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Medical Forum / General / Dentistry / February 2005Implants, partials, Another case
I've been watching the various discussions about what's possible with interest. I was interested in James' recent thread 'Implants or partials, or both?' and emboldened to also show my horrific xray. I've grown up in a small town area where the norm was full dentures by age 18. Sounds amazing nowadays, but that was the way then. I guess they thought it was some type of modern technological advance. Anyway my teeth were well filled and several pulled by the time I was 20, with triple abcesses in the bottom front. However I was convinced that the best action was whatever allowed me to retain my own teeth. Now in my mid-50s I have quite a wavy bone line from the gaps, over-eruptions, teeth reconstructed to the limit, and a few root fillings. The over-erupted upper molar is painful to cold/hot, so it's time to try prosthodontics. I had the molds done in December and am about to be called into my fixed prosthodontic clinic. I asked for a variety of options at this point, with a similar variety of costings. I can't afford a mouthful of work. I hope for a return to chewing well on both sides and that the variety of options will extend to what's available worldwide. Here's the state of my teeth www.adam.co.nz/xray/jpg As was pointed out to me there will be some bone and gum reconstruction needed in places, esp where there are missing teeth. Any thoughts here on what I could expect in the way of options? Thanks Brian  SignatureAuckland NEW ZEALAND > I've been watching the various discussions about what's possible with > interest. I was interested in James' recent thread 'Implants or partials, [quoted text clipped - 29 lines] > -- > Auckland NEW ZEALAND Brian: the correct URL for your xray is: http://www.adam.co.nz/xray.jpg instead of the www.adam.co.nz/xray/jpg you mentioned above. It's amazing how a slash instead of a dot can make all the difference! Anyway, the panoramic film posted is difficult to read, due in part to the severe half-toning of the image. Try resetting the scanner to eliminate the "newspaper half-tone" effect and see if that's any better. Regards, - dentaldoc >> Here's the state of my teeth www.adam.co.nz/xray/jpg >> As was pointed out to me there will be some bone and gum [quoted text clipped - 8 lines] >> -- >> Auckland NEW ZEALAND Two or three fixed bridges. This should take a couple of months and should not be outrageously expensive. If you want a more complete plan, some clear peripaical (around the roots) x-rays would be helpful. Joel > Two or three fixed bridges. This should take a couple of months and > should not be outrageously expensive. > If you want a more complete plan, some clear peripaical (around the > roots) x-rays would be helpful. > Joel Excuse me. On my OS the dots are slashes. No escuse. Here's a better one www.adam.co.nz/xray.jpg [64k] and a bigger one www.adam.co.nz/xray_324k.jpg B >> Two or three fixed bridges. This should take a couple of months and >> should not be outrageously expensive. [quoted text clipped - 13 lines] > >B Nixce x-ray. The back upper molar (UR as we view it) appears to be abscessed. This will compromise bridgwork. We gotta discuss this ....... Any ideas from the dentists? Joel > > Two or three fixed bridges. This should take a couple of months and > > should not be outrageously expensive. [quoted text clipped - 13 lines] > > B These pictures are much better. A set of periapicals would be better yet, as they show more detail than a single panoramic film, but this film gives a general idea. It looks like a large crown & bridge case, which is not uncommon. Assuming the periodonal condition can be improved and controlled, three fixed bridges ought to replace the missing teeth, although implants there -- expecially in the larger edentulous areas -- are usually preferable to long-span bridges. So one fixed bridge and several implants is another alternative. A couple of the lower molars seem to have restorations almost into the furcations, so that would take close examination to determine whether crowns or endo would be needed. So it might involve bridges, implants, perio treatment, and a few crowns and possible endodontics. Is that about what you have planned? Regards, - dentaldoc No offense, but it looks a lot tougher than that to me. (at least if you want it to last more than 5 years) JMO, Fawks > Two or three fixed bridges. This should take a couple of months and > should not be outrageously expensive. [quoted text clipped - 3 lines] > > Joel >No offense, but it looks a lot tougher than that to me. >(at least if you want it to last more than 5 years) > >JMO, >Fawks YUP, I just saw the better x-ray ...... there are complications. What would you suggest? Joel >> Two or three fixed bridges. This should take a couple of months and >> should not be outrageously expensive. [quoted text clipped - 3 lines] >> >> Joel >No offense, but it looks a lot tougher than that to me. >(at least if you want it to last more than 5 years) [quoted text clipped - 9 lines] >> >> Joel I would suggest full equilibration to a synchronous occlusion with two acrylic partials. Then, re-evaluate for prosthetics, Endodontics, etc. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>No offense, but it looks a lot tougher than that to me. >>(at least if you want it to last more than 5 years) [quoted text clipped - 15 lines] >Stephen Mancuso, D.D.S. >Troy, Michigan, USA I recommend a trip to Troy, Michigan, USA for treatment. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>No offense, but it looks a lot tougher than that to me. >>>(at least if you want it to last more than 5 years) [quoted text clipped - 17 lines] > >I recommend a trip to Troy, Michigan, USA for treatment. Only if Dr. George comes from DC .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>>I would suggest full equilibration to a synchronous occlusion with two >>>acrylic partials. Then, re-evaluate for prosthetics, Endodontics, etc. [quoted text clipped - 7 lines] >.. >Stephen Mancuso, D.D.S. Deal. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com | >>>I would suggest full equilibration to a synchronous occlusion with two | >>>acrylic partials. Then, re-evaluate for prosthetics, Endodontics, etc. [quoted text clipped - 15 lines] | Take out the G'RBAGE | wubbabubbazG@RBAGEyahoo.com You need a denturist as part of the treatment team? SignatureRoy rem NADA to reply >| >>>I would suggest full equilibration to a synchronous occlusion with two >| >>>acrylic partials. Then, re-evaluate for prosthetics, Endodontics, etc. [quoted text clipped - 17 lines] > >You need a denturist as part of the treatment team? Without a doubt. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>| wubbabubbazG@RBAGEyahoo.com >> >>You need a denturist as part of the treatment team? > >Without a doubt. If its in Troy Michigan, go incognito! >| >>>I would suggest full equilibration to a synchronous occlusion with two >| >>>acrylic partials. Then, re-evaluate for prosthetics, Endodontics, etc. [quoted text clipped - 17 lines] > >You need a denturist as part of the treatment team? Absolutely could use one. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>You need a denturist as part of the treatment team? > >Absolutely could use one. >.. >Stephen Mancuso, D.D.S. >Troy, Michigan, USA But not in Michigan correct? Montana, yes. Joel >>>You need a denturist as part of the treatment team? >> [quoted text clipped - 8 lines] > >Joel There would be plenty of "legal" ways to use the talents of a man such as Roy. Sharing a practice with him would be fantastic. Add in George's skills and we would be like the "A-Team". .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>>>You need a denturist as part of the treatment team? >>> [quoted text clipped - 12 lines] >as Roy. Sharing a practice with him would be fantastic. Add in >George's skills and we would be like the "A-Team". Yup ...... Joel >.. >Stephen Mancuso, D.D.S. >Troy, Michigan, USA > >I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>There would be plenty of "legal" ways to use the talents of a man such >>as Roy. Sharing a practice with him would be fantastic. Add in >>George's skills and we would be like the "A-Team". > >Yup ...... OK, Roy gets to be 'Face' ... Joel is "Murdock". And must fund 70% of the operation. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE | >>>You need a denturist as part of the treatment team? | >> [quoted text clipped - 17 lines] | | I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. I could handle being an in house tech for a couple of days. I'm sure that Steve and George could divvy up the impressions bite, try in and insertion between them. Alternatively, it is a quick jaunt across the border to Windsor (where I'm legally qualified to practice) I am sure I could borrow an operatory and a beautiful Kavo equipped lab of a Denturist I've met there. If not, then either Sarnia or Leamington are possibilities. Maybe even make a side trip or two to the Casino. Steve, does Michigan have any exclusion on their licensing requirements when it comes to educational endeavours? I know we do. SignatureRoy rem NADA to reply >| >>>You need a denturist as part of the treatment team? >| >> [quoted text clipped - 28 lines] >Steve, does Michigan have any exclusion on their licensing requirements when it >comes to educational endeavours? I know we do. Roy, If you mean do we allow treatment beyond the parameters of licensing regulations,,,,,, then no I do not think it is allowed, unless part of a Government approved dental school and the work is then done under the licensing of the supervising dentist (as I understand it). .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. "Dr. Steve" wrote "Roy Brown" wrote: | >I could handle being an in house tech for a couple of days. I'm sure that Steve | >and George could divvy up the impressions bite, try in and insertion between [quoted text clipped - 18 lines] | | I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. We have something like that.too. Not sure if applies to Full time courses, might also apply to part time or bonafide CE situations. SignatureRoy rem NADA to reply >There would be plenty of "legal" ways to use the talents of a man such >as Roy. Sharing a practice with him would be fantastic. Add in >George's skills and we would be like the "A-Team". >.. >Stephen Mancuso, D.D.S. Mancuso plays "B. A. Baracas" W_B plays 'Hannibal' Smith Roy plays "Murdock" We need a "Face"... "I love it when a plan comes together" -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>There would be plenty of "legal" ways to use the talents of a man such >>as Roy. Sharing a practice with him would be fantastic. Add in [quoted text clipped - 9 lines] > >"I love it when a plan comes together" Don't be messing wit da truck! .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > >>There would be plenty of "legal" ways to use the talents of a man such > >>as Roy. Sharing a practice with him would be fantastic. Add in [quoted text clipped - 14 lines] > Stephen Mancuso, D.D.S. > Troy, Michigan, USA J** can play Colonel Decker! T >> >>There would be plenty of "legal" ways to use the talents of a man such >> >>as Roy. Sharing a practice with him would be fantastic. Add in [quoted text clipped - 18 lines] > >T good one! .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >> >"I love it when a plan comes together" >> [quoted text clipped - 6 lines] > >T Good one. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com In article <1106728856.145990.50610@z14g2000cwz.googlegroups.com>, Bill <dentaldoc@hotmail.com> wrote: > It looks like a large crown & bridge case, which is not uncommon. > Assuming the periodonal condition can be improved and controlled, three [quoted text clipped - 7 lines] > So it might involve bridges, implants, perio treatment, and a few > crowns and possible endodontics. Is that about what you have planned? I've yet to see my prosthodontic man here, who is as we speak (I hope) making up from the castings he took of my mouth some choices of treatment. I'd like the choice of costings, though I guess cost equates to durability. My prosthodontic man also tells me that as a result of the bruxia-induced wavy dental line I have bone and gum decline in some parts and overgrowth in other parts. 'Periodonal condition'? So he's getting me to see a bone person and a gum person (excuse the lo-tech terms) for their evuations as to correcting this. Note that overerupted tooth. It's temperature sensitive now. what's possible there? > >I would suggest full equilibration to a synchronous occlusion with two > >acrylic partials. Then, re-evaluate for prosthetics, Endodontics, etc. > >Stephen Mancuso, D.D.S. > >Troy, Michigan, USA > I recommend a trip to Troy, Michigan, USA for treatment. Yes... ;) Might I assume then that the synchronous occlusion with two acrylic partials is a temporary solution? Sounds cheapest! How temporay? So what's the reason for this two-part treatment? Are there things that will become eveident after fitting the partials, and/or is a settling down period advised? Brian SignatureAuckland NEW ZEALAND >In article <1106728856.145990.50610@z14g2000cwz.googlegroups.com>, > Bill <dentaldoc@hotmail.com> wrote: [quoted text clipped - 35 lines] > >Brian In order to be able to do *ANY* restoration of your mouth, you have to stabilize the occlusion first. Achieving a synchronous occlusion at the begin inning gives you a pre-determined occlusion to build to. It also, provides reasonable temporary function. So this becomes diagnostic as well as transitional. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > In order to be able to do *ANY* restoration of your mouth, you have to > stabilize the occlusion first. Achieving a synchronous occlusion at > the begin inning gives you a pre-determined occlusion to build to. It > also, provides reasonable temporary function. So this becomes > diagnostic as well as transitional. > .. If it can be explained in writing, how would you make this occlusal scheme 'synchronous'? Thanks SP SignatureNot a real Addy, yet >> In order to be able to do *ANY* restoration of your mouth, you have to >> stabilize the occlusion first. Achieving a synchronous occlusion at [quoted text clipped - 7 lines] >Thanks >SP First, you need to correct the plane of occlusion. Then, remove excursive interferences. When rubbing stone models of the final occlusion together, it should almost feel like two ice cubes sliding across each other. No bumps or clicks. Then, provide 2-3mm long centric towards the distal. Then, give it some time to see if the patient has any occlusal disease. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > >If it can be explained in writing, how would you make this occlusal > >scheme 'synchronous'? [quoted text clipped - 12 lines] > > I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. So, basically, you'd have an almost 0-degree cuspid rise with long centric stops... toward the distal to allow free protrusion, I would think... If I understand this correctly, there are any number of my patients who would benefit from it. One thing I read in an old 'Dental Clinics of North America' on Prosthodontics: don't ignore the centric stop in the central fossa. If it is weak, the occlusion is unstable and the tooth will move, since all occlusion is now on inclines, usually angled in the same direction. So, I can see why a long centric in the central fossa or groove would be important. Thanks! SP SignatureNot a real Addy, yet >> First, you need to correct the plane of occlusion. Then, remove >> excursive interferences [snip] In my case I have what I imagine to be an excursive interference in the form of an over erupted maxillary 2nd molar. I have a commoner's attitude towards retaining as many teeth as possible, and assume this one could be chopped down and the root crowned so it doesn't extent down so much. >> Then, provide 2-3mm long centric towards the distal. Hmm. Is this 2-3mm forward movement from the relaxed position? >> Then, give it some time to see if the patient has any occlusal disease. > So, basically, you'd have an almost 0-degree cuspid rise with long > centric stops... toward the distal to allow free protrusion, I would > think... Are 'long centric stops' the points where opposing teeth touch (and work) and if they're long then the force is reduced? What's a cuspid rise? the curve of spee? (see, I've been reading up before I ask) Brian > One thing I read in an old 'Dental Clinics of North America' on > Prosthodontics: don't ignore the centric stop in the central fossa. If > it is weak, the occlusion is unstable and the tooth will move, since all > occlusion is now on inclines, usually angled in the same direction. > So, I can see why a long centric in the central fossa or groove would > be important. > Thanks! > SP SignatureAuckland NEW ZEALAND Dear "4-eyes", >>> First, you need to correct the plane of occlusion. Then, remove >>> excursive interferences [snip] [quoted text clipped - 3 lines] > towards retaining as many teeth as possible, and assume this one could be > chopped down and the root crowned so it doesn't extent down so much. You have the right idea >>> Then, provide 2-3mm long centric towards the distal. > > Hmm. Is this 2-3mm forward movement from the relaxed position? 2-3 mm Freedom to move backward (if your jaw is capable of doing so after relaxation of muscles). An additional 2-3 mm of forward movement is the "normal" concept of Long Centric. >>> Then, give it some time to see if the patient has any occlusal disease. > [quoted text clipped - 5 lines] > and if they're long then the force is reduced? > What's a cuspid rise? the curve of spee? If the contacts are in "long centric" the teeth have freedom to slide forward and backward. Cuspid rise is the functional occlusal scheme we are taught to persue in dental school. I check every new patient to see if they have this or not. Only about one person in twenty really has cuspid rise. In cuspid rise cases, the cuspids are the only teeth touching as the mandible slides side to side. Curve of Spee relates to the curve to the plane of occlusion. Imagine a piece of cardborad held between the teeth by biting on it. This is the plane of occlusion. The curve of Spee is a specific curve along this plane. > (see, I've been reading up before I ask) > Brian > [quoted text clipped - 8 lines] >> Thanks! >> SP 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. ...................... >Curve of Spee relates to the curve to the plane of occlusion. Imagine a >piece of cardborad held between the teeth by biting on it. This is the >plane of occlusion. The curve of Spee is a specific curve along this plane. Don't forget the Sphere of Monson. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com | >Curve of Spee relates to the curve to the plane of occlusion. Imagine a | >piece of cardborad held between the teeth by biting on it. This is the | >plane of occlusion. The curve of Spee is a specific curve along this plane. | | Don't forget the Sphere of Monson. That definately rounds out the curve of Wilson when combined with Spee. For the original poster: Spee = front to back curve Wilson = side to side curve Spee + Wilson = Monson Average radius of all is about 4" or 100mm -- Roy >| >Curve of Spee relates to the curve to the plane of occlusion. Imagine a >| >piece of cardborad held between the teeth by biting on it. This is the [quoted text clipped - 10 lines] > >Average radius of all is about 4" or 100mm And the center point is ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com Center Point ? Hmm ? Middle..MC | >| >Curve of Spee relates to the curve to the plane of occlusion. Imagine a | >| >piece of cardborad held between the teeth by biting on it. This is the [quoted text clipped - 13 lines] | And the center point is ? | -- Off the top of my head, I want to say the Glabella, but I might be getting things mixed up. I recall that goes with the conical concept. -- Roy >| >| Don't forget the Sphere of Monson. >| > [quoted text clipped - 12 lines] >Off the top of my head, I want to say the Glabella, but I might be getting >things mixed up. I recall that goes with the conical concept. Hmmm... Thought it was the Sella Tursica -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE | >| >| Don't forget the Sphere of Monson. | >| > [quoted text clipped - 19 lines] | -- | W_B I looked it up. Glossary of Prosthodontic terms, 4th Ed. JPD/Mosby 1977 says: Monson Curve. The curve of occlusion in which each cusp and incisal edge touches or conforms to a segment of the surface of a sphere 8 inches in diameter with its center in the region of the glabella. SignatureRoy rem NADA to reply >| Hmmm... >| [quoted text clipped - 8 lines] >or conforms to a segment of the surface of a sphere 8 inches in diameter with >its center in the region of the glabella. I'll buy that for a dollar. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >Off the top of my head, I want to say the Glabella, but I might be getting >things mixed up. I recall that goes with the conical concept. >-- Glabella is a version of plastic bag. | You have the right idea | [quoted text clipped - 5 lines] | relaxation of muscles). An additional 2-3 mm of forward movement is the | "normal" concept of Long Centric. So that's the point I've been missing with Otto's Synchronized Occlusion Thanks for pointing it out Steve! SignatureRoy rem NADA to reply I think two things stick out in the Horger concept of occlusal synchronization. One is the 2-3 mm of distal freedom of movement, (this way, you don't have to find CR, you just allow the mandible to go there if it wants to). The other is the "feel" of rubbing two models together in your hands and finding interferences by touch. 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. ...................... > > | You have the right idea [quoted text clipped - 11 lines] > > Thanks for pointing it out Steve! The more I think of it, Otto and I have been agreeing about the same concept all along, with the language or terminology being the issue. Thanks for clarifying this. -- Roy |I think two things stick out in the Horger concept of occlusal | synchronization. One is the 2-3 mm of distal freedom of movement, (this [quoted text clipped - 16 lines] | > | > Thanks for pointing it out Steve! >The more I think of it, Otto and I have been agreeing about the same concept >all >along, with the language or terminology being the issue. I can't even remember all of the cases that I have done where the teeth were set (dentures) with the patient in CO and they return functioning in CO but going to CR in a rest position. Would register the bite in CR, Remount case and adjust the occlusion to accomodate a smooth transition from CO to CR. Is this what Otto refers to? keith >>The more I think of it, Otto and I have been agreeing about the same concept >>all [quoted text clipped - 8 lines] > >keith He creates it in his original occlusal scheme. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Thanks for your kind explanations, Signor Mancuso. Brian -0-0- posted from googlegroupsbeta, please forgive if repeats occur, or editing is poor > So, basically, you'd have an almost 0-degree cuspid rise with long > centric stops... toward the distal to allow free protrusion, I would > think... No, you can have inclines on your teeth. The slopes have to all be in harmony with each other. As you slide up (or down) one slope, you don't want to click over something else. > If I understand this correctly, there are any number of my patients who > would benefit from it. Often > One thing I read in an old 'Dental Clinics of North America' on > Prosthodontics: don't ignore the centric stop in the central fossa. If > it is weak, the occlusion is unstable and the tooth will move, since all > occlusion is now on inclines, usually angled in the same direction. That is from the school of occluSION, not the school of occluDING. If the patient habituates in a lateral protrusive bracing position, having good centric stops do not stabilize the occlusion. If the patient has an isometric clench on the anterior teeth, the anterior splay outwards. Eliminating parafunctional activity is what stabilizes the occlusion. > So, I can see why a long centric in the central fossa or groove would > be important. The long centric is freedom towards the distal to allow the mandible to position itself more distally, (not for protrusive movements) if it wants to find CR. The key is not to create any interferences getting to CR. Then, if the patient never goes to that elusive and strange RUM joint position, you at least know there is not occlusal interference preventing it. Take your next set of *un-articulated* stone models of a mouth with most of its teeth in place. Hold the models in your hands with the teeth in CO and the plane of occlusion at a right angle to your body and to the floor. Now, softly rub the models in a circular motion. You will feel the interferences with your hands (if you are gentle enough). Outline the spots in red, remove a tiny bit of stone, and check again. You should end up with a series of red circles around cuspal projections which interfere with synchronous jaw movements. You can then use these marks as references as far as where to adjust in the mouth (if there are not too many). If a lot of adjustments was necessary on the models, this should probably done in stages with new models each time. I have to run back into the operatory, let me know if this makes more sense. I could not see it. Joel >I've been watching the various discussions about what's possible with >interest. I was interested in James' recent thread 'Implants or partials, [quoted text clipped - 27 lines] > >Brian |
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