A Simple and Inexpensive Technique to Open VDO

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Long-term success in restorative dentistry depends on occlusion as much as anything. Increasing VDO can give you a huge advantage when teeth are worn, or supra-erupted due to breakdown, or there just isn’t enough space to easily restore.

Learn how to build a new occlusion using composite on unprepped teeth in only a few minutes per tooth. This technique offers an appealing and affordable option for your patients.

A course explaining the use of transitional bonding with composites to increase the vertical dimension of occlusion (VDO) for aesthetic and functional purposes.

The Presenter: Dr. Corky Willhite

Dr. Corky Willhite is one of the foremost authorities in the field of aesthetic dentistry. He has earned fellowships with The Academy of General Dentistry and the American College of Dentists, and is one of only 84 accredited fellows out of the 5,000 worldwide members of the American Academy of Cosmetic Dentistry (AACD). He has also served on the board of governors for the AACD, and has spent many years as an examiner for accreditation with them as well. He also serves as a faculty member of the Cosmedent Center for Excellence in Chicago. Dr. Willhite’s practice, The Smile Design Center, is located just outside of New Orleans, Louisiana.

Overview: Opening VDO with Transitional Bonding Using Composites

Reduced vertical dimension can be the result of small or misshapen teeth, aging, deterioration, or bruxism that wears down both the anterior or posterior teeth. Transitional bonding using composites provides an affordable and practical  method of rebuilding and lengthening teeth to open the vertical dimension of occlusion (VDO) and requires little or no prep in most cases. This can serve as a more affordable and less invasive alternative to orthodontia or full mouth restoration with crowns or implants.

In this webinar, Dr. Corky Willhite discusses his methods for opening VDO for both the anterior and posterior teeth. You will learn

  • The goals of opening VDO (sometimes called OVD: occlusal vertical dimension)
  • The technique used to restore anterior guidance
  • The steps used to restore posterior teeth 
  • The advantages of using composite for transitional bonding

The video webinar includes several before and after patient restorations, and finishes with a Q&A.

When to Treat VDO: Aesthetics and Function

Patients with VDO are typically motivated to seek treatment due to either aesthetics or function. Composite bonding to address aesthetic concerns invariably results in improved function too, and vice versa. 

Patients often turn to orthodontics to correct occlusions, or crowns and implants to replace worn down or unstable teeth. Composite restorations on the affected teeth can open the vertical dimension. Adding length and bulk to the teeth, rebuilding centric stops, and keeping guidance paths intact all improve the look of the teeth and correct the bite.

Goals: Why Open the Vertical Dimension of Occlusion?

There are three main reasons for opening VDO:

  • Modify overjet and/or overbite
  • Gain space to restore anterior or posterior teeth
  • Improve facial aesthetics

Regardless of the case’s specific goals, the primary reason for the procedure is to prevent continued deterioration caused by the occlusion. 

Material Choice: Making a Case for Composites

Although teeth can be built up with porcelain to open VDO, this webinar focuses on the use of composite resin. Dental composite materials such as Renamel Microfill, Microhybrid, and NANO all may be used for the procedure. Dr. Willhite often recommends transitional bonding with composites even for patients who can afford more expensive materials like porcelain. 

In the webinar, several advantages are discussed:

  • Composites last for years.
  • Composites will not wear on the natural tooth structure of opposing teeth.
  • There is no need to replace existing restorations unless there is decay. With a small amount of roughening on the surface, composite material can be added directly on top of crowns or implants.
  • Renamel composite materials have a viscosity that makes them easier to work with.
  • Renamel composites have a good opacity that polishes nicely.
  • Treating each tooth can take as little as 10 to 15 minutes.
  • The cost is a fraction of what orthodontia or a full- mouth rehab would cost.

Technique: Opening VDO For Anterior Teeth

Transitional bonding with composites to open VDO involves lengthening the anterior teeth when they are naturally too small, or worn down over time. Doing so might increase the overbite, but opening the vertical (done by creating anterior centric stops) can compensate for that.

Adjustments to the overjet are accomplished by changing the steepness of the guidance path, the goal being to improve the smile while restoring correct contact points for a proper occlusion.

The technique to open VDO for the anterior teeth uses the following steps and methods:

  1. Mounted models
  2. Determine the minimum amount to open based on the goals of the procedure
  3. Diagnostic wax-up of the new vertical
  4. Evaluate occlusion and excursions on the wax-up
  5. Make a template (putty index) from the duplicate
  6. Build up the teeth with composite according to the template 

Before and after photos show that even subtle changes result in a marked difference in facial aesthetics. The process reduces the depth of nasal labial folds and makes lips look fuller.

Technique: Opening VDO For Posterior Teeth

Once the anterior teeth are set to a new vertical, there is space to work on the posterior teeth. In some cases, the posterior teeth may not occlude at all. Building up and creating centric stops will help hold and support the posterior teeth in the new vertical.

This procedure is done one tooth at a time, with each one taking as little as 10 to 15 minutes. It is best to complete the lower arch first. If the upper teeth are already lengthened, there is less room to work on the lower teeth. Also, a finished set of lower posteriors allows the dentist to check for interferences as the upper teeth are done.

The same steps are used for both upper and lower teeth:

  1. Microscopically roughen (using a diamond burr)
  2. Pumice the buccal and occlusal surfaces
  3. Etch (with mylar strips in place) and adhesive
  4. Place Renamel Microhybrid Composite to build up buccal cusp (Nano can be used, but Dr. Willhite feels that microhybrid has the perfect amount of viscosity and adapts well to the tooth structure for this step)
  5. Have patient occlude into the uncured resin and hold
  6. Light cure while patient is biting
  7. Patient opens, followed by curing again with glycerin gel
  8. Contour to remove excess (maintain the stop)
  9. Polish

One word of caution: When the patient bites down on the uncured composite, the opposing teeth must be smooth. If they are rough or jagged, the upper and lower arches can get stuck together!

In the webinar, Dr. Willhite features many cases of both anterior and posterior transitional bonding, with before and after photos as illustration.

The webinar A Simple and Inexpensive Technique to Open VDO also includes a Q&A with the audience.