How do you know when to increase OVD?  This is a challenging situation for many practitioners. Let's first review the "Turner Classification" for "wear" patients.  Turner class I is someone who lost vertical dimension.  Unless this was an acute process such as trauma from a car accident, I have not yet come across this scenario.  Turner class II is someone who did not lose vertical dimension, due to compensatory eruption of the dentition, and who has room to restore without increasing the OVD.  Turner class III someone who did not lose vertical dimension, due to compensatory eruption of the dentition, but has no room for the proposed restorations without increasing the OVD.  My patient presented with multi-factorial (erosion and attrition) etiology for tooth structure loss. Root tips/ teeth extracted #13,14,15. I articulated his casts in CR position and determined that there was not enough room to restore the dentition without increasing OVD. I plan the increase to be as small as possible while still giving me the necessary room for ceramic thickness.  It's important to remember that a 1mm increase in the posterior molar position equals about a 3mm increase in the anterior incisor region.  I make an acrylic anterior stop at this position as a starting point and see if that gives me enough room.  Remember, you also gain space when you do your tooth reduction. All planning was done with the aid of a full mouth wax up. Full mouth crown lengthening was used to create more favorable preparation heights and gingival architecture. 3i Certain implants were placed in sites #12,14 and restored with a metal ceramic screw retained implant FDP. Zirconia restorations were used on the terminal teeth and Emax was used on the rest of the dentition. Gingiva is still red due to photos being made the same day as the delivery appointment.

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