"Gary, a 40-year-old dental technician, presented with an overclosure scenario. His Simbashi (from Maxillary central CEJ to Mandibular central CEJ in CO) was 15mm. Ideally, this measurement is in the range of 19-21 mm. Gary was also unhappy with the overall aesthetic value of his smile. He decided to have his smile enhanced while addressing the overclosed nature of his skeletal profile and occlusion. He wore an overlay orthotic for approximately 3 months prior to dental treatment to retrain his neuromuscular apparatus to an increased VDO.

After a neuromuscular workup using the Myotronics K6-I and "TENS" equipment, a vertically increase neuromuscular bite registration was taken. Study models were mounted on an Acculiner articulator using this Myomonitor bite. A full mouth diagnostic wax-up was created at the new vertical dimension, which was approximately an increase of 5 mm from CO.

Full mouth preparations were carried out at the LVI Full Mouth Reconstruction program. Gary tolerated the vertical opening very well without adverse symptoms. The final IPS Empress full mouth restorations were inserted one month later.

One day later occlusal equilibration was carried out, again, using the K6-I Myotronics equipment. Gary has remained comfortable, symptom free and aesthetically pleased for the year and a half since his full mouth reconstruction was undertaken with his new increased VDO. Thanks to Aurum Ceramic for the fantastic job on the IPS Empress ceramic restorations."

- Dr. Antonio Mancuso

Full Face pre-op view - unaesthetic overclosed Class II occlusion.   Frontal smile showing unaesthetic smile.   Frontal retracted view.               Right lateral retracted 1:2 view.   Frontal 1:1 view showing close-up of old PFM crowns on laterals.   Mx occlusal view of unprepared dentition.               Md pre-op dentition - occlusal view.   Mounted study models on Acculiner articulator using Myomonitor Bite. Note: VDO has been increased 5 mm.   Left view of mounted study casts, with new vertical.               Final smile achieved using a neuromuscular approach to increase VDO. 1.4 years post-op.   Finished full smile aesthetic result.   Retracted 1:2 showing IPS Empress restorations.               Frontal 1:1 close-up showing the artistry of the ceramist.   Md occlusal view of lower dentition.   Lateral retracted view.

Antonio Mancuso, Antonio Mancuso, DDS, FAGD, FADI graduated from the University of Toronto in 1985. He is a graduate of the Level 1, the Advanced Anterior Esthetics, Occlusion 1, Occlusion 2, and the Full Mouth Reconstruction programmes at the Las Vegas Institute. Dr. Mancuso has participated as a clinical instructor at the University of Toronto Postgraduate Aesthetic programme through the department of continuing education.

He has been published in Oral Health, the Journal for Dental Technology of Ontario and Dentistry Today, and has lectured in both Canada and the U.S. to numerous dental organizations. Dr. Mancuso has also appeared on Canada AM and in Canadian Living magazine. He is a member of the American Academy of Cosmetic Dentistry and is CE chair for the Ontario AGD. Dr. Mancuso maintains a private practice in aesthetic/restorative dentistry in Welland, Ontario.