Becden has obtained new information from our Technical Trainer, Dr. Ed Miller, regarding transferring the final maxillary-mandibular relationship from the permanent orthotic. Please call Becden if you are interested in more information, 888.344.9991.
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Creating a new smile that involves correcting a midline discrepancy can be very challenging, especially when the shift required is ½ to 1 whole tooth width, which is not uncommon to encounter. Doctor / technician partnership and clear communication are critical to the success of these cases.
Following the steps below, as taught by Becden’s Technical Advisor, Dr. Ed Miller, will assure the most aesthetic, symmetric, result for your patients.
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1. When submitting a case for Diagnostic Wax-Up, draw a line on the study model or pre-operative photograph indicating the placement of the new midline. Take into consideration the feasibility of duplicating this shift during preparation. We would never make a decision regarding midline shift without direction from you to do so. During fabrication of the wax-up and matrix for use during temporization, our technicians have no problem moving the midline on a stone model, since they are not dealing with real teeth!
2. Be sure to include a stick bite to prevent a possible cant during mounting.
3. At the preparation visit, after depth cuts and facial and incisal reduction, now is the time to begin moving your preparations in the direction needed for the case.
a. If you are moving the midline to the patient’s right, begin by removing more interproximal tooth structure off of the mesial of the right central, lateral, and cuspid, which will create wide margins.
b. Next, remove more of the interproximal tooth structure off of the distal of the left central, lateral, and cuspid, also creating wide margins See photo 1.
c. Once you have the midline moved as desired, remove just enough tooth structure from the distals of the right side teeth and the mesials of the left side teeth to create narrow margins to allow for pressing (minimum of one millimeter is needed). See photo 2.
4. Now that the teeth have been moved to the patient’s right, it is necessary to recontour the wide marginal areas. If this step is missed it is impossible to fabricate restorations that will move the midline, since the restorations would either hit the margin or create a canted gingival area.
a. Use a Brassler burr 133f.010 to reduce the bulk of the wide interproximal margins and tooth structures below the margins, followed by a Brassler burr 133ef.010 to smooth the area. This step will now move the margins to the patient’s right. The technicians can only create restorations that move the midline to where you have moved the midline and margin during preparation.
Though this may sound complicated or confusing, if you visualize the end result you are aiming to achieve and think it through, it is really a quite simple sequence. Please call me if you have questions regarding this technical tip or other technical issues you would like to discuss.
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131 E. 13065 S.
Draper, UT 84020 |
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888-344-9991 toll-free
801-576-9991 phone |
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The editor of this newsletter is Emily Webb of Becden Dental Laboratory, Inc. Please send any questions or comments about this newsletter, or suggestions for articles to: emilyw@becdendental.com
©2006 BECDEN Dental Laboratory, Inc. |
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Technical Tip - Moving The Midline
