Aip Cheong 2019-winter

Presented by Dr. Chan Cheong

Winter 2019

Advances In Prosthodontics

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New Findings & Best Practices for Cosmetic & Restorative Dentistry

INSIDE THIS ISSUE

Do You Have a Patient Missing One or More Teeth? Before

CASE SUMMARY: Do You Have a Patient With This Situation? (see photos on right)... pages 1-2

DENTAL JOURNAL BRIEF: Quickly Get the Latest Research on Procedures & Materials For Better Outcomes... page 3

After

HAVE A LAUGH: Root Canal Diving... page 3

COMPLEX CASES: Dr. Hill & Dr. Cheong’s Training & Experience Make These Treatments More Successful... page 4 © Sams Media Group, LLC

Here’s the story of another dental professional who came to see our office for treatment… If you have a patient with several missing, broken or severely worn teeth—
 they may be a candidate for oral rehabilitation and esthetic enhancements with the assistance of an advanced Prosthodontist.

Read more on the next page…

Do you want another opinion on a complex case? Or to meet and share ideas? There are many ways we can help each other by working together on complex cases and by sharing knowledge and experience. With your reputation for quality dental care, and our experience with restorative treatments, we can work together on advanced cases and both benefit! 
 If you’d like to meet to discuss a difficult procedure, or talk on the phone about how we can help each other, please call or email our office with specific days and times when you are available to talk or meet. Drs. Cheong & Hill ! The Complex Case Specialists™ ! (978) 352-8206 ! [email protected]

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FROM THE PROSTHO FILES

CASE SUMMARY:

Are you doing a favor to your friends / patients? by Georgetown Dental

This was an interesting case because the patient himself is a dentist who we’ll call “Tim.” Tim was missing tooth #7 and wanted to restore this missing tooth without orthodontics. In addition, due to a root proximity issue, a dental implant was not an option for him. He initially started a treatment with his dentist friend, who convinced him to restore anterior sextant rather than focusing on tooth #7 restoration.

Pre-op

Other than missing tooth #7, Tim never had any dental issue in the past. However, since he started his treatment with his dentist friend, he had to receive two root canal treatments on his abutment teeth and periodontal treatment due to aggressive teeth preparation. As a result, he was emotionally distressed and skeptical about the treatment outcome. In addition, being a dentist himself, Tim wanted to make sure that everything went perfectly, just like any other case he might do for patients. That’s why he decided to come to our office because of our experience with challenging treatments. With Dr. Cheong’s prosthodontic training and Dr. Hill’s advanced training, we were prepared and experienced to plan this complex treatment. Tim felt comfortable knowing that we have experience with complicated dental issues, and have developed protocols to ensure the highest esthetic outcome of the restoration, with a minimally invasive approach. Since Tim came to our practice in the middle of his treatment and his teeth were already prepared, we tried our best to stay with his original treatment plan. We started with a wax-up to assess his outcome, and then moved forward with provisional restorations and delivery of finished restorations. We were able to deliver a fixed dental prosthesis with partial abutment crowns and ovate pontic on tooth #7.

Wax-up

Lab photo

With any case, we always need to present a treatment plan that is minimally invasive and delivers a predictable outcome to our patients. Our office gave Tim a full warranty (that we give to all patients, including a no-charge yearly exam). We usually refer patients back to their general dentist for regular hygiene, unless advised otherwise by the referring office, depending on the patient and treatment. If you have comments or questions about how we treated Tim from this example, please email us at: [email protected]

Do you have a patient in Tim’s situation? Or another complex case?

Final Result

If you have a question about a case and want another opinion, give our office a call. Or, if there’s a case that you want to work together on, please fill out and send in the enclosed referral form. We will take great care of your patient and keep you informed. Dental professionals refer to us as 
 The Complex Case Specialists™ because we perform complex cases every day. Drs. Cheong & Hill ! The Complex Case Specialists™ ! (978) 352-8206 ! [email protected]

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DENTAL JOURNAL BRIEF Quickly Get the Latest Research On Procedures & Materials For Better Outcomes…

Reliability and Failure Modes of a 
 Hybrid Ceramic Abutment Prototype Silva, N et al. J Prosthodont 2018; 27: 83-87 Purpose A ceramic and metal abutment prototype was fatigue tested to determine the probability of survival at various loads. Material and Methods Lithium disilicate CAD-milled abutments (n = 24) were cemented to titanium sleeve inserts and then screw attached to titanium fixtures. The assembly was then embedded at a 30° angle in polymethylmethacrylate. Each (n = 24) was restored with a resin-cemented machined lithium disilicate all-ceramic central incisor crown. Single load (lingual-incisal contact) to failure was determined for three specimens. Fatigue testing (n = 21) was conducted employing the step-stress method with lingual mouth motion loading. Failures were recorded, and reliability calculations were performed using proprietary software. Probability Weibull curves were calculated with 90% confidence bounds. Fracture modes were classified with a stereomicroscope, and representative samples imaged with scanning electron microscopy. Results Fatigue results indicated that the limiting factor in the current design is the fatigue strength of the abutment screw, where screw fracture often leads to failure of the abutment metal sleeve and/or cracking in the implant fixture. Reliability for completion of a mission at 200 N load for 50K cycles was 0.38 (0.52% to 0.25 90% CI) and for 100K cycles was only 0.12 (0.26 to 0.05)-only 12% predicted to survive. These results are similar to those from previous studies on metal to metal abutment/fixture systems where screw failure is a limitation. No ceramic crown or ceramic abutment initiated fractures occurred, supporting the research hypothesis. The limiting factor in performance was the screw failure in the metal-to-metal connection between the prototyped abutment and the fixture, indicating that this configuration should function clinically with no abutment ceramic complications. Conclusions The combined ceramic with titanium sleeve abutment prototype performance was limited by the fatigue degradation of the abutment screw. In fatigue, no ceramic crown or ceramic abutment components failed, supporting the research hypothesis with a reliability similar to that of all-metal abutment fixture systems. A lithium disilcate abutment with a Ti alloy sleeve in combination with an all-ceramic crown should be expected to function clinically in a satisfactory manner.

Have A Laugh: Root Canal Diving… We hope we made you smile during your busy day! We take the care of patients referred to us very seriously, including knowing how to educate them so they feel comfortable. It’s our goal to help every patient understand even the most difficult procedures, so they can regain the function and esthetics they desire. Drs. Cheong & Hill ! The Complex Case Specialists™ ! (978) 352-8206 ! [email protected]

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The Complex Case Specialists

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ABOUT OUR PRACTICE Georgetown Dental specializes in very challenging treatments. These include patients with severe bruxism, severely resorbed ridges, inadequate interarch space, complicated implant-supported prosthesis, failing restorations or dentition, and many other examples. Dr. Hill has over 40 years of experience with complex dental cases and partnered with Dr. Chan Cheong because of her specialized training from Harvard in prosthodontics. Together, they share the goal of working alongside other great dental professionals on restorative cases for removable prosthodontics, implant prosthodontics, and all phases of esthetic dentistry. The training and private practice experience that 
 Drs. Cheong & Hill have make treatments of complex cases 
 more successful, including the following examples: Dr. Chan Cheong

Dr. Howard Hill

• Patients with ill-fitting dentures, severely worn or damaged teeth can receive a single dental implant or a full arch of natural-looking teeth.

• Patients who have suffered from traumatic injury, congenitally missing teeth, or a chronic condition can 
 receive oral prostheses, which may be a combination of dental implants, crowns, bridges, or veneers. • Patients with severe neglect of their oral health can receive reconstruction to restore function & esthetics.

Personal Message To Fellow Dental Practitioners: 


“As the referring dentist, you know your patient’s mouth and have key insight into your patient’s needs. We want to work with you to provide your patients with the best possible treatment outcomes. We will treat your patient in a manner that will reflect well on you and strengthen 
 your relationship with your patient. We are here to make you look good! When your patient’s care is completed, they are referred back to your office for their ongoing dental care. We are grateful for your colleagueship and trust with your patients!”

Why other dentists work with a Prosthodontist

Prostho Pledge When your patient is referred:

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We will only treat what’s 
 been referred.

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We will send you updates.

√

We will be part of your team,

not take over your patients.

Prosthodontists are specialists in implant, esthetic, and reconstructive dentistry.

You have a patient requiring complex treatment outside of your typical practice. 


1. 


Examples include patients with vertical dimension discrepancies, severely resorbed ridges, 
 inadequate interarch space, TMJ, severe bruxism, traumatic tooth loss, or congenital abnormalities.

You have a patient with complex needs that may drain your time.


2. 


If your patient may require treatment from several specialists, Prosthodontists can help because 
 they are trained to appropriately stage and manage complex treatment plans.

You have a demanding patient who wants perfect esthetics.


3. 


Examples include patients with a high smile line or needing a single tooth replacement in the 
 esthetic zone. A Prosthodontist is trained in selecting the best solutions for high-demand patients.

You have a question and want to discuss a case with a colleague to ease your mind.


4. 


A Prosthodontist can be an excellent resource for you to ask questions because they are trained in 
 many types of complicated treatments. For example, you may want to consult or refer to a Prosthodontist 
 for complex implant-supported restorations. A Prosthodontist can work with you or complete the treatment 
 for you to achieve the best in both function and esthetics.

Drs. Cheong & Hill ! The Complex Case Specialists™ ! (978) 352-8206 ! [email protected]

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