diagnostic...

[sidesh0wb0b]

looking for thoughts....been sick as a dog this week and having this case put in front of me is frustrating.
full diagnostic wax up. NOT allowed to open vertical. pt wants .5mm added to maxillary anterior length. and of course, hollywood perfect smile is the end result. sometimes i feel like throwing models out the door.

 

[2thm8kr]

Full upper arch or just front 6?

 

[Car 54]

This is a "put it on a good articulator" time, and thankfully it's a wax up, so you and the Dr can see what's realistic and what isn't.

To me the lowers are more of the issue, as far as how much he can reduce, to help
with the length of the uppers and the chipping that is now, and has occurred due to the in out, and the corners of the lowers.

 

[user name]

Ill be accused of doing things wrong, but this is how I do cases like that. I dupe the model, pin and section one. Every tooth removable. Ill conservatively prep each tooth we're going to do, scan and design. I generally don't comply with patient specific requests. They don't know what they want and aren't usually able to articulate their ideas. I do whats possible and give my best case scenario. I get low cost PMMA and mill in that. Then the Dr has a prettier presentation and can use my stuff as temps.

Works for me. It costs them more than just a wax up, but I think its worth it. No complaints.

 

[Car 54]

Ill be accused of doing things wrong, but this is how I do cases like that. I dupe the model, pin and section one. Every tooth removable. Ill conservatively prep each tooth we're going to do, scan and design. I generally don't comply with patient specific requests. They don't know what they want and aren't usually able to articulate their ideas. I do whats possible and give my best case scenario. I get low cost PMMA and mill in that. Then the Dr has a prettier presentation and can use my stuff as temps.

Works for me. It costs them more than just a wax up, but I think its worth it. No complaints.

I may not go as far as you do, but I do duplicate the casts so I can have a before and after reference
for the Dr and patient to see, of what may be possible.

 

[zero_zero]

I'd just open the bite with the ariculator pin a bit, there will be minimal opening in the posterior region and you'll have enough room to lenghten the anteriors. The patient wouldn't know. Having said that, case looks quite overclosed to me (prolly TMJ ?),not sure how could you achieve a proper function without increasing the vertical.

Sent from my SM-G930W8 using Tapatalk

 

[Doris A]

Nothing about the case, but I hope you feel better soon.

 

[sidesh0wb0b]

Full upper arch or just front 6?

full upper and lower diagnostic wax

 

[sidesh0wb0b]

This is a "put it on a good articulator" time, and thankfully it's a wax up, so you and the Dr can see what's realistic and what isn't.

To me the lowers are more of the issue, as far as how much he can reduce, to help
with the length of the uppers and the chipping that is now, and has occurred due to the in out, and the corners of the lowers.

how about that the pt has sheared off the facial of #8 due to incisal wear....and he wants to just add more incisal length....

 

[sidesh0wb0b]

Ill be accused of doing things wrong, but this is how I do cases like that. I dupe the model, pin and section one. Every tooth removable. Ill conservatively prep each tooth we're going to do, scan and design. I generally don't comply with patient specific requests. They don't know what they want and aren't usually able to articulate their ideas. I do whats possible and give my best case scenario. I get low cost PMMA and mill in that. Then the Dr has a prettier presentation and can use my stuff as temps.

Works for me. It costs them more than just a wax up, but I think its worth it. No complaints.

that's an interesting way of doing it. can't charge enough for diagnostics as it is...how do you figure pricing on that more aggressive strategy?

 

[sidesh0wb0b]

I'd just open the bite with the ariculator pin a bit, there will be minimal opening in the posterior region and you'll have enough room to lenghten the anteriors. The patient wouldn't know. Having said that, case looks quite overclosed to me (prolly TMJ ?),not sure how could you achieve a proper function without increasing the vertical.

Sent from my SM-G930W8 using Tapatalk

that was my first thought. even a wee bit of more room would help...not sure why the Dr requested no opening of vertical at all. once i hear from him ill post results of the convo.

 

[sidesh0wb0b]

Nothing about the case, but I hope you feel better soon.

thank you, Doris. you're always very kind!

 

[Car 54]

that's an interesting way of doing it. can't charge enough for diagnostics as it is...how do you figure pricing on that more aggressive strategy?

I can't either. I would rather the Dr prep for the temps if they needed long term PMMA temps, and make them from his prepped impression
and billing accordingly.

 

[2thm8kr]

Do you have photos of the patient smiling, at rest, profile, etc?

Scan both arches and do it digitally. Save the original scans as pre-op and merge to the working jaws. Use the virtual articulator and set at average values, but flatten the condylar angles to 20°. I extract the teeth virtually and in free form make sure that I have the buccal/lingula dimensions wide enough to accommodate the future preps. I would covertly open the bite. I find most times I open the bite I end up closing it back down most of the way.

Save your design and print the models so they can be used for the temps day of surgery. After you get the prep models register to your original design.

 

[rkm rdt]

I'd put it off until after Christmas.

 

[Car 54]

I'd put it off until after Christmas.

No, they want to see the wax up on Monday to approve it and seat the temps, then have it all done
BY Christmas. At least that's the way it usually goes this time of year

 

[2000markpeters]

This a very complex case. There is an incredible amount of wear of both linguals of upper anteriors as well as lower incisal edges.The upper anteriors have over erupted . It seems the gingival heights of centrals and laterals are at the same level. The wear on posteriors is quite severe. I would suggest ortho first to bring teeth back to proper heights them work from there. This is really a case for a prosthodontist and his team. You cant just go and open up the pin willy nilly. There is a lot going on here. If you just go ahead and make 6 anterior crowns you are in for disaster. This is not a case to rush. I see at least a years worth of ortho before any restorations can be done.

 

[adl]

Convince the Dr. to open the bite,and that’s just the beginning

 

[rkm rdt]

This a very complex case. There is an incredible amount of wear of both linguals of upper anteriors as well as lower incisal edges.The upper anteriors have over erupted . It seems the gingival heights of centrals and laterals are at the same level. The wear on posteriors is quite severe. I would suggest ortho first to bring teeth back to proper heights them work from there. This is really a case for a prosthodontist and his team. You cant just go and open up the pin willy nilly. There is a lot going on here. If you just go ahead and make 6 anterior crowns you are in for disaster. This is not a case to rush. I see at least a years worth of ortho before any restorations can be done.

In other words,put it off until after Christmas.

 

[charles007]

Mount first and make custom guide incisal table.
After spending hour waxing and knowing you can't do what the patient wants,
throw the case against the wall and go home to rest.