Aip Nw Pros 2019-spring

Presented by Dr. Josh Manchester & Dr. Rodger Lawton

Spring 2019

Advances In Prosthodontics

TM

New Findings & Best Practices for Cosmetic & Restorative Dentistry

Do You Have A Patient With
 Palatal Wear?

INSIDE THIS ISSUE

Part 2 (Palatal Veneers)—keep reading…

CASE SUMMARY:

Part 1 (Palatal Veneers) available at:

Do You Have a Patient With This Situation? (see photos on right) Chief Concern page 2

AdvancedProsthodontist.com/NWpros

Before

Potential Causes page 2

Treatment and Result pages 2-3

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

COMPLEX TREATMENTS: Dr. Manchester & Dr. Lawton Have Prosthodontic Training & Experience That Make These Treatments More Successful... page 4 © Sams Media Group, LLC

After

Here’s the story of a patient who was referred from another dental professional... If you have a patient with failing dentition or failing restorations— they may be a candidate for assistance from a Prosthodontist. For instance, the case summary in this newsletter shows another example of how our office identifies and addresses the source of tooth wear in order to deliver a long-term solution for each patient. Read more on the next page…

Do you want another opinion on a treatment? Or to meet and share ideas? There are many ways we can help each other by working together on complex treatments and by sharing knowledge and experience. With your reputation for quality dental care, and our experience with restorative dentistry, we can work together on advanced treatments and both benefit. If you'd like to meet to talk about a patient, please contact us. We’re looking forward to talking with you on the phone or in person. Please call our office or email us with specific days and times when you’re available to talk or meet.

Drs. Manchester & Lawton, NW Center for Prosthodontics ! Artistry Driven By Science ! (360) 459-4400 ! [email protected]

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FROM THE PROSTHO FILES

CASE SUMMARY:

Restoration of Palatal Wear with Veneers Dr. Joshua Manchester, DDS, MSD, Prosthodontist

“John” was referred to my office for treatment of fractured tooth #10 and for restoration from wear on all upper anterior teeth (Figures 1-5). His chief concern was that his tooth had broken off and he was worried about the other teeth adjacent to #10 fracturing off in the future.

Fig. 1

John presented with a unique severe pathway wear into dentin that was localized only to his upper anterior teeth and mild wear among his posterior teeth. Notice in the initial presentation, John had a 
 deep overbite and very little horizontal overjet. This type of wear is due to a combination of relatively deep overbite from a “weak” Angles Class I malocclusion and a constricted envelope of function. As a prosthodontist, I have experience with challenging cases, planning multi-stage treatments, and coordinating with a patient’s general dentist and other dental specialists. If you have a patient like this example, consider a prosthodontics consultation or referring the patient before their teeth are so worn they fracture teeth and require multiple RCTs or clinical crown lengthening for restoration. Our standard protocol is to identify and address the source of the tooth wear. This pattern of severe wear seen in John’s case most likely did not occur during his sleep. Nocturnal bruxism is usually more lateral in direction. In John’s situation, this type of functional pathway wear occurs with patients who have constricted envelopes of function mainly when they chew food, or during moments of stress will “play on their incisal edges.” This will also manifest as the patient’s unintentional “bumping” of upper and lower anterior together while the patient is speaking when crowns and/or veneers have violated this envelope of function. This could lead to fracturing of porcelain restorations, mobility of anterior teeth and/or symptoms of temporomandibular joint disorder (TMD).

Fig. 2

We discussed the possible benefits of orthodontics with John, as we do with most patients who present with malocclusion and would benefit from tooth movement before extensive dental treatment. For John, this could reduce the degree of overbite his anterior teeth have and give him more space for his envelope of function. However, he decided to not go through orthodontics to treat his malocclusion and instead sought only a restorative solution.

Fig. 3

Due to the large degree of wear on the maxillary anterior teeth and minimal wear of the posterior teeth, 
 I decided to treat John with a restorative/orthodontic technique known as the Dahl technique. This technique will increase the vertical dimension of occlusion (VDO) and reduce an overbite. Once the palatal surfaces of the teeth #6-11 have been restored with composite resin, he would only be left occluding between teeth #6-11 and #22-27 and would have a posterior open bite. Utilizing the Dahl technique, the patient is left with a posterior open bite for a period of 6 to 8 months. In this time period, the anterior teeth will intrude and the posterior teeth will erupt until there is occlusal contact in the posterior areas.

Continued on next page...

Fig. 4

Fig. 5

Final photos on next page...

Do you have a patient in John’s situation? Or another complex treatment? If you have a question about a patient and want another opinion, give our office a call. Or, if you would like to work together for treatment, please fill out and send in the enclosed referral form. Our office will take great care of your patient and keep you informed.

Drs. Manchester & Lawton, NW Center for Prosthodontics ! Artistry Driven By Science ! (360) 459-4400 ! [email protected]

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FROM THE PROSTHO FILES

Delivery of palatal veneers

Continued from previous page…

4 month follow up

Fig. 6

Fig. 10

Fig. 7

Fig. 11

Fig. 8

Fig. 12

Fig. 9

Fig. 13

In order for successful execution of this treatment, accurate diagnostics were made recording the centric relation at the desired vertical dimension. During the initial phase of treatment, composite resin was used to restore the missing hard tissue and tooth #10 had intentional RCT performed for future post and core and temporary crown. As stated in the previous Palatal Veneers: Part 1 newsletter (read at: AdvancedProsthodontist.com/NWpros), direct restoration of the palatal surface with composite resin is very difficult to perform in the mouth. It was decided to have minimal preparation of the palatal surfaces of the teeth to create smooth contours for composite resin application and to make a PVS impression for indirect fabrication of composite restorations. Once the indirect composite restorations were fabricated, they were bonded to the teeth with resin cement. John was pleased with the esthetic outcome of the composites (Figures 6-9). His vertical dimension was opened slightly only for the thickness of composite resin that was added to the teeth, which translated to approximately 1-2 mm in the posterior teeth. I then started monitoring John’s teeth every two months for progress and mobility of anterior teeth. At 4 months, noticeable progress was made with the closure of the posterior open bite (Figures 10-13). After the posterior open bite has closed, his six anterior teeth will then be able to receive definitive ceramic restorations on #6-11, or he can continue to use his composite resin restorations on #6-9, #11 and restore #10 with a definitive crown.

After treatment is completed, I will give John my full warranty and send him back to the referring doctor’s office for long-term care. I give all referred patients a warranty and refer them back to the general dentist for hygiene unless advised otherwise by the referring office, depending on the patient and treatment. If you have comments or questions about how I treated John from this example, please email my office: [email protected]

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. Manchester & Lawton, NW Center for Prosthodontics ! Artistry Driven By Science ! (360) 459-4400 ! [email protected]

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The Complex Case Specialists

TM

ABOUT OUR PRACTICE Northwest Center for Prosthodontics specializes in very challenging treatments. Dr. Rodger Lawton has 38 years of experience with complex dental cases and partnered with Dr. Josh Manchester because of his specialized training from the University of Washington in prosthodontics. Together, 
 they share the goal of working alongside other great dental professionals on restorative cases. Their prosthodontic training and experience make complex treatments more successful, including the following examples: • Patients with multiple missing, loose, or severely worn/damaged teeth, or 
 with ill-fitting dentures can receive a full arch of natural looking implant 
 supported or removable dental prostheses to restore function & esthetics.

Dr. Rodger Lawton Prosthodontist

• Patients with congenital defects, a chronic condition, or traumatic
 injury can receive oral prostheses, which may be a combination of
 dental implants, full or partial dentures, crowns, or veneers.

Dr. Joshua Manchester Prosthodontist

• Patients with difficult anterior cases in the esthetic zone can receive
 single or multiple dental implants to replace missing teeth, or 
 veneers or crowns to improve the appearance of their smile.


In addition, Northwest Center for Prosthodontics, is equipped with a private dental laboratory. 
 An in-house, experienced, and certified dental technician creates each custom restoration for 
 referred patients from only the best materials using the latest dental laboratory technologies.

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 Certified Prosthodontist

Prostho Pledge When your patient is referred:

√

We will only treat what’s 
 been referred.

√

We will send you updates.

√

We will be part of your team,

not take over your patients.

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

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


1. 


Examples include patients with vertical dimension discrepancies, severely resorbed ridges, 
 inadequate interarch space, 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, Certified 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 Certified 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 Certified 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 a Certified
 Prosthodontist for complex implant-supported restorations. They can work with you or complete 
 the treatment for you to achieve the best in both function and esthetics. Drs. Manchester & Lawton, NW Center for Prosthodontics ! Artistry Driven By Science ! (360) 459-4400 ! [email protected]

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