Dentaltown July 2015 - (Page 40)

prosthodontics feature Multi-Disciplinary Rehabilitation Case by Andrew Chandrapal, BDS, MFGDP, DPDS, MClinDent(Pros) R ehabilitation of worn and failing dentition can hold many issues that complicate the process. This case presents a number of clinical issues such as tooth surface loss (TSL) through erosion, abrasion, posterior super-eruption, lack of posterior support, hypodontia and periodontal attachment loss. Within this myriad of complications, the clinician is expected to gather data, plan, execute and maintain such dentitions. This case highlights some of the techniques employed to achieve a predictable outcome, despite complications. The patient, who I will refer to as Mr. V, had been a routine patient in private practice for many years. The patient was fully aware of the level of tooth surface loss and occlusal breakdown, although he remained symptom-free and functional for a number of years (Fig. 1; see p. 42). Following the breakdown of a posterior tooth, the patient decided to investigate the possibility of improving functionality and aesthetics while retaining many of the individual features of his dentition so the aesthetic change was not too extreme. The initial visits were focused on data collection and establishing a risk assessment and profile for this patient. This exercise proved to be invaluable given the scale of treatment being proposed to get the patient to a predictable desired outcome. The patient was provided with updated medical and dental histories that pertained to levels of risk allowing the clinician to form a prognostic value to key areas such as periodontal, dento-facial, functional and bio-mechanical prognoses (Fig. 2; see p. 42). 40 JULY 2015 // dentaltown.com Clinical observations * * * * * * * * * * * * * Moderately restored dentition Moderate risk of periodontal breakdown Missing #10 Chronic apical infection to #29 Severe gum recession to upper posterior teeth-with marked bone loss to upper molars Low sinus levels bilaterally Recently extracted upper right molar due to deep caries Stable diastema of 4-5mm between #8, #9 Front teeth progressively chipping and wearing down due to edge-toedge centric occlusal position High biomechanical risk, observed given levels of chemical erosion and abrasion Loss of vertical dimension leading to slight over-closure Passive super-eruption of upper posterior teeth No current caries The aim of treatment * * * * * * Stabilize active disease processes Augment upper back jaw areas to accept dental implants Provide implants to the lower and upper arches Gain a stable position for bite and jaw position Build up the dentition to meet this position using a combination of ceramic, gold and composite in the most indicated areas of the mouth Maintain the status for long-term predictability Continued on p. 42 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown July 2015

On Dentaltown.com
Howard Speaks: The Sweetest Taboo
Professional Courtesy: Power Through Participation
Continuing Education Update
Digital Impressions
Tips for Hiring New Team Members
Probing Systems That can Make a Difference in Your Practice
The Six Ways Staff Incentives are Revolutionizing the Dental Industry
A Multidisciplinary Rehabilitation Case
4th of July Emergency
Orthodontic Treatment in the General Dentistry Office
Industry News
TRIBUTE: DR. JOE STEVEN JR. The Story of a Legend, and the Legacy He Left Behind
TRIBUTE: DR. JOE STEVEN JR. Maybe We Should Ban Amalgam … a Profession Divided
TRIBUTE: DR. JOE STEVEN JR. Where are the Olives in Your Practice?
Why Mobile-First Really Means User-First
Continuing Education: Past, Present and Future Trends in Today’s Implantology
Airway Health: Dentistry’s Role in the Hidden Key to Wellness
Product Profi le: Accutron
Staff Pay and Rewards
The Whys and Hows of Adult Sedation Dentistry
A Review of “Uncomplicate Business”
Townie Choice Awards Product Showcase
Poll
Going the Extra Mile in Marketing
Ad Index
e.max—Matching a Dark Central
Product Profi le: Synergy
Dentally Incorrect

Dentaltown July 2015