In this video, Gary highlights a great new networking resource – the Associates forum on the Spear Faculty Club discussion board.
If you cannot see this video, please visit speareducation.com/blog.
Anterior Bite Plane Appliances
In this video blog, Gary gives you the when, why and how on appliances.
If you cannot see this video, please visit speareducation.com/blog.
Third Molars: In or Out?
I grew up in a time when everyone got their tonsils out – well, almost everybody because I never did. I remember feeling that in keeping my tonsils, I had actually missed something – especially all of the ice cream, ginger ale, and attention. When my own children were growing up we practically had to threaten our physician to have our son’s tonsils removed – it was like he was going to have to pay for it if we went to the ENT and they actually did the surgery. Maybe he did have to – I never read much of the fine print in our medical insurance plans.
What I learned was that it was not right to always remove them, and it was not right to never remove them. I’m really not certain where the pendulum is now about tonsils as there are only one set left in my family and I’m hangin’ on to ‘em. I’m a little closer to the question about WISDOM TEETH.
In Pemberville, I scheduled one Friday per month for third molar surgery and it was one of my favorite days. A cocktail of Demerol, Seconal, and Promethazine and those happy patients would let me do anything I wanted. That feeling was rekindled recently (except for the doing anything I wanted part) when I had a request from a colleague to perform third molar removal surgery for a friend. I borrowed appropriate equipment from one of the Faculty Club members, Doug Benting (thanks, Doug!), and removed four teeth on each of two patients. Once the word was out that I had an elevator, a pair of forceps, some 3-0 suture and the willingness to use them, they practically lined up at the door! I really enjoyed the procedure and both patients are doing very well.
This experience brought me back to thinking about thirds and wondering what the current pendulum position is – SO I’M ASKING ALL OF YOU:
Do you routinely recommend removal of third molars?
Why or Why not?
I already put some time in on PubMed to investigate the current thoughts but I really believe the best source will be all of you. I can’t wait to hear what you think.
Compromise versus Accomplishment
Compromise is usually the enemy when dealing with esthetic dental outcomes. The danger for patients is that their ability to clearly visualize the difference created by the compromise is not within their experience, and that once completed, the treatment will not have achieved the expectation created by the mental image of the outcome they pictured.
Unfortunately, for some patients, the things we doctors see as necessary to achieve ideal results may be roadblocks patients are unable or unwilling to climb in pursuit of the result. My resolve to “hold out for the best” should be tempered with this reality, and both the patient and I need to be crystal clear on what we CAN accomplish together.
When this patient was submitted to me as a potential case for the Live Patient: Anterior Esthetic Restorations course, I was concerned that the patient may have unrealistic expectations regarding the outcome that could be created by only treating the six anterior maxillary teeth restoratively. There are gingival issues, buccal corridor things with tooth angulation, and a lower arch that would require considerable reshaping to accommodate the new incisal edge position. Did I mention the occlusal plane cant?
This doctor and patient were very clear on what the limits of accomplishment were given the constraints. The outcome suggests that there are times when those discussions are warranted when compromise presents the only way to proceed.
Can the Tissue Be Trimmed? Results Are In!
Trimming the tissue to create symmetry at the time of a restorative procedure can create a great result. This tissue was trimmed using the Sirona Diode Laser during a Live Patient: Anterior Esthetic Restorations course at Spear Education. The admitted risk, of course, is that the tissue will return to its original position a few months following the procedure. As we discovered when the above photos were posted on my blog, many thought that the tissue would rebound rather quickly. If you’re like me, you have no doubt experienced that occurrence when you hoped for another outcome. And as the old saying goes, once burned, twice shy.
Here’s the result after 20 weeks of healing time. The probe shows tissue has indeed come back, with a sulcus measuring 1.5 mm at time of treatment and 2.5 mm after healing. Not illustrated is the initial measurement of a 3 mm sulcus on the unprepared tooth, meaning about .5 mm of change was effected with the trimming of the tissue. The change in morphology of the zenith toward the distal and a slight change in emergence profile of that portion of the tooth with the restoration completed by The Winter Lab have created a striking difference in symmetry and therefore in overall impact of this treatment.
Match the Mounting with the Mouth
At the Occlusion in Clinical Practice workshop, we gather multiple bites taken on each participant by his or her two clinical partners. Each “doctor” in the exercise gathers a bite record taken using bilateral manipulation, a Lucia jig, and a leaf gauge. We use the collection of these bite records not only to teach and practice the techniques but also to compare our mountings to our intraoral observations and look at cross operator and cross technique reliability.
In the Occlusion workshop that ended on March 15 we reached a new milestone. This group of participants set a new record for mountings matching the findings in the mouth, 33 of 36 participants, or 92 percent found their models duplicated the contacts noted intraorally. The three who did not match were all patients with joint and muscle issues, just the type of patient we expect not to reliably gather a joint position from.
We believe that the reason for this high degree of correlation is due to the use of the model stabilization kit for holding the casts together, an addition that we implemented at this Occlusion workshop with kits provided by Great Lakes Orthodontics. A wire is connected to the casts at four points with cyano-acrylate gel to protect the models from the movement that occurs with mounting stone expanding.
Want to match what you find in the mouth? Here are some tips:
• Gather excellent impressions and pour them quickly if you are using alginate
• Adhere to the water/powder ratios recommended by the manufacturer
• Use a vacuum mixer
• Use die stone rather than plaster or Buff stone
• Don’t flip the poured model over
• Let the stone set completely before removing from impression
• Trim the material on the bite fork
• Trim the bite records
• Stabilize the models together
Facebow Leveling Options
In this short clip, Gary presents helpful tips for using facebows for optimal lab communication.
If you cannot see this video, please visit speareducation.com/blog.
Segmental Appliances
In this video, Gary addresses appliances, conditions and results.
If you cannot see this video, please visit speareducation.com/blog.
Protrusive Bite Records
As a supplement to Lee’s tips on Centric Relation Bite Records, in this video Gary expands on techniques for capturing protrusive bite records.
If you cannot see the video, please visit speareducation/blog.
Treatment Planning Roadblock
If you come to a point in treatment planning where you can’t make a decision about what to do, it’s usually because you’re not supposed to make it. If there are two (or more) ways to accomplish the outcome and you find yourself going back and forth, take it to the person who should make the decision – the patient.