Dentaltown May 2022 - 18

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Profi table GPs
Member Since: 05/14/19
Post: 6 of 55
In my opinion, the skeletal and TMJ geometry/size and his teeth were and still are incompatible,
and nothing but metal restorations would work for this guy. Even those may wear through
or pop off after a while. I would not take this case on as a full-mouth rehab for a million dollars.
I'd just repair the damaged areas with composite and tell the patient that even those may need
to be redone every three years or so. ■
3/15/2022
koala123
Member Since: 08/01/13
Post: 8 of 55
Upper incisors: 10 mm.
Lower incisors: 8 mm.
Overbite: 2-4 mm. ■
3/15/2022
Guitar Hero
Member Since: 05/29/08
Post: 9 of 55
Obviously, this case needs FMR. If you feel it is out of your league, refer.
There are some CE courses that can walk you through it: Dawson, Spear, Kois, John Nosti.
The fi rst step would be fi nding out what is patient's chief complaint, addressing that
and setting expectations: This patient will need a nightguard after treatment. What are the
aesthetic concerns?
You also need pictures without a lip retractor. Good idea if you deprogram fi rst with Kois
deprogrammer before facebow record and CR. Once you get facebow record, you will need a lab
to make you a wax-up. Use this wax-up as a mock-up in the patient's mouth. If the patient feels
happy with aesthetics and comfortable with bite, proceed with crown preps and use wax-up to
make your temps> The patient will come in for adjustments, may break temps. Once you get to
the point where the patient is not breaking temps and temps are stable and comfortable, time
to start making fi nal crowns, fi nal impressions capture bite at new VDO. Timeframe for this
treatment would be six to nine months. ■
3/15/2022
terrys409
Member Since: 07/21/05
Post: 12 of 55
I did a case like that straight out of dental school. I can't believe now that this guy trusted
me. The only problem he had for years after treatment was some of his crowns coming off. As
one would come off, I would use a different cement. He is doing well today.
Try not to do RCTs and posts to increase retention form. Use good 3% taper on your preps
and maybe place a groove.
You can do this. There have been some very good instructions for your strategy. Don't let it
mlau
Member Since: 11/08/08
Post: 13 of 55
get too complicated that you refer out. ■
How comfortable are you with prostho? Personally, I'd punt to a good prosthodontist. But
if you want to tackle this case, I'd recommend:
1. Make a full-coverage splint removing the posterior lateral excursives, and with a gentle
anterior ramp. Open to the bite you want to restore as good.
2. Take earbow-/facebow-mounted upper and lower models. Have the lower mounted in CR
du jour. Create a custom incisal guide table.
3. Pin and section your model; remove the posteriors for now. Wax up anterior teeth for
guidance.
4. Put back in posteriors. Wax up posteriors.
5. Make a stent off your wax-ups. (I'd go alginate -> models -> suck down).
6. Temporize the guy with your wax-ups. Try for a few months. Have a CYA bite (Lane Ochi,
patent pending).
3/15/2022
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