Opening Vertical Dimension and Full-Arch...

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How much should you open the vertical dimension of occlusion, and how do you actually build it chairside? In part two, Dr. Dennis Hartlieb breaks down the lab and clinical steps of his CPR for the Worn Dentition workflow: setting VDO by restorative space and aesthetics rather than a formula, coordinating aesthetic crown lengthening with a periodontist, building full-arch direct composite prototypes efficiently, and helping patients decide whether to keep their prototypes or move to porcelain.

In this episode, you'll learn:

• The myth that general dentists shouldn't open vertical dimension, and the condylar rotation math behind it
• Why the amount you open VDO depends on the restorative space you need, not how much was lost
• Waxing like setting denture teeth: facially generated treatment planning, lower incisor length and width, and incisal edge position relative to the lower lip
• Crown lengthening guides, reducing the stone model, and his sequence of a laser or electrosurgery gingivectomy before the periodontist's osseous surgery
• Bonding to root surfaces versus orthodontic intrusion, and how to present that trade-off to patients
• His two-day sequence: maxillary arch first, mandibular arch next, usually without anesthesia and with little to no tooth preparation
• Using the new lower anterior bonding as an anterior deprogrammer to seat the condyles before posterior buildups
• Posterior composite cusp buildups in about 15 minutes per quadrant using a bite block and guided closure
• Freehand bonding versus injection molding versus printed restorations, including wear concerns
• The three paths after prototypes: keep them, enhance with porcelain (veneers, crowns, or a sandwich technique), or resurface with layered enhanced bonding

Questions answered in this episode:

Is it safe for a general dentist to open the vertical dimension? In a healthy joint, opening a few millimeters at the incisal edge stays within the rotational path and changes condylar rotation by only about a degree. Understanding the patient's joint anatomy is what matters.

Do patients keep their composite prototypes long term? About half do, often for around seven years, with occasional repairs that are quick because the bite is already established.

Freehand or injection-molded composite? Any method can work. Dr. Hartlieb prefers freehand bonding for control and speed and cautions that printed restorations may wear faster than expected.

About the guest: Dr. Dennis Hartlieb has practiced restorative dentistry for nearly 40 years. His approach blends facially generated treatment planning, joint-based occlusion, airway awareness, and composite artistry learned from mentors including Frank Spear, Pete Dawson, Jim McKee, John Kois, Jeff Rouse, Buddy Mopper, and Corky Willhite.

Hosted by Dr. Melissa Seibert, DMD, MS, FAGD, ABGD. The Dental Digest Podcast is a top 1% podcast for general dentists focused on clinical dentistry: restorative dentistry, occlusion, endodontics, implants, imaging, and practice growth. For CE, case discussions, and a community of GPs who love clinical dentistry, join Elevated GP at theelevatedgp.com.