The original post did not show on my news server. I'll reply to both. Fawks
first because he is on the top and then Gail because she might consider what I
am saying to Fawks.

Fawks:

Anything above a 4 mm change in vertical with complete dentures I will consider
using a branching technique (Pound, Turbyfill, or Muraoka and now Massad) in one
form or another. I can typically get a patient to accept an 8mm change in
vertical as described below.

I take the worst fitting denture (typically the lower and tissue condition it.
Increasing the vertical by 2 mm. A week or two later  I take the opposing
denture and do the same. Now we are up to 4 mm.

Two weeks later I check the plane of occlusion and start to idealize the upper
(bench lathes or model trimmers make quick work of this. I then try to provide
some semblance of cusps and a the appropriate curves. Add cold cure tooth
coloured acrylic to the lower posteriors, fold a small  piece of  baseplate wax
in two, place it between the anteriors and have the patient bite down till the
teeth just touch the wax.  Pressure pot for 3 min (if using Jet) and add more
tooth coloured acrylic to the lengthen the lower anteriors. Shape accordingly.
Pressure pot 5 min, trim the bite pads and polish. You are now at 6 mm change.
Next appointment build up the uppers the same way. You can get better functional
results by using an intra oral tracer at this stage.  Viola, you have increase
the vertical by 8 mm. And the patient usually has not complained. R&R the
conditioner when indicated and adjust occlusion as required.

I usually make models of the original dentures at the beginning for records and
pt. ed.. Some where along the way, I'll take preliminary impressions, and
possibly even finals. All the way through I am modifying for speech and
esthetics. The odd time I will throw a cheap set of anteriors on for esthetics.
If you and the patient are happy with everything, you can take the bite using a
Bite block to one denture then the other bite block to the first. Take a couple
of alginates of the modified dentures and send them along to the lab as a guide.

Yes this takes more time, but you can bill for most of it. Do you have codes for
Tissue conditioners, posterior bite pads and simple repairs? With the linear
techniques you can't bill for the adjustments and remakes. The patient's
confidence in you is better, the tissues are better and you end up with a better
result. The patients adjust to the minor changes more readily and will be more
accepting of the "text book" results.

Remember we talked about not ID-ing a problem case before treatment or soon
enough? Any time I thought we should take this approach and I let the patient
talk me out of it for one reason ($$) or another (time), I will recognize my
predicament earlier and both the patient and I suffer longer till we find out
how much change they can accept.

Gail

Your father is wrong. Unless he has a perfect mouth and perfect feet. Shoes may
stretch to fit but dentures need to be adjusted to fit. Your father has merely
adapted to his ill fitting lower dentures over the years. Does he really expect
to adapt to new ones over night? Ask him how long it takes before he is really
comfortable driving again when he changes vehicles.

Your father has only had 1/3 of the work completed. Would he expect a house to
keep out a strong wind or a storm if it was only 1/3 finished? The way his mouth
is now with only 1 new denture is like you walking out with one high heel and
one sneaker. You aren't going to be running too soon very easily.

Your dad is a difficult case. I'm not sure I would have done it in the same
sequence as his dentist. Unless his dentist has only made a temporary or
transitional upper denture.  Doing the final upper denture first limits what you
can achieve with the lower. I might patch up his upper using some of the
techniques I described to Fawks. Then worked on both dentures and the crowns at
the same time. This gives greater flexibility and greater control over the final
product.

I think you are on the ball, saying his new teeth still require a lower. If your
dad is like the average person, once he has had all the work completed, and then
gone through the typical 3 month adjustment period. Most of his complaints will
be long forgotten.

I should point out that your father's situation might be different from the
average person, and unless someone here has seen him and described his situation
in dental language to the rest of us, we are describing typical situations.