Treating Severe Attrition - Help Gerald!!!!

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Posted on By R. Terry Councill In Occlusion

80 year old healthy male desires cosmetic dentistry.
It has been suggested that the interpupillary distance does not change. With that in mind, the measurement was taken. A ruler was then calibrated and transferred to the elder picture. DSD was done with this calibration. Will treat by redefining the incisor length, CR, and VD ala "Gerald Benjamin". Restore with anterior crown lengthening, posterio Zirconia and Empress layered Zirconia anteriorly. Post-op Tanner Applaince. Thoughts?

Pre-op, DSD Workup

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6 Comments

Hi Terry,
I am honored that you are willing to approach your case in the same manner that I do..
1.Look at the patients posterior molars..draw a line from the buccal cusps and see if that is where your incisal edge position should be...It is going to be close.
2. The maxillary anterior teeth have worn and erupted so that after you find the correct incisal edge position i.e. the length, then go up gingivally 10.5 mm which means that you probably will need esthetic crown root lengthening.
3. The incisal edges should approach but not impinge on the lower lip in a full smile..The incisal edges should also follow the curvature of the lower lip
I think that you will love this technique.
You can have the lab fabricate the wax up and let them fabricate the pieces of resin to lengthen the teeth. The pieces can be bonded to place in sections i.e. 28-31 can be one section of onlays just bonded to the occlusal of the molars...very quick and easy especially if you place a rubber dam and slot prep it. Then bond one piece of 22-27 and lastly 18-21..
This would take no time at all..Air abrade the piece, etch it, bonding agent and variolink (place in a light protected box)
Place rubber dam, Air Abrade the quadrant, etch bonding agent (cure or don't cure) and place the one piece onlay...
Your thoughts???
Regards,
gerald


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I must agree with Dr. Benjamin. Dr. S


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Thanks Gerald, I lost you a little bit on the "little pieces".
Can you please describe more fully or suggest something I can read. It seems as though the maxillary teeth are waxed and mocked up based upon the metrics you have presented before and the incisal edge is roughly defined by the line from the molars. This incisal edge is then adjusted to interact with the lower lip as you now describe. The length of the lower incisors are then waxed and mocked up, again, based upon the metrics you have presented before. This length is then defined phonetically to crystallize the VD. Now we have resultant
posterior clearance which will define CR. The clearance is then
closed with the prefabricated resins the lab makes, and these are bonded into place, then adjusted to the defined CR. Is that the workflow or did I miss something?

Thanks again.
I'm honored that you answered.


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Hi Terry, I prefer to bond resin to teeth myself but I know that many dentist prefer to have the lab do the work and simply bond what the lab returns AS A ONE piece restoration. Yes the patient won't be able to floss for a few days but a water pick will suffice. If you don't mind bonding the teeth using a matrix created from a lab wax up. this is the best way. 1. Mock up the Maxillary teeth for incisal length and speech as per a denture protocol. 2. Mock up the mandibular teeth for esthetics and speech. 3. When the patient closes on what would be their back teeth, record the open posterior space by injecting bite registration material. 4. Take impressions of the mockup and the lab will mount to your bite registration. 5. Remove the mock up pieces and sent to lab so that they can wax up the case 6. If you want, the lab can do all the work and send you one piece, multiple teeth onlays that you bond to place. One piece for 18-21; one piece 22-27, one piece 28-31; Does this make more sense??? For the maxillary teeth, you probably will need crown root lengthening unless you want to orthodontically intrude the teeth. Thoughts? Always a pleasure to help. Gerald


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I'm thinking this through. Thank you. I've done this before, however the segmented approach as you describe simplifies the process and has some definite benefits. Wrapping my head around it!!!! hopefully.


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Terry...I think Gerald has given you sound advice.This is a challenging case but will be a dramatic result for you. When I do these cases I will want to make certain the patient wears the temporaries for an extended period of time to verify speech, comfort, occlusion and especially final esthetics.


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