicate denture was articulated against this mandible.

Ask your dentist questions and try to be eager and interested in the process. Maybe that will inspire them to communicate and explain more about the process.

You get it free in the UK you don't have to pay any insurance

Dawn Hirst hat is a wonderful benefit of paying uk taxes! How long is the queue to get that service?

Derek Gatta you can get to see a dentist the same day

I rang today and I got in this afternoon

Hey thank you, the putt remounts give you an opportunity to make a new maxillary cast if you want one to make occlusal adjustments on the articulator instead of intra-orally.

carlos botello thank you!

Derek Gatta, I want to learn more of porcelain crow with metal

carlos botello I am not familiar with that technique.

In my opinion, I would absolutely make your patient immediate dentures. Most patients will not accept walking around with no teeth. This first set gives them an opportunity to practice speech and muscle coordination with these restorations.

And it does take a LOT of practice and patience. I've had my immediate dentures for just a little over five weeks now, and while the upper plate has gotten to the point that it almost feels natural (especially since my dentist finally let me start using adhesive), I'm still struggling with the lower plate because that thing flops around in my mouth no matter what adhesive I use, which makes eating pretty much impossible as long as I have them in my mouth (and which also continues to create mouth sores in my lower mouth, especially at the very back where my rear molars used to be).

@sharon keef Would love to help. Email me at dgatta@gmail.com and we can chat more.

Derek Gatta. Really ok thanks

sharon keef. Co out Russell Kline on Etsy ....there is also a FB group for denture wearer ...look for Margaret !

*ck out

You are welcome! Keep me posted for future video ideas.

Derek Gatta i sent u a message plz help me

Great Presentation I usually use 4 implants in upper what is the rational for three?

I agree. My surgeon was not able to get a fourth and the patient did not want to undergo grafting procedures. If I could have gotten a fourth implant in, I just would have made a fixed restoration instead.