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Medical Forum / General / Dentistry / March 2005the Crown Racket (dentistry cash cow)
I'm convinced that very often a crown is installed when a filling would have done just fine. Modern composities are extremely good, whereas the average crown lasts just ten years. Clearly crowns provide a reliable cash flow to the average dentist. I chipped a tooth; the dentist said, "Oh, you need a crown!" but filled it with a composite while the crown was being made. That filling was terrific, but then I went in for the crown. He ground the tooth down to a nubbin and stuck in a crown,which wobbled and captured food underneath it and was a general pain. At that point I switched dentists, and eventually had the crown replaced. The replacement is now failing, so I'm looking at crown #3 or a root canal. At least the new dentist has been willing to work with me, and twice, when he wanted to put in a crown, I requested a filling instead. He agreed that if the filling failed, he could then do a crown, so all that was lost was the cost of the filling. Several years now into the fillings there are no problems. Sceptical Bill >I'm convinced that very often a crown is installed when a filling would >have done just fine. I agree ....... (ducking for cover now). >Modern composities are extremely good, whereas the >average crown lasts just ten years. Clearly crowns provide a reliable [quoted text clipped - 4 lines] >terrific, but then I went in for the crown. He ground the tooth down to >a nubbin and stuck in a crown, DEF. A small nub (especially an undeveloped fruit or ear of corn) >which wobbled and captured food underneath >it and was a general pain. At that point I switched dentists, and >eventually had the crown replaced. The replacement is now failing, so >I'm looking at crown #3 or a root canal. Yup. Fillings can be grand. Or less ....... >At least the new dentist has been willing to work with me, and twice, >when he wanted to put in a crown, I requested a filling instead. He >agreed that if the filling failed, he could then do a crown, so all that >was lost was the cost of the filling. Several years now into the >fillings there are no problems. Yup. But you would be surprised at the resistance the other way. So many patients INSIST on crowns! Joel > Sceptical Bill >>I'm convinced that very often a crown is installed when a filling would >>have done just fine. > > I agree ....... (ducking for cover now). I agree too.....(also ducking for cover). >>Modern composities are extremely good, whereas the >>average crown lasts just ten years. Usually longer than that. Most of the crowns that I see needing replacing are 15-25 years old. >Clearly crowns provide a reliable >>cash flow to the average dentist. Yup. But they also provide a reliable long-term restoration for the patient. Win-win. >>I chipped a tooth; the dentist said, "Oh, you need a crown!" but filled >>it with a composite while the crown was being made. That filling was [quoted text clipped - 24 lines] > But you would be surprised at the resistance the other way. So many > patients INSIST on crowns! So many dentists put porcelain inlays in teeth that could have been served just as well with a direct composite resin. My theory is to fill the teeth that don't need cuspal coverage, and crown the ones that do. (except for the buccal cusp of maxillary molars...I can usually replace these with a resin that lasts a long, long time). >So many dentists put porcelain inlays in teeth that could have been served >just as well with a direct composite resin. I like the direct BONDED better ........ Joel >My theory is to fill the teeth that don't need cuspal coverage, and crown >the ones that do. (except for the buccal cusp of maxillary molars...I can >usually replace these with a resin that lasts a long, long time). Yup, non-working cusps at that! Joel > My theory is to fill the teeth that don't need cuspal coverage, and crown > the ones that do. (except for the buccal cusp of maxillary molars...I can > usually replace these with a resin that lasts a long, long time). You've never considered onlays for cuspal coverage? Thanks SP  SignatureNot a real Addy, yet >> My theory is to fill the teeth that don't need cuspal coverage, and crown >> the ones that do. (except for the buccal cusp of maxillary molars...I [quoted text clipped - 4 lines] > Thanks > SP Sometimes. >> My theory is to fill the teeth that don't need cuspal coverage, and crown >> the ones that do. (except for the buccal cusp of maxillary molars...I >> can >> usually replace these with a resin that lasts a long, long time). > > You've never considered onlays for cuspal coverage? I'm typically seeing broken teeth that have a large, deep subgingival class II amalgam, and buccal abfraction. There's not much point in trying to preserve a single (lingual) wall. >> You've never considered onlays for cuspal coverage? > >I'm typically seeing broken teeth that have a large, deep subgingival class >II amalgam, and buccal abfraction. There's not much point in trying to >preserve a single (lingual) wall. Unless your bank account is thin... right ? Endo, dude. No 'standard' type post. Look for vertical root fracture... Otherwise rip it out. Oh, I forgot that you aren't good at endodontic diagnosis either, mofo... -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>> You've never considered onlays for cuspal coverage? >> [quoted text clipped - 4 lines] > > Unless your bank account is thin... right ? A crown costs the same as an only, right? But neither is as lucrative as a root canal. > Endo, dude. > No 'standard' type post. > Look for vertical root fracture... Joel and I were talking about doing a composite in lieu of an inlay...and you want to do endo and a post? > Otherwise rip it out. So now you've progressed from a endo to an extraction for a tooth that needed nothing more than a class II restoration? You must be one hell of a clinician. > Oh, I forgot that you aren't good at endodontic diagnosis either, > mofo... I hope you don't diagnose teeth as poorly as you diagnose people. >>>> You've never considered onlays for cuspal coverage? >>> [quoted text clipped - 26 lines] > >I hope you don't diagnose teeth as poorly as you diagnose people. what is a post? .. 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've never considered onlays for cuspal coverage? >>>> [quoted text clipped - 29 lines] > > what is a post? It's a cylindrical artifact that some dentist put in teeth that shouldn't have been endo'ed in the first place. It's usually placed by people who like to do implants and are hoping that the tooth will fracture and can be subsequently extracted. ;-) > > what is a post? > > It's a cylindrical artifact that some dentist put in teeth that shouldn't > have been endo'ed in the first place. It's usually placed by people who > like to do implants and are hoping that the tooth will fracture and can be > subsequently extracted. ;-) Well, _I_ wouldn't go _that_ far, and Dr S would say that posts are tantamount to criminal negligence, but if you have teeth like that, (weakened by carious attack and restoration), I'd be prescribing an NTI to hold things together. In fact, when I see a heavily restored mouth come into my practice, I tell them as much, and if they refuse, I let them know that the next tooth that breaks is very likely THEIR OWN FAULT, as they now know there is a preventative measure. If you don't know about this, check out http://www.nti-tss.com Cheers SP SignatureNot a real Addy, yet >> > what is a post? >> [quoted text clipped - 13 lines] > know about this, check out http://www.nti-tss.com > Cheers The NTI is certainly one area I'd like to learn a little bit more about. I've used it with mixed results in my practice. It seems to work for what is was meant for, but for some odd reason, patients haven't been very compliant with its use. > The NTI is certainly one area I'd like to learn a little bit more about. > I've used it with mixed results in my practice. It seems to work for what > is was meant for, but for some odd reason, patients haven't been very > compliant with its use. What I would suggest is to make one up using exactly your technique, but FOR YOURSELF. Then wear it every night for TWO WEEKS. You would be surprised at what you might learn. _I_ learned where my polishing efforts were lacking and what a well adjusted device feels like. I also learned that the back side of the DH has to be rounded, and the front edge has to be bevelled so the lip can't pry under it like a bottle opener . I also learned that the labial gingival outline has to be blunted/smoothed or you get inflammed gums over the centrals. These are all things that the patients perhaps feel but won't necessarily _tell_ you. They'll just say it is uncomfortable and they won't wear it. Also, FWIW, I get better results using the Standard Long device. Because you include the laterals (four teeth for retention instead of two), you don't need to 'clamp' the centrals as tightly. This makes it more comfortable. Hope this helps SP SignatureNot a real Addy, yet >> The NTI is certainly one area I'd like to learn a little bit more about. >> I've used it with mixed results in my practice. It seems to work for [quoted text clipped - 17 lines] > don't need to 'clamp' the centrals as tightly. This makes it more > comfortable. Excellent suggestions! It also makes a difference in how you communicate the need for the device. "Here is a bite guard to help you protect your teeth" vs. "You show several signs of damaging your teeth from clenching. It is imperative that we stop this process now before your teeth need even more treatment." Gentle reminders on check ups and more forceful comments when they come back with a sensitive tooth, fractured cusp, painful TMJ, or headaches. JME, Fawks > It also makes a difference in how you communicate the > need for the device. > "You show several signs of damaging your teeth from > clenching. It is imperative that we stop this process > now before your teeth need even more treatment." Have you been bugging my office? ;-) Hey, I might learn something in the process! <G> Fawks > Have you been bugging my office? ;-) And, don't forget to do as Stovie says and make one for yourself FIRST. 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. ...................... > > It also makes a difference in how you communicate the [quoted text clipped - 14 lines] > JME, > Fawks I typically spread the SNAP acrylic (with my fingers) over the laterals, then trim it back to cover about half of each lateral incisor. 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. ...................... > >> The NTI is certainly one area I'd like to learn a little bit more about. [quoted text clipped - 20 lines] > Hope this helps > SP > I typically spread the SNAP acrylic (with my fingers) over the laterals, > then trim it back to cover about half of each lateral incisor. WHO ASKED YOU!?!?!?!? :-) You're right: If I use a standard short and have to reline it, I do the same. Then I mix up a fresh batch and reinforce those extensions on the labial and palatine (outside the mouth). If I don't, these thin extensions will cover the laterals but will break off soon after. They must be THICK, as there is no Lexan to reinforce them, just acrylique. How do you spread this stuff without it sticking to your fingers or gloves? Do you use water as a separator? 'Pretty sure W_B would use Macintosh/Crapintosh parts liberated with a sledge hammer.... ;-) Also, for what it is worth: Brassler makes a disposable polishing disk set with its own latch type mandrell (like the 3M SofLex). They are shaped like the SofLex but have a cone shaped rubber part under the disk (looks like a graduation cap, with the cap part snapping onto the mandrell). This rubber part means you can push the whole polisher surface into those nooks and crannies, like on the sides of the DE after you've ground it down. It makes for a better polish because you can put pressure on the center of the disk this way. .... not that y'all really give a horse's petootie.... :-\ SP SignatureNot a real Addy, yet >'Pretty sure W_B would use >Macintosh/Crapintosh parts liberated with a sledge hammer.... ;-) and wrecking bar. >Also, for what it is worth: Brassler makes a disposable polishing disk >set with its own latch type mandrell (like the 3M SofLex). They are >shaped like the SofLex but have a cone shaped rubber part under the disk >(looks like a graduation cap,... What's a graduation cap ? Max dental salary in Kaanaadaa ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com W_B <no_one@nowhere.net> wrote in response to SP's blubbering: > >Also, for what it is worth: Brassler makes a disposable polishing disk > >set with its own latch type mandrell (like the 3M SofLex). They are > >shaped like the SofLex but have a cone shaped rubber part under the disk > >(looks like a graduation cap,... > > What's a graduation cap ? It's a thing that looks like a Brassler disposible polishing disk. of course.... [SP rolls his eyes and shakes his head doing his best Don Adams Get Smart imitation....] > Max dental salary in Kaanaadaa ? Hey-Zeus.... I wouldn't have a CLUE... seriously, I couldn't tell you. I will ask the CPA next time I see him. Nein, Nein, ninety-nine SP SignatureNot a real Addy, yet I place the NTI matrix in the mouth with SNAP inside it. I immediately, wipe my gloved finger on the buccal mucosa to coat it with saliva, and then form the SNAP to the shape I want with my fingers. I will free-form it over the laterals about the same thickness as the matrix. I then look to see if the DE is perpendicular to the lower incisors, roughly gauge the thickness of the DE needed, and visualize the anterior and posterior extent of the protrusive/retrusive movements. I take it to the lathe (keeps the mess in the lab rather than on the marble clinic floors), and grind and shape the matrix and DE. Return to the patient to verify everything, and return to the lab to polish with a rag-wheel and pumice followed by a dry rag-wheel and whiting. I treat it like a denture. Steverino >> I typically spread the SNAP acrylic (with my fingers) over the laterals, >> then trim it back to cover about half of each lateral incisor. [quoted text clipped - 22 lines] > .... not that y'all really give a horse's petootie.... :-\ > SP > I take it to the lathe (keeps the mess in > the lab rather than on the marble clinic floors), ...Thought you had 'Hazel' as yer cleaning lady... >and grind and shape the > matrix and DE. Return to the patient to verify everything, and return to > the lab to polish with a rag-wheel and pumice followed by a dry rag-wheel > and whiting. I treat it like a denture. Yes... I should be doing this. I'm using the SofLex or Brassler I/O disposable disks (expensive). If by 'whiting' you mean stuff like Acry-Luster that comes in a thick stick, I have usually found that it makes the thing pinkish. If you have a brand name to suggest, I'd appreciate it Thanks SP SignatureNot a real Addy, yet >>and grind and shape the >> matrix and DE. Return to the patient to verify everything, and return to [quoted text clipped - 6 lines] > makes the thing pinkish. If you have a brand name to suggest, I'd > appreciate it I am still using the block I got in dental school in 1980. >>>and grind and shape the >>> matrix and DE. Return to the patient to verify everything, and return to [quoted text clipped - 8 lines] > >I am still using the block I got in dental school in 1980. I just ran out of 'white diamond' last year. Got my block in '79. Ordered a new 'high shine' compound from the prosthetics lab, what they use. Don't know the name of it but it is yellow. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > I just ran out of 'white diamond' last year. > Got my block in '79. > > Ordered a new 'high shine' compound > from the prosthetics lab, what they use. > Don't know the name of it but it is yellow. Good... I'll ask the local guys Thanks SP SignatureNot a real Addy, yet >> Ordered a new 'high shine' compound >> from the prosthetics lab, what they use. >> Don't know the name of it but it is yellow Order from Shine, err, Schein. > >> Ordered a new 'high shine' compound > >> from the prosthetics lab, what they use. > >> Don't know the name of it but it is yellow > > Order from Shine, err, Schein. Very good..... I should have thought of that... but up here in Igloo land, we usually refer to Shein as 'Arcona', because (I assume) that Arcona is a Kanadiannan reseller of Shein. Merci Beaucoup SP SignatureNot a real Addy, yet >> >> Ordered a new 'high shine' compound >> >> from the prosthetics lab, what they use. [quoted text clipped - 7 lines] >Merci Beaucoup >SP And we were just thinking it was because of brain permafrost. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>Arcona is a Kanadiannan reseller of Shein. >>Merci Beaucoup >>SP > >And we were just thinking it was because of brain permafrost. What is bran permafrost? >-- > >W_B >Take out the G'RBAGE >wubbabubbazG@RBAGEyahoo.com >>>Arcona is a Kanadiannan reseller of Shein. >>>Merci Beaucoup [quoted text clipped - 3 lines] > >What is bran permafrost? JD's area of expertise, goes good with a double latte... ...enema -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>>Arcona is a Kanadiannan reseller of Shein. >>>>Merci Beaucoup [quoted text clipped - 7 lines] > > ...enema Yup,,,,, Jan's husband turns her out into the winter air ... hence the bran permafrost in the outhouse. >>> Ordered a new 'high shine' compound >>> from the prosthetics lab, what they use. >>> Don't know the name of it but it is yellow > >Order from Shine, err, Schein. They should make a product called Schein Shine. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>>> Ordered a new 'high shine' compound >>>> from the prosthetics lab, what they use. [quoted text clipped - 3 lines] >> >They should make a product called Schein Shine. Let it shine on ... al...la ... Schein Shine! > The NTI is certainly one area I'd like to learn a little bit more about. > I've used it with mixed results in my practice. It seems to work for what > is was meant for, but for some odd reason, patients haven't been very > compliant with its use. Tell us about the problem cases. Perhaps we can offer suggestions. >> The NTI is certainly one area I'd like to learn a little bit more about. >> I've used it with mixed results in my practice. It seems to work for >> what is was meant for, but for some odd reason, patients haven't been >> very compliant with its use. > > Tell us about the problem cases. Perhaps we can offer suggestions. My front desk. Migraine headaches. Posterior teeth are mobile, but with no sign of radiograph bone loss or pocketing. She "claims" she wears it, but there's no way the posterior teeth should be that mobile...unless she's bruxing during the day. You answered your question. She needs 2-3 months of day-time NTI use. Perhaps permanently. Has her CR/CO position changed since wearing the NTI? I bet her mandible has shifted back and up. Notches in the NTI DE??? Another trick is to make another NTI with a shorter DE and make a lower slide bar from a universal NTI. Have the patient randomly switch from a full height DE, to a short DE with the lower slide bar. It keeps the muscles from getting used to squeezing on the NTI. The patient now has 4 heights of disclusion to switch between by varying which devices she wears alone or with the slide bar. 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. ...................... > >>> The NTI is certainly one area I'd like to learn a little bit more about. [quoted text clipped - 8 lines] > but there's no way the posterior teeth should be that mobile...unless > she's bruxing during the day. > You answered your question. She needs 2-3 months of day-time NTI use. Thanks. But how do I keep her from spitting on patients while she's walking them out? Have you ever worn a day-time device yourself? I wore mine for a month. No one knew I had it in until I took it out and showed 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. ...................... > >> You answered your question. She needs 2-3 months of day-time NTI use. > > Thanks. But how do I keep her from spitting on patients while she's > walking them out? > Have you ever worn a day-time device yourself? I wore mine for a month. > No one knew I had it in until I took it out and showed them. No. I'll try it. IT really helped when I was explaining to the patient that they needed to wear an NTI device while I still had my mask on. As I would slide my chair to a position more in front of the patient, and take off my gloves and mask while still discussing it with them. The patient often will say they cannot talk with something like that in their mouth and they need to talk at work, etc. After I was done discussing the pros and cons with my mask off, I would wash my hands and grab the NTI and take it out in front of them and show it to them. It would kind of destroy their argument that they could not wear one at work. 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. ...................... > >> Have you ever worn a day-time device yourself? I wore mine for a month. >> No one knew I had it in until I took it out and showed them. > > No. I'll try it. > IT really helped when I was explaining to the patient that they needed to > wear an NTI device while I still had my mask on. As I would slide my chair [quoted text clipped - 5 lines] > show it to them. It would kind of destroy their argument that they could > not wear one at work. Also, it's good to 'walk the talk' anyway.... I always have my nighttime Standard Long device in my pocket. When I tell them that I really think they need the device, and they ask how much it costs, I tell them it's 400$ CDN dollarettes. Being Latin blooded Quebecois, they slap their foreheads, feign a heart attack, and while they're doing their 'Oh GOD.... Take-a-me from-a dis-a Satanic Dentiste..' routine, I wash my hands and show them the box, open it and put it on. Then smile. Then smile in profile. Then open to maximum so they can see it won't fall out. Then I finish the talk with it in the mouth; they can see it is not difficult to speak. I put a new one in their hands so they can see how small and light it is.... They look from it to me, still with a stupid grin on my mug... (SOME would say I look like a..... dork....) They may not LIKE that I won't lower the price (but it is STILL less than a hard splint made locally plus chair time), they may DECIDE that it's not for them 'just right now', but they CAN'T say they were UNINFORMED; and they CAN see that I really believe in the device, as I wear it nightly, and even during work hours sometimes, when the ADD is stressing me out. Hell, even the NIGHTTIME device is not difficult to speak around, once you've practiced a bit. They see all that, and I feel it makes the thing more believable. ... Then they go outside and puke.... Hope this helps SP SignatureNot a real Addy, yet If done right, you should be able to speak normally with it in place. You may slightly mess up the "s" , "sh" and "ch" from time to time. 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. ...................... > >> Have you ever worn a day-time device yourself? I wore mine for a month. >> No one knew I had it in until I took it out and showed them. > > No. I'll try it. > If done right, you should be able to speak normally with it in place. You > may slightly mess up the "s" , "sh" and "ch" from time to time. IMO, that just makes them curious as to why that is, and when I show them the device, it natrually leads to a discussion about the Lost Hockey Season. True, it's not the same type of protector, but there ya go... SP SignatureNot a real Addy, yet >You answered your question. She needs 2-3 months of day-time NTI use. >Perhaps permanently. Has her CR/CO position changed since wearing the NTI? [quoted text clipped - 6 lines] >heights of disclusion to switch between by varying which devices she wears >alone or with the slide bar. I like this trick, gonna make a set for myself. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Another trick is to make another NTI with a shorter DE and make a lower > slide bar from a universal NTI. Have the patient randomly switch from a > full height DE, to a short DE with the lower slide bar. It keeps the > muscles from getting used to squeezing on the NTI. The patient now has 4 > heights of disclusion to switch between by varying which devices she wears > alone or with the slide bar. If you were doing this for a patient, I would imagine all the pieces would count as one 'NTI treatment' as far as fees goes? Thanks SP SignatureNot a real Addy, yet I very seldom have to do this, so it does not impact my overhead very much. Also, I can make the second or third piece in a few minutes. The first one takes a bit of time, as I am reviewing the NTI_Consent/instruction form and telling them what to expect. >> Another trick is to make another NTI with a shorter DE and make a lower >> slide bar from a universal NTI. Have the patient randomly switch from a [quoted text clipped - 8 lines] > Thanks > SP > The first one > takes a bit of time, as I am reviewing the NTI_Consent/instruction form and > telling them what to expect. OK, thanks SP SignatureNot a real Addy, yet And make the day-time device as small as possible on the lower so she can speak clearly. JME Fawks > You answered your question. She needs 2-3 months of day-time NTI use. > Perhaps permanently. Has her CR/CO position changed since wearing the NTI? [quoted text clipped - 6 lines] > heights of disclusion to switch between by varying which devices she wears > alone or with the slide bar. >And make the day-time device as small as possible on the lower so >she can speak clearly. > >JME >Fawks So do you always construct the daytime device on the lower ? What are the different indications if any ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > My front desk. Migraine headaches. Posterior teeth are mobile, but with no > sign of radiograph bone loss or pocketing. She "claims" she wears it, but > there's no way the posterior teeth should be that mobile...unless she's > bruxing during the day. Then make her a daytime device... SP SignatureNot a real Addy, yet "Dr. Steve" <drsteve@no-spam.com> wrote.............. > what is a post?...... What you're reading now. carabelli >"Dr. Steve" <drsteve@no-spam.com> wrote.............. > [quoted text clipped - 3 lines] > >carabelli Good one ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com -- > "Dr. Steve" <drsteve@no-spam.com> wrote.............. >> what is a post?...... > > What you're reading now. > > carabelli Ohhhhh ! In the case you just described, often the remaining lingual wall is all that remains with any strength. Consider reducing the lingual wall in height by 50%. Do this perfectly flat. Remove all the residual filling materials and caries. Round all the internal line angles (gentle curves everywhere). You do NOT want any sharp line angles. In most cases, there will be enough concavity to the center of the preparation, but you may need to create some sort of resistance form to prevent the restoration moving buccally. Fabricate a piece of porcelain to replace everything that is missing and bond it to place. If you whack off the lingual wall (thin it down in a conventional crown prep) you will have nothing left to prevent snapping off the clinical crown at the gingival crest. BTW, I do NOT restore every abfraction lesion I see. Even if I am making a 5-surface onlay on that tooth, I may still leave the abfraction alone. Make an NTI instead. 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. ...................... > >>> My theory is to fill the teeth that don't need cuspal coverage, and [quoted text clipped - 8 lines] > class II amalgam, and buccal abfraction. There's not much point in trying > to preserve a single (lingual) wall. > In the case you just described, often the remaining lingual wall is all > that remains with any strength. Consider reducing the lingual wall in [quoted text clipped - 5 lines] > moving buccally. Fabricate a piece of porcelain to replace everything that > is missing and bond it to place. > If you whack off the lingual wall (thin it down in a conventional crown > prep) you will have nothing left to prevent snapping off the clinical > crown at the gingival crest. BTW, I do NOT restore every abfraction > lesion I see. Even if I am making a 5-surface onlay on that tooth, I may > still leave the abfraction alone. Make an NTI instead. Good suggestions. But why not extend down to the gingiva on the area of abfraction? The patient already prepped the margin for you! ;-) >>>> My theory is to fill the teeth that don't need cuspal coverage, and >>>> crown [quoted text clipped - 7 lines] >> class II amalgam, and buccal abfraction. There's not much point in >> trying to preserve a single (lingual) wall. Depends on how much solid thick tooth is coronal to the abfraction. I try to never prep more than half way down the buccal or lingual wall. Exceptions are (obviously) caries and fractures, discolorations (which the patient wants to cover) and very short teeth. A typical abfraction lesion will have tons of solid and thick tooth structure just coronal to the lesion. Remember that patients do not comply with everything you ask them to do. You provide an NTI, but they may not wear it for ever. They start isometric bruxism on this tooth again (don't go into equilibration, because they will abrade the equilibration right back to where it was without an NTI), They begin flexing this tooth again. Now, the natural flexure of the tooth is no longer at the mid-point of the abfraction lesion, but half-way between your crown margin and the crest of alveolar bone. You just moved the flexure point into a thinner and less flexible part of the tooth. Before long, you get a call that the tooth broke off. People with abfractions are an entirely different type of patient to work on. You have to consider what they will be doing to their teeth in the future and you have to plan where the tooth will break next time. I want it to break in porcelain, not tooth structure. I can re-place porcelain all day long. 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. ...................... > >> In the case you just described, often the remaining lingual wall is all [quoted text clipped - 27 lines] >>> class II amalgam, and buccal abfraction. There's not much point in >>> trying to preserve a single (lingual) wall. > BTW, I do NOT restore every abfraction lesion I see. > Even if I am making a 5-surface onlay on that tooth, I may still leave the > abfraction alone. Make an NTI instead. IOW, you stop your onlay just above (occlusal to) the chopped-out abraction? Thanks SP SignatureNot a real Addy, yet I stop my onlay preparation just apical to the caries/old restoration. Where-ever that may be. Usually, 1/3 to 1/2 way down from the cusp tip. >> BTW, I do NOT restore every abfraction lesion I see. >> Even if I am making a 5-surface onlay on that tooth, I may still leave [quoted text clipped - 5 lines] > Thanks > SP Hi, How about a cap. I know several people who really use thrie teeth and had some caps put in over 20 years ago and they say the caps are as strong as when they got them. I took a good look at them and was shocked at how good they looked. I guess it depends on the Dentist's work to. Best of Luck...MC > I'm convinced that very often a crown is installed when a filling would > have done just fine. Modern composities are extremely good, whereas the [quoted text clipped - 16 lines] > > Sceptical Bill >Hi, How about a cap. I know several people who really use thrie teeth and >had some caps put in over 20 years ago and they say the caps are as strong >as when they got them. I took a good look at them and was shocked at how >good they looked. I guess it depends on the Dentist's work to. Best of >Luck...MC YUP true. The caps that last longest are the ones placed on the teeth that do not need caps in the first place! Joel What is the difference between a cap and a crown. How covering the tooth, material, reducing the tooth, etc. Gail >What is the difference between a cap and a crown. >How covering the tooth, material, reducing the tooth, etc. >Gail Two different words for the exact same thing. Joel >>What is the difference between a cap and a crown. >>How covering the tooth, material, reducing the tooth, etc. [quoted text clipped - 3 lines] > >Joel Nope a 'cap' goes on a soda bottle. Crowns go on teeth. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>>What is the difference between a cap and a crown. >>>How covering the tooth, material, reducing the tooth, etc. [quoted text clipped - 6 lines] >Nope a 'cap' goes on a soda bottle. >Crowns go on teeth. Then what does a king wear? A cap? >>>Two different words for the exact same thing. >>> [quoted text clipped - 6 lines] > >A cap? Already answered. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE W_B bellowed, and Joel M. Eichen blathered: > >Nope a 'cap' goes on a soda bottle. > >Crowns go on teeth. > > Then what does a king wear? > > A cap? Depends whether the king is more of a 'pop bottle' or more of a 'teeth'. SP SignatureNot a real Addy, yet If a Cap goes on a Soda Bottle Then a Crown goes on a head...MC > >>What is the difference between a cap and a crown. > >>How covering the tooth, material, reducing the tooth, etc. [quoted text clipped - 12 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE >What is the difference between a cap and a crown. A 'cap' goes on a baseball players head. A 'crown' goes on a tooth. Yep, kings and queens wear crowns on their heads. >How covering the tooth, material, reducing the tooth, etc. >Gail -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >>What is the difference between a cap and a crown. > >A 'cap' goes on a baseball players head. >A 'crown' goes on a tooth. > >Yep, kings and queens wear crowns on their heads. The ones I know wear caps. Which is the right word when you are eating margarine and suddenly something appears on top of your head? >>How covering the tooth, material, reducing the tooth, etc. >>Gail >>Yep, kings and queens wear crowns on their heads. > >The ones I know wear caps. > >Which is the right word when you are eating margarine and suddenly >something appears on top of your head? Stupid commercial. (two words) I don't use margarine/oleo; if buttery flavor is part of a meal/recipie, use the real thing. Real butter tastes better and you will use less. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE Sounds Like Everyone Needs to be Crowned.. MC > >>Yep, kings and queens wear crowns on their heads. > > [quoted text clipped - 16 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Insanity Joel, let us know the next time it happens. Send Pictures to...AIF...MC > >>What is the difference between a cap and a crown. > > [quoted text clipped - 10 lines] > >>How covering the tooth, material, reducing the tooth, etc. > >>Gail Reducing the teeth to what Gail ? To a Toot...MC > >What is the difference between a cap and a crown. > [quoted text clipped - 11 lines] > wubbabubbazG@RBAGEyahoo.com > Take out the G'RBAGE Hi, The Cap's IM talking about were placed over a 20 year old's two front teeth that broke. The dentist filed the teeth down to little points and put permanant capp's in. They look just like real teeth and he said he's had them for over 25 years and feel like and work like his real teeth. They look Great.. Top Notch Dental Work...MC > >Hi, How about a cap. I know several people who really use thrie teeth and > >had some caps put in over 20 years ago and they say the caps are as strong [quoted text clipped - 8 lines] > > Joel > I'm convinced that very often a crown is installed when a filling would > have done just fine. You won't get much arguement about that here! > Modern composities are extremely good, whereas the > average crown lasts just ten years. Says who? I have seen numbers like that before, but that certainly does not match my own experience. I have had exactly one crown replaced, and that was the direct result of some unfortunate dentistry. I also have fillings that must be well over 30 (OK, 40) years old, they also can last a long time. The above having been said, If I were a dentist, I would probably try to temper the expectations of my patients by telling them that not all of their expensive dentistry will necessarily accompany them to the grave. Vaughn >> I'm convinced that very often a crown is installed when a filling would >> have done just fine. [quoted text clipped - 12 lines] >temper the expectations of my patients by telling them that not all of their >expensive dentistry will necessarily accompany them to the grave. Wise move. >Vaughn Actually a crown will last forever. The tooth underneath it usually gives way ....... eventually! Vaughn, The expensive dentistry will never accompany anyone to the grave. It will be removed by the first person that spots it. Unless of course, one is a pharaoh. Then expect the grave to be robbed. Still, it is good while it lasts. To beef jerkey, unless the crown is made of iron, skip the jerkey. have some applesauce instead. Gail > Vaughn, > > The expensive dentistry will never accompany anyone to the grave. (Shudder) I guess if I am dead they can have it. Vaughn |
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