Using a custom anterior guide table with complex cases.
If you are planning to treat patients with more complex dental problems you should consider using an anterior guide table. Many patients with tooth wear, especially pathway wear and restricted envelopes will have milled out the envelope of function that they feel comfortable with.
It would be wise to recreate this pattern in the restorations you make for them when you restore their case. One of the best techniques to recreate this pattern is to make a custom anterior guide table for your case using the accurate, mounted study models on an articulator.
It is essential to have an accurate mounting for this technique to work and I have created my occlusion DVD series to instruct you in the step-by-step process to take the bite records and then mount the case on an articulator. I will also cover this topic in detail during my new occlusion seminar.
Once you have an accurate mounting you or your technician can use the original models to create a custom anterior guide table and recreate the patients pattern of wear and envelope of function in the diagnostic wax-up.
This technique allows you to make esthetic changes to the case but still maintain a familiar occlusal scheme that the patient will feel comfortable with.
I have included some pictures from an anterior guide table my technician, Mr. Harald Heindl has created for the diagnostic wax up for a patient with severe anterior attrition and erosion as well as pathway wear in the envelope of function. I have also included the before and after images of the lower incisors from this case so you can see the dramatic change that occurred during the full mouth reconstruction for this patient
In the next post in this series I will talk about how to transfer the diagnostic wax-up to the patient’s mouth and test the results.
Feel free to add any comments or questions using the link above.