In this video blog, Gary gives you the when, why and how on appliances.
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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.
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.
A Reminder About the Process
I was speaking to a patient recently and I asked if she wanted to do something about her “gummy smile.”
“What gummy smile?” she responded, and then asked for a mirror.
Oops.
I’m constantly reminded that there is a wide variation in beauty and that every individual gets to decide what that is for them. By the way – the patient had not come in asking about esthetics and I had failed to engage her in a process to see what I saw. Had I done that (which IS what we teach here at Spear Education), her response would undoubtedly have been different. In fact, had I engaged her in the process, I might have discovered that her smile and her grandmother’s were nearly identical (she REALLY loved her grandmother), and not even asked the question.
It’s about them, not about me.
To Mock-up or Not to Mock-up
To mock-up or not to mock-up depends on what you’re changing. If you’re altering incisal edge position significantly a mock-up can be very helpful in determining whether or not you’re on the right path. In this case from our Anterior Esthetic Restorations live patient experience, the patient feedback confirmed that this is the result she envisioned.
Shade Matching Tip
What will the provisional material look like when I get the temporaries completed? Which shade of this particular material is the closest match for this patient? Because the provisional materials are not usually as well color matched to the classic shade guide as most of us would like, it’s often necessary to try it and see what you get. Using lab putty, press shade tabs into it and allow it to set creating a mold. Now put small amounts of provisional material into the shapes and you’ve got a shade tab. Trim it to the expected thickness, hold it on the tooth, and you’ve got an idea of what the shade will be.