Clinical Portfolio
Implant Supported Bridge
65 yo female presents with partial edentulism
Site: UR posterior, #3-5
Extractions and grafting 1/2022
ASA II
Hypothyroidism
Managed w/synthroid
Surgical guide used for locator drill
Drill protocol:
#3 - 3.8 soft bone
#5 - 2.8 soft bone
Implants:
#3 - simply Legacy 2, 4.7x10
#5 - Legacy 2, 3.7x10
Two Months
Final Restoration
Full Mouth Rehabilitation
Middle-aged man presents with CC: "I want to fix my teeth." No significant med hx. Light plaque and calculus, fair oral hygiene. Clinical exam shows edge to edge bite with severe wear, lack of posterior occlusion, and collapsed bite.
Consult reveals that pt has been to see three other dentists who have told him that his teeth are hopeless and he will need to have them all extracted. Following discussion of the case with colleagues, I designed and presented the following treatment plan and acknowledgement of pt risks and responsibilities. He agreed to start treatment.
Diagnosis: Malocclusion, posterior edentulism, loss of vertical dimension of occlusion
Treatment: Full mouth rehabilitation
Phase 1
Following cleaning, impressions were taken and mounted utilizing WhipMix facebow and articulator. Patient was given oral hygiene instruction and counseled on the importance of maintaining his investment in his dental work with proper use of prostheses and oral hygiene.
Using a wax up that restored anatomy and opened the bite, acrylic occlusal guards and wrought wire partial dentures were fabricated for the maxilla and mandible. Provisional crowns were fabricated with bisacryl and adjusted to accommodate the occlusal guards and partial dentures, as well as patient comfort. Patient was instructed to never be without either his partials or the occlusal guard to prevent failure of the crowns.
With some occlusal adjustments and reline of the partials, Phase 1 was successful. Patient was compliant with wearing his prostheses and was able to maintain the provisional restorations.
Phase 2
Performed caries control and root canal therapy on teeth with caries infiltration of the pulpal chamber. Teeth were built up, prepped for zirconia, and provisionalized using the wax up from Phase 1.
Following delivery of crowns, fabrication of the cast metal partials was initiated. Patient continued to wear occlusal guard and wrought wire partials until definitive partial dentures were delivered.
At final delivery, chipping was noted on incisal edge of crown #8. Reinforced importance of compliance with occlusal guard, counseling that without constant and consistent prosthetic maintenance of his opened bite, the restorative work would fail. I offered composite bonding to the chipped zirconia, informing him that, while not chemically ideal, it could improve esthetics. The patient was not bothered by the chip and did not elect to have bonding done.
Patient did not want to crown, bond, or bleach lower anterior teeth at this time.
Phase 1: opened bite with provisional crowns and wrought wire partials, stabilized with occlusal guard. Evaluated pt compliance, tolerance, and feasibility of restoration
Phase 2: fabrication of metal framework partials; patient in permanent crowns with wrought wire partials
Initial Presentation
Final Restoration
Reflection:
The two primary results of this case was that the patient was pleased and I was completely exhausted. The time that went into treatment planning and sequencing, fighting tooth and nail with the lab to get decent products, obtaining seemingly endless impressions (initial, direct restorative, wrought wire partials, cast metal partials, etc.), scheduling difficulties, pressure to complete the case from the patient, and much more, tilted the scale from "exciting challenge" to "inspiration for my ulcer" over the months that this case took, from start to finish.
What made it all worth it? When, after delivering the cast partials, the patient told me how happy being able to smile again had made him. The office team also had fun seeing his transformation from behind the front desk!
Direct Restorations
31 yo M presents with CC: "I am moving at the end of the week to start a new job out of state." Moderate plaque, light calculus, gingival inflammation, poor oral hygiene. Teeth tested vital.
Diagnosis: Gingivitis, dental caries
Treatment: Performed caries control and restored teeth using Gaenial Sculpt composite. Provided oral hygiene instruction and a referral to a sister corporate office in the state to which the patient was moving for completion of treatment.
Patient was informed that he needed periodontal therapy to address his gingival inflammation and that, due to the extent of decay, some of the teeth restored may need root canal therapy in the future. Recommended occlusal guard following final restoration of posterior teeth.
When he looked at his teeth following restoration, patient was extremely pleased and stated that he felt more comfortable and excited to move, start his new job, and connect with others in his new community.
Cast Metal Removable Partial Denture
Middle-aged M presents with CC: "I am a nice, respectable guy and I don't want to look like a tweaker." He had had failing teeth removed 1+ years prior and was dissatisfied with the retention, and the size and shape of the teeth on his immediate. Patient was adamant that he wanted the denture teeth to match his natural teeth and that he did not want metal to show when he smiled. Explained that due to the location of his edentulism, anterior clasps would be evident, but I would design the denture with esthetics in mind.
Differential: Partial maxillary edentulism, malocclusion
Treatment: reline immediate denture, cast metal maxillary partial denture
Patient was very happy with the prosthesis at delivery and left in a great mood. His wife, however, still left the office a one star review due to the time it took to complete the case.
The little joys of dentistry!
Initial Presentation (above); Delivery (below)
Delivery of partial - patient happy with his new smile!
Aberrant frenulum correction
37 yo F presents with CC: "My frenum is causing my gums to recede." Inferior labial frenum with high attachment at mucogingival junction leading to recession on #25. Light plaque and calculus, good oral hygiene.
Diagnosis: Aberrant inferior labial frenum
Treatment: Local infiltration using 2% lidocaine w/1:100k epi. Release of frenum from attached gingiva using SIROLaser, allowing for free movement of the lip while preserving free gingiva and underlying attached mucosa.
Operculum removal
30 yo M presents with CC: LL pain on biting. Moderate plaque and calculus, fair oral hygiene.
Diagnosis: #18 operculum interfering with occlusion
Treatment: Local infiltration using 2% lidocaine w/1:100k epi. Removal of opercular tissue using DiolaseST.
Pt did not present for post op
