One of our recent Gems Insider Circle Webinars featured Dr. Steve Phelan, the founder of Occlusion Design Online Training Program, which is a system containing six educational modules to help Dentists better alter patients’ vertical dimension. After years of studying with many Occlusion Masters, including Dr. John Kois, Dr. Frank Spear, and Dr. Peter Dawson, and creating his own training program, Dr. Phelan claims that he receives these two questions the most often: “Why is vertical dimension the optimal route to take?” and “How can I alter the verticals for a patient with a lot of tooth wear?” If you’ve pondered these questions yourself, then we have some crucial information for you to consider. First, if your patient is young and has a tremendous amount of tooth wear, then you’ll likely want to lengthen their teeth by approximately 3 millimeters. If they already have a medium overbite, then you’ll create a very deep overbite if you don’t simultaneously alter the vertical dimension. Of course, the other obvious option you have to treat this patient is orthodontics. But if the patient declines this option, then their only choice is restorative alteration of the vertical dimension. In short, the primary reasons for altering vertical dimension are to find room for restorative material, lengthen the teeth without creating a deep overbite, and jump to an end-to-end occlusion that has developed as a result of tooth wear. Now that you know why vertical dimension is an optimal course of action, we can discuss how to alter the verticals for a patient with a lot of tooth wear.
provides a great foundation for you to consider the treatment planning options for that patient. It involves not only the complete exam, digital photos, and digital radiography, but also the creation of two sets of mounted study models on an adjustable articulator, which will allow you to evaluate the patient’s situation. You can then conduct a muscle exam to explore the patient’s range of motion, measurements, joints, and then look for how easy the patient is to manipulate into Centric Relation.
1) CRITICAL FACTOR: COMPREHENSIVE DIAGNOSTIC RECORD
Regardless of the patient, every single complex case involving the alteration of vertical dimension must start with a comprehensive diagnostic record. In Dr. Phelan’s practice, that includes the complete exam — meaning all the usual steps you’d take — and a digital photo series where he takes 20 photos, which offer more information than even the 12-image AACD photo series.
3) CRITICAL FACTOR: CR BITE RECORDS
Dr. Phelan instructs that the most important step of the functional analysis appointment is taking two CR bite records. He uses the Sam 3 Articulator (but any semi-adjustable articulator will do) to take two sets of upper and lower models and a face bow to mark the initial point of contact in the mouth.
2) CRITICAL FACTOR: FUNCTIONAL ANALYSIS APPOINTMENT
Patients who come in and need some form of complex restorative treatment require a functional analysis appointment, which
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