Case of the Month
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CASE 7 & 11 NOT FOR THE SQUEAMISH!



This is a case we just seated yesterday 12/6/01. The photo shown here is in the wax try in stage a few days earlier.

A little history ... This new patient came in with a suspicious area we found immediately on our soft tissue oral exam. The biopsy showed Dysplasia which I felt had been there already for quite some time. I emphatically explained and implored him to get this totally removed at once as 100% of these as per Sol Silverman at UCSF (another of my hero figures) will go into full blown cancer. This patient tried to cure this holistically with herbs ... and sure enough it became malignant. One of our great ENT physicians (Dr. Kaplan) did a fantastic job on the surgery but had to remove all the maxillary right teeth and bone to the center line leaving the total area open into the floor of the nose. I had prefabricated an all plastic immediate temporary Obterator with plastic teeth in place. After healing I had Jamie Moreno at our lab (Golden West Prosthetics) fabricate this swing lock partial. It fits wonderfully and when locked shut is very stable.
If you will notice I had Jamie leave the inside concave instead of convex so that any food that works it's way up around and above it, will with with gravity accumulate in the concave portion. This design works wonderfully and looks fantastic!! The pink plastic covers the metal clasps and actually acts as a clasp its self.

I had had experience early on as the Prosthetic Officer at the Mountain Home Air Force Base in Idaho during Vietnam fabricating these ... got some fantastic special training at San Diego Naval Hospital. And, as our dental school was very weak in partial design and fabrication it proved to be invaluable.
Jamie and I have made a lot of these in the past 30 years but most are on the lower.

(12/9/01 ... I must apologize as some of these pages I have not even looked at in years ... I have finally tried to update this page a little as I added the above case ... we have over 700 individual info and hobby pages, and the time to even open them is staggering. I will slowly update all the dental pages and try to weed out much of the superfluous wording.


10/1/99


8/6/99
Below see our new style Fiber Core bonded in bridge .... my own prep design ..... a small onlay in conjunction with the inlay prep so twisting on the pontic will not tend to put splitting forces in the center of the abutment teeth. The fibers inside the heat cured very dense composite gives it it's strength. It is also a 100% match to natural tooth replacement in color. I would not try to do this on molars or on Bruxers (teeth Grinders). Gold is still king here!
12/9/01 .. both these bonded in Fibercore bridges on this young woman are still perfect.



IT'S NEVER TO LATE TO START LOOKIN FINE! SEE YOUR DENTIST!!



2/10/99

This is just a simple partial denture we made about 15 yrs ago with metal occlusions in the limited distal space = has held up very well ... notice the mesial rests & the I bars .... still no better way to preserve the abutment teeth or more conservative way to make a standard style partial. On bruxers we make entire dentures out of a Vitalium II metal base with all metal occlusions with the plastic bonded onto the fronts of the metal where it shows .... they can eat nails with them!!! hee-hee! .... have some that are 28 yrs old & still going ... some are on their 2nd or 3rd go around of plastic added over the same Vitallium II.

10/15/98

Above is one of the custom trays which I make for ALL our dentures. In the primary model I cut in the postdam & build the custom tray into it - saves modeling compound in most cases. I also cut the tray back on all peripheries making room for muscle trimming & all muscle attachments. You must first spray the tray with Alginate adhesive, seat & work the lips
7/8/98
This case above is an easy one - one that I smoothed the chipped part & copalited on Nov 5, 1979 at no charge. The patient comes in regularly & he bit on something hard & fractured this piece of tooth out! It was 19+ years ago - before bondodonticts! I show it to demonstrate my philosophy of looking for reasons not to drill instead of reasons to drill!! To fill this would have necessitated drilling out good tooth structure & weakening the tooth to place undercuts to hold an amalgam in.
Granted, now I prolly would liner bond, etc. & fill it in without any drilling & protect it for sure. On the other hand when the technology finally caught up to treat this one it had already gone 13 yrs with no problem .... so why have the patient waste money on a done deal!

3/31/98 - Started today - this crown had a large lingual cavity, had to be built up & remade. The tissue was too low on the facial of the old crown - see yellow arrow. The color is off too. Did periodontal Surgery to raise the facial gingival margin up even with # 10. Will show the finished high noble crown with gold lingual in place in about 3 weeks.


1/26/98 - I THINK THIS MAY BE THE FIRST TIME THIS PROCEDURE HAS EVER BEEN SHOWN! I have never seen it written up before.
This patient fractured off this crown #14 into the tri-furcation area & into 2 separate pieces of root! I couldn't reattach it in any way. He literally begged me to save it - try anything even if it only holds for a while! Well, this is what I did just today 1/26/98! On the photos from Left to Right - #1 was how it looked before I cleaned it up. #2 after I cleaned it out. #3 the crown prep with Hybrid composite build up (I usually use Ti - Core but the hybrid was easier to handle in this tough situation) over 2 kruer posts tapped, threaded & bonded into the two facial canals. This also showing the extraction site of the extracted lingual root. Photo #4 is a lingual view - the prep is very parallel.

We covered it with a high noble yellow gold since it went so well. The natural molar was extremely huge to begin with & this crown will be about the size of a small lower 2nd molar when done & being built on just the two buccal roots. It is ideally situated directly over the mandibular buccal cusps. This is the same individual we re attached his maxillary left 1st bicuspid a couple of teeth in front of this one after it had fractured at the gingival or gum area over 4 years ago. I think we have shown #12 on the adhesion page.

(12/9/01 - BOTH THESE ARE STILL IN PLACE!) We also have a similar one that was fractured into 3 separate roots that is now over 8 years old. And, if they fail we now have an implant option. But posts inside of natural roots are still better than metal to bone. Now, It is things like this you can't put a stop watch on! Don't let the money managers control your office, time and life! Take all the time you want on everything - go for the long walk in life, not the sprint! And, eventually develop a practice with only patients that care enough about their own teeth to maintain them and keep regular appointments !
Below are the finished photos of #12 and #14.


2/10/98 - Remember, these Accucam photos above are mirror image. The upper left photo is tooth # 12 that we re attached at the gingival level about 4 years ago. The one on the upper right shows # 14 from the lingual with the high noble gold crown in place over only the buccal roots of #14! The lower left photo shows #14 in occlusion. The LR photo just shows a little of #12 & #14, neither 12 or 14 are strong enough to support a fixed bridge.

Denture case - inserted 12/1/1997 - I trim all my own ridges at boil out. Always use a surgical tray at insertions on immediate cases where there are teeth to be extracted & the dentures placed at the same visit. Use only Swissident Teeth.


Before



After



CASE ONE

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  • End to end bite
  • Massive abrasion
  • CLICK HERE IF YOU ARE IMPATIENT
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  • 13 months of conventional orthodontics
  • Extracted 1 lower incisor
  • Developed an over jet & overbite
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  • Only crowned 5 of his teeth
  • The rest were bonded where necessary
  • Vertical dimension was left unchanged

I am particularly proud of this case, as according to the patient, his previous dentist wanted to leave him in his end to end bite & open his vertical (he had 0 freeway space) and do full mouth crowns for around $40,000.00 None of the posteriors were in need of crowns as almost all the wear was anterior!





Peg lateral and missing lateral case.
Shaped the left cuspid to look like a lateral & did four porcelain veneers.



CASE FOUR

Removal of decay & chair side quartz laminates.



CASE FIVE

Porcelain Veneers, total time from before
to after was 2 weeks.




CASE SIX

This is just a boring standard
porcelain to gold bridge with the
laterals turned out, with narrow
& deep embrassures.




CASE SEVEN

HOPE YOU DIDN'T JUST EAT LUNCH!
This benign tumor was removed by
Dr. Rust. It could not have been found
without a Panelipse xray machine.
It is laid out in the position it was
found in the maxillary sinus, at the floor
of the orbit (eye ball). The patient did fine


CASE Eight

Before & After with 2 new crowns
And 2 Veneers

CASE Nine

Kitty cornered - Bi- Cuspid to look like a cuspid,
after making cuspid into a lateral with a veneer also
Peg Lateral to a full Lateral with a veneer

CASE 10



BEFORE


AFTER


CASE 11




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