NTI problem

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StovePipe - 22 Oct 2004 05:16 GMT

Howdy gang

Lady about 65yrs, P/P with poor posterior support, recurrent breaking of
mesial Cl 4 on upper right central (small and right at the corner). I
told her I'd do it again (second time) if she agreed to protect it and
the rest of the mouth with an NTI. This is what brought her in to see me
originally, so I assume it had broken before as well.

Two months later, broken again, same place, and tells me that the upper
left central is sore. Buccal gum tissue is reddish, slightly edematous,
though no pockets, no real mobility. Percussion sensitive, but she
didn't want xray. She said all the retention of the NTI was coming from
that left (painful) central and the right one (with broken Cl 4) was not
supporting the NTI.

Repaired the Cl 4 (third time, this time with Filtek flow and P60 from
3M for strength).

Suggested putting aside the NTI for a few days, letting the upper left
central heal up if possible, and then do a reline.

Think that the torquing action of the NTI, as it held onto only one
tooth is the cause of the pain and gingival redness on the upper left
(yet unbroken) central.

Any one have any thoughts as to what is going on here? Unfortunately, no
pictures, no time (we had about 25 mins to do this, then I did a
cosmetic job on Brittney Spears' teeth ... nudge nudge wink wink SAY no
more... SAY no more....)

Actually, I saw a picture of her recently: she SMOKES cigarettes....
Jeez, do people still DO that????

Will be going to T.O. this weekend. Will report on the Ray Bertolotti
lecture... to all four of us dentists, if you can believe that.... when
I get back. Will take my camera and get a picture of me with Roy and
Molly. ;-)
Cheeahs
SP

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Not a real Addy, yet

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Dr Steve - 26 Oct 2004 14:10 GMT

Hi Stoverino,

I suggest taking study models. Do two sets. One with the RPD's in place
and one without. Then,,,,,,,,,,,,,,, HAND-ARTICULATE (read--no mounting).
Hold the models lightly in your hands and slide the two models lightly
around from CO. You should find a bracing position from which she
parafunctions and this tooth gets in the way of this action. It may well be
with the RPD's removed while she is sleeping. Mark the bracing position on
the models (there should be wear facets there. In the mouth, re-contour the
edges of these facets (without removing the center of them). Then, figure
out how you can restore this anterior tooth without allowing the
parafunction to recur. If the bracing position only occurs with the RPD's
out of the mouth, and the patient wears the RPDs during the day, then an NTI
at night will protect very well. If the restoration is in the way of
day-time parafunction, you have to make a decision to either put the patient
in a day-time NTI or adjust the occlusion (any chance the VDO is reduced on
the RPDs?).

Pain in the teeth the NTI locks onto will indicate that the patient can get
cuspid contact on the DE and clench vigorously, or that the re-line of the
NTI is "off" by microns. Check excursions to see if she can get lower
cuspid contact to the DE, or if she can get molar cusp tips to touch with
the NTI in place (usually due to excessive Curve of Spee). If so, adjust
these cusps. And, regardless, grind out some of the SNAP and re-line it.
Leaving it out for a few days leaves everything exposed to parafunctional
damage.

What works nicely is to thin down the buccal "flange" of the NTI until it is
about 4-5mm thick near the border. Shorten this "flange" until it only
covers about 6-8 mm of gingival. Re-line the NTI and adjust the inner
surface with a Bard-Parker knife until the patient can remove it with
moderate tugging. The thinner and shorter "flange" will increase tolerance
to wearing the NTI, and reduce pressure on the gingiva.

Are you wearing an NTI? If not, make one for yourself ASAP. You will
understand how these feel and be better equipped to adjust them.

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.
......................

> Howdy gang
>
[quoted text clipped - 35 lines]
> Cheeahs
> SP

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