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Medical Forum / General / Dentistry / June 2004MonoDont Sort of...
Greetings all again. And again, I am really very sorry that I can't spend more time conversationally and helping out with patients queries.... Gawd, I don't know how you all do it: you must read and type at the speed of light... I still lurk though, and still have questions... :-) If you want to see what I'm yakking about, I suggest you load my web page and come back here while it's loading; the photos are quite high resolution. http://tinyurl.com/2lfg5 This time it's concerning the MonoDont I wanted to put to replace an upper left lateral. The problem is that I cannot figure out what it is that you pepole do: When I go on their site, they describe an indirect method where you take the impressions and send them to EastFlex, and they do a MonoDont in lab and send that back to you. I asked the Local Lab Guy to look at the EastFlex site and send me one after contacting the company to get the metal skeleton. Well, they didn't do that: they made a mini-butterfly bridge that one would cement in cavity preps in both abuttment teeth (central incisor and 1st PM; no canine). The back of the thing (occlusion side) is in porcelain and the part that is cemented is C&B metal (C&B gold, I presume). This chef d'ouvre can be seen on the same page: http://tinyurl.com/2lfg5 Just scroll down to MonoDont I'm wonering with what I would cement such a thing so that it has a hope in hell of holding? Further, do you think there's any truth to Karl Leinfelder's assertion that the 7th generation of bonding agents are superior for bonding to metal, as in this case? I read that in one of our French language equivalents of Dentistry Today, and YES, on the overleaf was a huge add for i-Bond.... Coincidence? Thanks Secondly, under the MonoDont photos, you'll see 2 photos of one of my many C/P cases; a lovely mid-aged lady who needs grafts to reinforce her gums at the canine and PM position. These grafts scare the beJesus out of me: The mental vasculo-nervous bundle is in there somewhere, and even if I don't hit it, I'll surely hit a small venule or arteriole that would give enough bleeding to compromise the graft with a hematoma. Further, free gingival grafts are not what she needs; Subepithelial connective tissue grafts that have the potential to cover the roots while reinforcing the area are what she needs. I don't know how to do those, and reading a book just doesn't give me the confidence I need. So, my question: Who gives courses on these types of grafts; demonstrating a technique that is SAFE and predictable? I cannot overemphasize the SAFE aspect. I don't feel like having to change my underwear after doing these surgeries. We don't seem to have courses on that here in QC. Thanks X 2 PS: Sorry it takes so long to load: I neglected to take down the original photos, and I should also perhaps have chopped them down to lower resolution. This won't happen again.... :-)  SignatureCheers/Chüss SP 'A Day...' is not a real email >Greetings all again. > [quoted text clipped - 19 lines] >I asked the Local Lab Guy to look at the EastFlex site and send me one >after contacting the company to get the metal skeleton. WHERE? Its not there. Where is the metal skeleton? >Well, they didn't do that: they made a mini-butterfly bridge that one >would cement in How can you cement this IN? The wings are huge, like a Maryland Bridge. >cavity preps in both abuttment teeth (central incisor >and 1st PM; no canine). The back of the thing (occlusion side) is in >porcelain Why? It needs to be cement INSIDE cavity preparations ...... The lab guy seems like he does excellent work but lacks the concept. Keller Laboratory is the lab to work with on this next time ........ Your lab guy needs to understand this: Some dentists use the Monodont as a temporary before an implant so you can see its not a big deal. The structure merely keeps the 'thang from breaking as it spans from natural tooth to natural tooth. The metal structure from Drs. Maris and Dan (Eastflex dudes) is embedded inside the cavity preparations ...... I would love to see an x-ray of just the bridge and see if your lab guy even used the metal structure from Eastflex or if he is really fooling with you ..... Some dentists doing it themselves in the office carve up a denture tooth and quick cure it onto the framework the day before the dental appointment. When the patient returns, they prepare the teeth and bond it in place. If it is deeply embedded, and if the bite is not excessive, it stays. JOEL >and the part that is cemented is C&B metal (C&B gold, I >presume). [quoted text clipped - 36 lines] > >:-) Thanks, JME- Sorry to take so long to reply, but here's what I think: > >http://tinyurl.com/2lfg5 ....<snip>.... > >I asked the Local Lab Guy to look at the EastFlex site and send me one > >after contacting the company to get the metal skeleton. > > WHERE? Its not there. > > Where is the metal skeleton? Like I said: They didn't _do_ a true Monodont with the real skeleton. They did a pontic in PFM with some mini wings on it. I'm supposed to dig a cavity in each tooth and ciment it into those cavities. The back of the wings would cover the cavities and so there would be no composite on the surface. The porcelain on the outside of the wings would _be_ the surface. > >Well, they didn't do that: they made a mini-butterfly bridge that one > >would cement in > > How can you cement this IN? The wings are huge, like a Maryland > Bridge. Like I said: that's really what it _IS_: a mini-Maryland bridge... > >cavity preps in both abuttment teeth (central incisor > >and 1st PM; no canine). The back of the thing (occlusion side) is in [quoted text clipped - 14 lines] > structure from Drs. Maris and Dan (Eastflex dudes) is embedded inside > the cavity preparations ...... OK, I'll tell him. In the meantime, I'll have them do a flipper for the lady, as she's getting impatient (with good reason). > I would love to see an x-ray of just the bridge and see if your lab > guy even used the metal structure from Eastflex or if he is really > fooling with you ..... Again, he did _not_: he made a mini-Maryland bridge, as far as I can tell. I don't think he's fooling with me per se, just doing what he thinks is best. In fact, their PR lady phoned last week to ask how it went with that thing. > Some dentists doing it themselves in the office carve up a denture > tooth and quick cure it onto the framework the day before the dental > appointment. > > When the patient returns, they prepare the teeth and bond it in place. > If it is deeply embedded, and if the bite is not excessive, it stays. I'll do it differently next time: I'll make a Vectris skeleton covered with Sinfony. This is another thing that Jeff Bruchia said: the Vectris framework actually works BETTER with Sinfony than Targis. > JOEL Thanks SignatureCheers/Chüss SP 'A Day...' is not a real email >Thanks, JME- Sorry to take so long to reply, but here's what I think: > [quoted text clipped - 15 lines] >the surface. The porcelain on the outside of the wings would _be_ the >surface. What is going to keep this bridge "IN?" At least a Maryland Bridge is etched so it will adhere (hopefully) to the teeth. This puppy as pictured will fall right out, right? >> >Well, they didn't do that: they made a mini-butterfly bridge that one >> >would cement in [quoted text clipped - 3 lines] >> >Like I said: that's really what it _IS_: a mini-Maryland bridge... But how will it ahere? What about the bite? If its a Class II, okay. If its a Class I with any type of close bite.... the wings will interfere with the patient closing his teeth ..... >> >cavity preps in both abuttment teeth (central incisor >> >and 1st PM; no canine). The back of the thing (occlusion side) is in [quoted text clipped - 36 lines] >with Sinfony. This is another thing that Jeff Bruchia said: the Vectris >framework actually works BETTER with Sinfony than Targis. If you want to develop this technique, start simple. Get the patient who has been without the lateral incisor for three years and tell him you will fix it. Take an impression, and the next day, in the lab drill out the intended cavity preparations. Fit the Eastflex extender bar and quick cure on a denture tooth. When the dude comes back, dril lthe teeth and install. Then observe how it went as far as pontic design, depth of preparation, etc. So the first one is a loss leader for you, but you gain KNOWLEDGE! JOEL >> JOEL > >Thanks > If you want to develop this technique, start simple. Get the patient > who has been without the lateral incisor for three years and tell him [quoted text clipped - 3 lines] > intended cavity preparations. Fit the Eastflex extender bar and quick > cure on a denture tooth. %%% First make a "vacuum-formed" template (0.02") like you would for C&B provisionals. Cut the preps on the models through the template. You can later place the template on the mouth and cut the same prep on the teeth. The preps MUST have undercut. The metal "tabs" have to extend at least 2 mm into SOLID tooth. %%% > When the dude comes back, dril lthe teeth and install. Then observe > how it went as far as pontic design, depth of preparation, etc. > > So the first one is a loss leader for you, but you gain KNOWLEDGE! >> If you want to develop this technique, start simple. Get the patient >> who has been without the lateral incisor for three years and tell him [quoted text clipped - 9 lines] >The preps MUST have undercut. The metal "tabs" have to extend at least 2 mm >into SOLID tooth. %%% EXCELLENT! Thanks. JOEL >> When the dude comes back, dril lthe teeth and install. Then observe >> how it went as far as pontic design, depth of preparation, etc. >> >> So the first one is a loss leader for you, but you gain KNOWLEDGE! > > If you want to develop this technique, start simple. Get the patient > > who has been without the lateral incisor for three years and tell him [quoted text clipped - 9 lines] > The preps MUST have undercut. The metal "tabs" have to extend at least 2 mm > into SOLID tooth. %%% TWO millimeters??? Jesus... I better look at the BiteWings of the 1PM. I think it's OK, but I'll check. > > When the dude comes back, dril lthe teeth and install. Then observe > > how it went as far as pontic design, depth of preparation, etc. > > > > So the first one is a loss leader for you, but you gain KNOWLEDGE! This, in my case, is painfully true, as it is for the second and maybe the third.... OK, it's starting to make sense. The next one will be done this way. Thanks to all SignatureCheers/Chüss SP 'A Day...' is not a real email Hey Stove, At least at the office with DSL the images came up almost instantly. Instead of apologizing for loading time, just warn people by telling them what the file size is, and let them decide for themselves if they want to open the web-page. What lab fee did you get with that contraption? Can you send it back? A Monodont is designed to save money, not incur big lab fees. If you are going to do PFM, just do a Maryland FPD, your cost will be the same. Please do your first MonoDont in your office lab yourself. You need to understand it properly to be able to evaluate what you are getting from your lab. You should be having a denture lab make it, NOT a C&B lab. It should have a denture tooth slotted to fit over the MonoDont component and adhered to the component with tooth colored acrylic. The MonoDont is cheaper so the patient who cannot afford the PFM restoration is NOT denied treatment. It is a great alternative to the flipper. After the model has hardened, it only takes about 30 minutes of your own time to fabricate the lab-work for a MonoDont. I NEVER send them to a lab. This is also a great restoration for periodontally involved teeth, as you don't feel bad if it gets thrown out in 3-4 years when the tooth fails. Email Maris or Dan at Eastflex, and they will sell you a starter kit of components. Once you see what you can do with them, you think up many more places to place them. I love them for transitional FPD's placed immediately during an extraction appointment. You should be able to google backwards about 4 years on SMD to the case I posted. It was my first case and I posted a bunch of photos with it. Back then, my ISP allowed attachments to non-binary NG's. The case I described was on a fellow with a hereditary disorder causing his dental roots to resorb and have his secondary teeth exfoliate like primary teeth. I had a MonoDont component sitting on my desk that day (Maris sent me one to convince me they were as great as he said they were). I had been very skeptical of the technique up to that point. This patient came in with a lower central incisor broken off subgingivally, and not restorable. The adjacent teeth only had 1/3 to 1/2 of their roots remaining. Implants were out of the question, conventional FPD with PFM abutments would have been silly. Then, I remembered the Monodont component on my desk. I snapped a quick alginate, and sent the patient home. He came back after lunch, and I placed my first MonoDont. It came loose a few months ago. I cleaned everything up, and re-bonded it in place. I think he has had it since 1999 now. The adjacent teeth continue to lose root structure. Who knows how long it will stay in place? He has gotten more than his money out of it already. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Greetings all again. > [quoted text clipped - 63 lines] > > :-) >Hey Stove, > >At least at the office with DSL the images came up almost instantly. Me too, and that's with my cheeze-O-rama %9.95 dial-up ....... PULSE not TONE dialing! JOEL >Instead of apologizing for loading time, just warn people by telling them >what the file size is, and let them decide for themselves if they want to >open the web-page. Small files..... >What lab fee did you get with that contraption? Can you send it back? A >Monodont is designed to save money, not incur big lab fees. If you are [quoted text clipped - 37 lines] >long it will stay in place? He has gotten more than his money out of it >already. > Hey Stove, > > At least at the office with DSL the images came up almost instantly. > Instead of apologizing for loading time, just warn people by telling them > what the file size is, and let them decide for themselves if they want to > open the web-page. Better yet, I'll use my graphics app to cut the resolution down. > What lab fee did you get with that contraption? The same about as Keller labs will charge for a SoloPontic: Roughly 110$ USD >Can you send it back? Maybe.... > A Monodont is designed to save money, not incur big lab fees. If you are > going to do PFM, just do a Maryland FPD, your cost will be the same. Wish I had read this b/4 sending the case to Keller Labs. I finally got fed up and took JME's advice on that. I sent the models back to the local lab and asked them to make up a flipper. They'll prbably do that for free. The 'MonoDont' was sent to Keller along with the original models, for comment. What I wanted was a simple solution to at least see what the MonoDont is all about, and it's been dragging since early April. That's why I finall said 'scew it' and sent it to them. > Please do your first MonoDont in your office lab yourself. You need to > understand it properly to be able to evaluate what you are getting from your > lab. You should be having a denture lab make it, NOT a C&B lab. It should > have a denture tooth slotted to fit over the MonoDont component and adhered > to the component with tooth colored acrylic. Fine... I just hope all instructions and all things needed are there (including the tooth colored acrylic, as I have no Idea what that is, unless you're talking about Snap or Trim, as used to make temporaries in Fixed cases). > The MonoDont is cheaper so the patient who cannot afford the PFM restoration > is NOT denied treatment. It is a great alternative to the flipper. After > the model has hardened, it only takes about 30 minutes of your own time to > fabricate the lab-work for a MonoDont. I NEVER send them to a lab. So, you prep the class 3's or the MO's and DO's on the models in your lab. What can you use to do this? I would try my Dremmel mini drill kit? I would think that using the turbine on stone or plaster models would gum it up....unless I had a scrap turbine to use for that. If I had an electric lab motor, I'd use it, but I'm not equiped for that yet. >This is > also a great restoration for periodontally involved teeth, as you don't feel > bad if it gets thrown out in 3-4 years when the tooth fails. So, this is what I need. The lady is a school teacher, who can't afford much else. It's to replace a lateral, but the rub is that there is no canine, and the 1PM is almost all composite. So, at least I have no qualms about cutting an MO in that to hold the thing. > Email Maris or Dan at Eastflex, and they will sell you a starter kit of > components. Once you see what you can do with them, you think up many more > places to place them. I love them for transitional FPD's placed immediately > during an extraction appointment. I shall... but I WILL go through with the Keller Labs SoloPontic, as it will compensate the lag time that she's been waiting, and it will give me an idea of what the thing should look like. Some can figure it out themselves, some need to SEE it first. When I get it back, I'll post a photo for those (like me) who have no idea what the thing is. > You should be able to google backwards about 4 years on SMD to the case I > posted. It was my first case and I posted a bunch of photos with it. Back > then, my ISP allowed attachments to non-binary NG's. OK, will do. This is why I send my photos to my little web site. You're not the only one in that bind, I'm sure. > The case I described was on a fellow with a hereditary disorder causing his > dental roots to resorb and have his secondary teeth exfoliate like primary [quoted text clipped - 11 lines] > long it will stay in place? He has gotten more than his money out of it > already. Thanks. I'll tell y'all what happens with this case. BTW, I've archived all info on the MonoDont since I've come in here in March. SignatureCheers/Chüss SP 'A Day...' is not a real email I use the denture lab trick of mixing SNAP powder with denture repair liquid. Cure in a pressure pot and it gets very hard. Signature`~`~`~`~`~`~`~`~`~`~`~`~`~`~`~ Stephen Mancuso, D.D.S. Troy, Michigan USA =+=+=+=+=+=+=+=+=+=+=+=+= . > > > Hey Stove, [quoted text clipped - 90 lines] > Thanks. I'll tell y'all what happens with this case. BTW, I've archived > all info on the MonoDont since I've come in here in March. Wow! Great suggestion ....... so you are using standard methyl methacrylate liquid with ethyl methacrylate power........ I never thought of that. JOEL PS- SNAP is highly recommended for doing direct temporary bridges ... without a template ........ it does not slump, etc. JOEL >I use the denture lab trick of mixing SNAP powder with denture repair >liquid. Cure in a pressure pot and it gets very hard. > Wow! Great suggestion ....... so you are using standard methyl > methacrylate liquid with ethyl methacrylate power........ I never [quoted text clipped - 9 lines] > >I use the denture lab trick of mixing SNAP powder with denture repair > >liquid. Cure in a pressure pot and it gets very hard. Good.... Thanks to both. I'll shout if I have trouble finding a denture repair kit. SignatureCheers/Chüss SP 'A Day...' is not a real email >I use the denture lab trick of mixing SNAP powder with denture repair >liquid. Cure in a pressure pot and it gets very hard. Keep it G-rated dude. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Sorry Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA > >I use the denture lab trick of mixing SNAP powder with denture repair > >liquid. Cure in a pressure pot and it gets very hard. [quoted text clipped - 3 lines] > > W_B |
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