Compromised Occlusion

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Posted on By Ahmed Elgaysh In Occlusion

44 years old female patient .. seeking for improving aesthetics and occlusion .. upon examination there is no inter-arch space and occlusion is compromised .. whats is the ideal treatment plan if the patient refused orthodontic treatment ... also we extract the lower 1st molar (*)

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What is YOUR treatment plan?

You have several options:
1. Orthodontics, implants and restorative dentistry (full mouth rehab).
2. Extractions, implants and restorative dentistry (full mouth rehab)
3. Endodontics , implants and restorative dentistry (full mouth rehab)
4. Do nothing

Patients cannot tell you what they want and then restrict your treatment options. Dentists are neither magicians nor God. Patients have become extremely demanding for the right to select their own modality of treatment to their own detriment. Not only does the patient suffer but the dentist becomes the villain for agreeing to perform treatment that has little to no chance of long time success.

There are often times when any of these combinations of treatment are equal to any of the options and then the patient can decide whether time, money convenience or just personal preference will dictate their choice.

Standards are standards for a reason...some very fine dentists have tried many different modalities of treatment and finally decided on what is most successful. And while we can (and often do)deviate from standards, you must be very bright, very educated and very talented to pull off the treatment successfully.

I know that many on the forum will disagree with me but I am a 'Standards guy."


thank u our legends :) i will do my best


Must open bite and TEST increase VDO 1st with removable appliabce....then OHI and clean and debride. Then re-evaluation.


thank u dr Murice


The opinions thus far are good...I agree with Maurice that the bite does need to be opened and the test appliance needs to be worn for 3 months to make sure the opening will not cause a TMJ problem...Then the options for either fixed bridge or implants and full mouth restoration can be accomplished.


Hi Ahmed, first periodontics (cleaning the working zone) & extract the lower right root tip. Than an anterior bite plane to open the bite plus orthodontics to put everything where it should be. After teeth are in a corrected position. Implants plus restorative dentistry. Regards, Miguel


As described by others previously, my prferred tx would be the same:- Inflammatory control/Ext. #30, - Re-engage the patient to emphasize orthodontics as the most conservative of therapeutic options. - Open & test vertical. - Final restorative PRN
However, only because your original query requested an alternative to orthodontics do I offer the following:
- Note: a) the biggest challenge in opening the bite without orthodontic correction is that it will likely create a significant increase in the OVERJET relationship to be managed from an occlusal, functional and phonetic perspective.
b)Notice the dual plane of occlusion between lower left 1st premolar and canine created because the lower anteriors over-erupted.
An alternative to orthodontics, UNFORTUNATELY, would be to:
a) open the vertical on an articulator to a more therapeutic vertical dimension.
b) wax-up the case by removing the lower anteriors on the model and positioning them to an ideal overbite/overjet relationship
c) extract the lower anteriors and fabricate a provisional restoration (from wax-up) with only the 1st premolars as abutments and supporting the new vertical dimension. -Test occlusion and phonetics in temporary
d) replace anteriors with implants positioned based on the wax-up, i.e. more labially and apically.
e) finalize restorative
Reluctantly offering an alternative... Good luck


Henry Schein