Overlays to Open VDO and Test a Muscle Mediated Position

This patient presented with a concern about his bite. A first look at the top image would not alert the observer to the fact that he was incredibly uncomfortable unless his mandible is positioned forward and down on the appliance he has been wearing.

My patient CAN be seated and actually loaded, but it is on a psuedo-disc, tissue that has become avascular and enervated; a type of scar tissue that can function very well against load but may not position the condyle in a comfortable relationship within the fossa. There is also the possibility that the remodeling of the condyle and the fossa throughout the adaptive process have made that "seated position" one at which the patient cannot function.

Because he is comfortable with the appliance but uncomfortable at times after eating without it, my goal is to mimic the appliance occlusion with a bonded plastic occlusion that the patient can now test in actual function. He wore these overlays without incident for five months before we created definitive restorations. The three images below show the overlayed occlusion bonded to the mandible after that five months.

This technique can also be used to create a provisional stage in a case which must be phased. Altering one arch to a final design permits treatment of the opposing arch to the ideal finish and then completion of part or all of the provisionalized arch when appropriate for the patient.