PAGD Keystone Explorer Summer 2020

Keystone Explorer |  Summer 2020  11 dentistry issues Q What’s your practice worth? Receive a free market value analysis today. www.AFTCO.net | 800.232.3826 Since 1968 My treatment plan: » Study casts should be taken and mounted to determine occlusion. » Wax up of anteriors that were broken off needs to be made by the dentist or the lab to help the treatment plan and provide the patient with a reliable temporary bridge. 1. Endo/retreat teeth #24–27. a. Conservative instrumentation and post placement, passive posts, and internal bonding techniques (i.e dual cure bonding and build up materials) should be used to prevent weakening of the root structure and future root fracture. The passive post is your “rebar” in the core. b. Conservative removal of crowns on teeth #22, 23. c. Temporize teeth #22–27; provide the patient some anterior esthetics during this terrible time. 2. Finalize crown preps on #22–27. a. Make sure to have proper crown ferrule 1.5–2 mm. Bone loss in the case will help to achieve this. Remember we are splitting these teeth due to the fact the crown to root ratio isn’t ideal. 3. Determine a proper path of insertion, which may have been the reason that the 3 splinted crowns broke in the first place. a. A final temporary bridge will help to reveal under cuts. Also, an alginate and quick plaster cast can be made to reveal areas that composite can be added. This will conserve tooth structure of the anteriors to reach a perfect path of insertion. 4. Finalize an all-zirconia splinted crowns #22–27 made with hygienic embrasures. 5. Determine occlusion on final prothesis so that canine or posterior group guidance is achieved. 6. Have patient wear a night guard and three-month cleanings at first to determine that she is properly cleaning under the splinted areas to prevent future bone loss and failure of the prothesis. 7. During any part of the treatment if any of the teeth #24–26 are compromised beyond restorability and need to be extracted, a bridge #22–27 is still a viable option with 1–3 pontics.