Restorations Du Jour

[Affinity]

So if a pt rejects full mouth are we supposed to put them back in the same worn down incisors? We all know 99% of pts who "need" rehab cannot afford it and just want a nice smile. IMO it has nothing to do with a segment of the lab industry not knowing how to do full mouth rehab.... I would say a larger segment of dentists dont know anything about full mouth rehab...
Let them have their long centrals! There are many roads to Rome!

 

[rkm rdt]

[QUOTE

Patients go to the dentist for 2 reasons,

A: They hate the look of their teeth
B: They are in pain

Once you fix the look they rarely care about consequences and will not return till something either hurts or fails.

[/QUOTE]

Maybe back in the 50's but todays patients are a bit more educated than that. Checkups and biannual hygene appointments are also part of most treatment plans and are covered under most basic insurance plans.

 

[Affinity]

Very nice work!

While we all want stuff to turn out pretty, how do we go forward and make the pretty things last? The second case you posted looks to have altered the guidance with the additional length, while of course its just a centric relating picture the overbite appears to be drastic enough to change the guidance drastically.

So the question of the day should be, How do you manage these sorts of issues when you get a case that has obvious other issues effecting the final restoration?

Can you educate us how you manage these issues? What would you do differently to that case?

 

[JohnWilson]

Way to kill the mood.

Sorry guys if I broke up the back patting party. Thats never my intention. I was trying to exploit the resources of many many fine and talented techs and share/ start a conversation to aid less experienced techs. God knows every big case has its own intrinsic set of challenges, however its how we address them that takes our roll in the team to the next level.

 

[JohnWilson]

[QUOTE

Patients go to the dentist for 2 reasons,

A: They hate the look of their teeth
B: They are in pain

Once you fix the look they rarely care about consequences and will not return till something either hurts or fails.

Maybe back in the 50's but todays patients are a bit more educated than that. Checkups and biannual hygene appointments are also part of most treatment plans and are covered under most basic insurance plans.[/QUOTE]

I was generalizing, but generally on big restorative cases the patient didn't get to that point in their life by going to the dentist 2 times a year. While past habits are not indicative to future results I have seen this scenario more than once

 

[rkm rdt]

Maybe back in the 50's but todays patients are a bit more educated than that. Checkups and biannual hygene appointments are also part of most treatment plans and are covered under most basic insurance plans.

I was generalizing, but generally on big restorative cases the patient didn't get to that point in their life by going to the dentist 2 times a year. While past habits are not indicative to future results I have seen this scenario more than once [/QUOTE]

True, but they usually have to begin with a committed hygene program before the Dr will even begin to treat them long term.
And I really appreciate that when taking a custom shade !

 

[JohnWilson]

Can you educate us how you manage these issues? What would you do differently to that case?

I will share what we do on cases such as this.

We start off by mounting 3 preoperative casts from a facebow. We make a custom incisal table that we will use once the case is prepared. We do a diagnostic wax up to check movements/esthetic's. We take the second preop and prep the cast and make reduction matrix's and shell temps. We check all movements again trying not to alter guidance with the temps. If we are adding significant length its often hard to impossible not to. At this point we present our concerns to the client who has a consultation with the patient to educate them on our findings. This is all done before a hand piece has ever been picked up. The costs associated with this makes all but the most serious clients shutter but all it takes is one big case to fail and they will see the benefit.

This is how we proceed with many of my clients.

 

[2thm8kr]

I will share what we do on cases such as this.

We start off by mounting 3 preoperative casts from a facebow. We make a custom incisal table that we will use once the case is prepared. We do a diagnostic wax up to check movements/esthetic's. We take the second preop and prep the cast and make reduction matrix's and shell temps. We check all movements again trying not to alter guidance with the temps. If we are adding significant length its often hard to impossible not to. At this point we present our concerns to the client who has a consultation with the patient to educate them on our findings. This is all done before a hand piece has ever been picked up. The costs associated with this makes all but the most serious clients shutter but all it takes is one big case to fail and they will see the benefit.

This is how we proceed with many of my clients.

We start off with a full mouth exam, charting, and radiographs of the patients existing condition. Patient's desires are taken into account. Impressions and facebow
taken for study models. Consultaion with clinician(s) about the challenges of the case. Full diagnostic wax up with notes pertaining to difficulties achieving patient's
desires. Another consultaion with patient explaining all treatment options from full mouth to leaving them in current situation or getting a second opinion.
If patient agrees to treatment, preperation matrix and temporaries made in office from diagnostic wax up. Guidance double checked and shape of temps worked out in patient's mouth.
Patient gets to 'test drive' temps to see how well they tolerate any changes to verticle, guidance, etc. Upon patient approval, impressions are taken of temps and
we proceed with finished prosthetic. Starting with the end in mind certainly gets you there with a lot less headaches.

 

[paulg100]

"We make a custom incisal table that we will use once the case is prepared"
"We check all movements again trying not to alter guidance with the temps".

hardly ever seem to do that any more. A good amount of these large cases end up de-programmed (kois)/reorganized so the existing function is irrelevant be time we get to the wax up stage.

 

[JohnWilson]

"We make a custom incisal table that we will use once the case is prepared"
"We check all movements again trying not to alter guidance with the temps".

hardly ever seem to do that any more. A good amount of these large cases end up de-programmed (kois)/reorganized so the existing function is irrelevant be time we get to the wax up stage.

On big cases where total treatmet has been accepted, what I was refering to is ant patchem/prettyem up cases

 

[Gdentallab]

veneers

feed backs are welcome

 

[Affinity]

Needs glazed..?

 

[Gdentallab]

Needs glazed..?

you're right, they look grainy. dunno why!

 

[paulg100]

spend more time on the pre treatment before glazing.. fine diamonds with water and rubber wheels

emax always looks like that otherwise.

 

[corona]

trying again ... learning to send pics .

[/URL] [/IMG]

 

[Affinity]

Most of my 'glaze' is manual, polished after glaze, but the glaze cant be grainy or your finish will be pitty, full of dirt. Try to get to a semi-gloss finish then highlight your line angles and height of contour with a high shine wheel and polish with paste until you get the right luster, check it under light. I use a liberal amount of glaze, but dont overfire the glaze. This way you control the luster not your oven.. If its not glazed enough then just run it up again with another light coat of glaze. Overfiring or using too much glaze will cause you to lose all your texture, find a medium. I lightly sandblast before glazing even rubberwheeled areas so the glaze doesnt pool up.

These crowns look low in value is this an HT ingot? They look like a2 but very gray, maybe this is only the luster..?

 

[Al.]

This is what I meant when I said I err on the light side and the patient more often than not wants it seated.

This is a pfm over a implant abutment.
Dr wanted to send it back for me to darken or add the OB Trans on the M incisal area.
Patient wouldnt have anything to do with that. My bet is later she will want 9 lightened.



These went out today.

A3 LT layered with A35, B1, Inc 1, OE1.



Emax LT A2 Layered with Denten A2, Inc 1, OE1

 

[Scotts studio]

Beeeautiful Al thanks for sharing.

 

[NicelyMKV]

Awesome Al!!

 

[rkm rdt]

Nice emergence of the pontic.

I see what you mean by a touch lighter. Sometimes the patient needs to see the contrast.