Big dental cases are hard to handle. It is difficult for even experienced dentists to take physical impressions (or digital scans) with correct bite and good margins. Therefore, big dental work could be problematic with fitting and occlusion. Today we will discuss the importance of trying fitting and bite for your big dental cases.
1. A real case example
We recently received a request for a full mouth Malo bridge. It was from a very experienced dentist. He shipped stone models to us, along with a bite registration. On the stone models and the bite registration, he also marked mid-line, and asked for design before production.
Normally, we would ask to mill an aluminum bar with 3D printed bridge to try fitting and bite. This was the common practice for big implant cases. However, the stone models and the bite seemed to be taken well, and mid-line was well marked. So the doctor asked to directly mill a titanium bar with temporary bridges.
2. Temporary bridge with incorrect mid-line
As requested, we sent designs of the titanium bar and temporary bridges. After our doctor’s approval, we milled the titanium bar and made temporary bridges in 7 days. However, about 10 days later, we received a picture. Our doctor said that the fitting and occlusion were good, but the mid-line was off.
It meant that we would have to remake temporary bridges and even the expensive titanium bars. And the doctor had to pay again. Suppose we had made an aluminum bar and 3D printed bridges, we could have finished work much faster, and could have tried the fitting, bite and mid-line at a much lower cost.
3. Re-design with new bite
About 5 days later, we received stone models, the titanium bars, temporary bridges, and a new bite registration. With the help of pictures and new bite registration from our doctor, we re-designed titanium bars and temporary bridges.
4. New titanium bar with new temporary bridges
At this stage, we could normally just finish the case by making the permanent restorations: the mid-line would be fine because of the help of pictures and temporary bridges. Yet, the doctor wanted to try mid-line again. After having approval of the new designs from our doctor, we milled new titanium bars and temporary bridges again.