Hi everyone, I'm a relatively recent grad and this is my first post on the forum. After going though all of the related Spear videos and discussing with collegues, I figured this would be the best place to come for advice.

I'm having a tough time with this case. The patient came in saying that he wanted a full mouth reconstruction and had seen a few specialists over the years. He's currently in his 50's and did not have the finances at the time, so he was waiting before considering it again. Now that there are several posterior teeth requiring attention and he feels financially ready. He would like to know what our office can offer.

Since the patient has been to other reconstruction specialists, he has heard plans ranging from opening his VDO to orthagnathic surgery to address his Class III jaw position. I told the patient we could take records and start to come up with a plan. Following the EFSB treatment planning sequence, I'm getting stuck on how to deal with his posterior situation.

Here are some details (illustrated in the images):

He has anterior wear with compensatory eruption on the upper and lower. His resulting bite is end-to-end.
His current incisal plane for the uppers is in a good place.
He has occlusion on the posteriors between his second molars on the top and 3rd molars on the bottom. The premolars do not touch on the left and he has a posterior cross-bite from his first molars through his premolars but not on the 3rds.
His lower anteriors are very short and crowded.
No TMJ issues.

Tentative plan::

Have him come in a take CR records. He may have loss of VDO. The previous dentist had him wear a splint for a month to open everything up and he tolerated it well. If he does have room, make a splint from a wax-up in VDO and bond on some material to open his bite temporarily.
Besides orthodontic intrusion on the anteriors to make space for crowns, consider extruding the posteriors that have erosion and correct the cross-bite.
Consider removing the lower 3rds and shifting his bite back to change his Class III occlusion to more Class I.

Any ideas would be helpful. At this point he has not commited to anything and I'm just trying to give him an idea for a plan and timeline. Even if he decides not to do anything, it would be great to learn from this puzzle.

Thanks!

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