“This female patient felt that her current teeth were “too short” and didn’t look like the teeth of a youthful mid 30’s professional. For a long time, friends had told her that she had short “worn-looking” teeth. Upon examination, it was apparent that she had been wearing her teeth down for years through nighttime clenching and grinding. The damage from the clenching and grinding had also caused a significant decrease in lower facial height due to the wear of the teeth. She reported only mild symptoms of temporomandibular joint dysfunction but definitely had significant muscle stiffness. Other than a few composite restorations in her mouth, she had healthy dentition and gingival structures. The critical factors in this case were to restore her vertical to improve her smile, reverse the wear of her teeth, and to improve her facial esthetics by increasing the lower facial height. This would involve comprehensive treatment planning including neuromuscular factors, smile analysis, facial esthetics, and TMJ assessment.

The first stage involved utilizing the Myotronics K-7 computer system and myomonitor to establish a comfortable vertical position. Following the K-7 computer workup, she was placed in a LVI fixed orthotic made of Integrity placed on her mandibular arch. She responded very well to the new vertical position, which increased her Shimbashi number from 11 mm to 17 mm. Over the next 3 months, her vertical position was stabilized with minor adjustments. The final vertical was re-evaluated with the K-7 computer system and a relined bite registration was done to provide the lab with the final occlusal position. Complete records including photographs, shade analysis, smile analysis and trimmed Acculiner mounted models were sent along with the final bite position to Aurum Ceramic Laboratory for final wax-up of the case.