overjet[Editor's Note: To access Part I of this series, click on the link.]

Once your double layer pour up is trimmed to the wax bite, use a lab saw cut through the distal contact of the teeth to be reset.

In this case we are resetting #22 through #27. Cut to the bottom of the first layer on each side of your pour up and the entire segment of teeth will lift off. (Fig. 2)

Cut from the base up to the interproximal contact but not through it. (Fig. 3) Gently squeeze and the segment will separate without reducing the contact. (Fig. 4)

overjetOnce all the teeth are separated – it helps to write the tooth number on the lingual to keep track – trim each tooth base to a slightly convergent shape. (Fig. 5) Do not trim the model base, as this is your vertical reference. You can then proceed to reset the teeth using Play-Doh. In this case, we also need to estimate the intrusion needed to open space for restoring the wear on #6 through #11, as well as #22 through #27.

To alter the vertical measure with a caliper, the millimeter change you are planning, and add 1mm so you can adjust by adding a thinker layer of Play-Doh. (Fig. 6) In this case, I measured 3mm of intrusion and reduced the plaster with a plaster bur.

overjetIn cases of severe wear, you can also rebuild the tooth length quickly with tooth colored Triad or place a pontic in place for a missing tooth.

The flexibility offered by the Play-Doh set up allows you to try out several potential resolutions of your overjet and overbite needs to demonstrate in your case presentations to your specialists and your patient. Once you have settled on the "best option," you can impression the Play-Doh set up model and pour that in plaster for a long-lasting record, if needed. A Play-Doh model will stay several weeks if it's tightly sealed in a plastic bag or container.


Your Overjet Puzzle Checklist:

Step 1: First pour includes just the crowns of the teeth. Mark the impression with a Sharpie to help you place the Vaseline only in the set up area. Add some wires to stabilize the posterior teeth. Use Vaseline on the area of the teeth you will reset and pour the second layer to include a working base. (Fig. 1)

Step 2: Cut at the distal of the last tooth in the set up on each side of the arch. (Fig. 2)

Step 3: The set up segment will lift off in one piece leaving a level area to set teeth. (Fig. 3)

Step 4: Cut from the bottom to just below the contact point. (Fig. 4)

Step 5: Squeeze the segments and it will separate without loss of tooth size. (Fig. 5)

Step 6: Trim the base for ease of setting your teeth with the contacts together. (Fig. 6)

Step 7: Measure, mark and trim the base when intrusion is planned. (Fig. 7)

Step 8: Pre-set up: Deep bite with compensatory eruption due to excessive wear. (Fig. 8)

Step 9: Post-set up: lower incisor intrusion and alignment for restorative space. (Fig. 9)

Donna J. Stenberg D.D.S., M.S., P.A. Spear Visiting Faculty and Contributing Author. [www.stenbergorthodontics.com]

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