Excellent. Very excellent.

As an aside, how many people here would do this case with an edge to edge
bite and how many would leave the case in a cross-bite, assuming the patient
would not get the cross-bite corrected through orthodontics, the recommended
way?

Joel

Hi Stoveman,

1)  Regarding the proposed veneer case. I would strongly suggest getting a
set of decent study models.  Hold them in your hands and move the models (in
CO) as you line up all the wear facets you can find both anteriorlly and
posteriorly.  You need to find al the lateral bracing positions this person
rests (more likely clenches) at.  Then, you can see if there is enough space
to create the changes you wish to make on the maxillary incisors.  You will
need to restore to a class III occlusion, but you knew that.  The central
incisors show some attrition.  I would want to see how he does that.  If the
attrition was made by a dental handpiece to smooth out the incisal edges,
and he has zero bracing positions where he can hit these teeth, then you
should be able do whatever you want (within reason).  As you study the
models, remember that the mandible is not rigid, but does flex a bit as
patients clench.  What does not seem to touch with light pressure, may touch
with heavy force.

2)  The second molar RCT............ I see lots of those with only two
canals.  Often the mesial root has a ribbon shaped canal.  I did endodontics
on one like that yesterday.  I will usually take a long shank round bur on
the slow speed handpiece and explore laterally from the canals I find on a
tooth like this.  Then, study it with magnification.  If I cannot find
evidence of a third or fourth canal, I stop and restore the case.  In twenty
years, I have only seen 1-2 teeth like this that did not respond to RCT and
needed removal.  Even the ones where I only found one canal did well.  Just
make sure you cannot see any more canals radiographically or in the pulp
chamber.  I usually will remove ALL old filling material, and cut down the
occlusal surface 3-4 mm to do this inspection.