We never had time to get into the racoon story,

And my lab was a disaster, having trouble finishing all the work as
promised.

I am sort of glad Roy is in Canada and not here in this area.  I would
probably have to refer all my denture cases to him.  Too hard to do a better
job than he does.

Well if you don't mind my input, sounds very reasonable.

Will the patient wear two devices ?

Have a couple of patients in this configuration.
Existing mand. planes. I added the NTI.
Neither patient is prognathic but this config works quite well.

'specially in the uneven realm.

Motor on bro,

--
W_B

wubbabubbazG@RBAGEyahoo.com
Take out the G'RBAGE

Well, if the lower anterior diastema are wide, then we need to keep
the DE from dropping between the teeth.  If lateral range of motion is
not *too* great, we could make a wider DE to make sure we can never
wedge it between two teeth.  If at all possible, I would adjust the
lower incisal edges so that the DE would be able to ride across them
from one side to the other without "bumps".  If the NTI is worn all
night and a little bit during the day, you could adjust incisal edges
until you had a reasonable incisal plane for the DE to work on.  

If the lateral range of motion is great, and the lower cuspids are
going to contact the DE easily during lateral excursions, or the
patient refused incisal recontouring, then I would add a lower NTI.

I think success rate in this individual would be better with the upper
NTI hitting natural teeth. If the lower teeth are periodontally
involved, then a lower NTI would come back into play as a removable
night-time splint.  

For the upper, making a stent type of appliance with a pair of ball
clasps would probably work well.  Add the DE to the anterior portion.
Extend the DE out as far as needed to make it work.  Again, a lower
NTI might be beneficial as you would only have to extend the DE
anteriorly enough to stay on the lower NTI.  You could even add
acrylic to the lingual of the lower NTI so that the DE would not have
to extend out so far.  As long as the stent-type appliance is
retentive, I would consider drilling a bunch of holes through it for
saliva and air flow.  Just to keep the soft tissues from getting
"soft".  

This case would probably require bringing the patient back every week
or so for the first few weeks to make sure he is complying with
protocol and to make necessary adjustment.  To gain any success at
all, the patient has to wear all this stuff at night.  I would insist
the patient insert everything at least 3 hours before bed-time to make
sure it feels moderately natural by the time he is trying to sleep.  

Any chance that once the clenching is under control that a lower
appliance could be made to pull the lower incisors more upright?
..
Stephen Mancuso, D.D.S.
Troy, Michigan, USA

Writing on a tablet PC,so forgive me if the PC misreads my poor handwriting.