Pre Work Thoughts

Wheaton cosmetic dentist Bryan Bauer

Step 1 for full mouth dental rehabilitation Step 2-->

Prior to impressing for final prosthesis ideally

  1. Temporomandibular joints in proper disc and condylar position in centric relation
  2. Occlusally equal intensity stops on teeth or acceptable substitute checked with T-Scan
  3. No posterior contact in excursive movements
  4. Anterior guidance in harmony with envelope of function

If joints not health and functioning in a stable position than any changes made will not be stable

Dawson has 16 step 2D checklist and 10 step 3D checklist

Posterior wear no anterior – really must intrude or cl the posteriors Spear

Condylar guidance set at 20 degrees unless severely worn posteriors, lack of anterior guidance due to AOB or end-to-end relationship, or if doing group function for some reason. Spear
Check neutral zone

TMJ examI like to break these treatments up into phases letting the patient know there are too many unknowns to give a definitive treatment plan.  At each phase the treatment is re-evaluated and both parties get to decide if they wish to continue treatment.

Phase 1:  Transition.  Removal of sources of infection

-Remove old failing dentistry, decay, hopeless teeth or implants, and place a transitional prosthesis either fixed or removable.   The benefit of this treatment is it removes or slows or stops infections, bone loss, etc.  Gives time for better hygiene and resolution of soft tissue in order to better access biology around the teeth and implants.  RCT’s may be done during this phase too.

Phase 2:   Assessment of remaining foundations.

-Questions I want answered are long term prognosis of remaining teeth, remaining implants.   Some may be great others so-so.  We can decide to remove so-so teeth or implants or maybe keep them but make sure when they fail its not catastrophic, ie hooked to bridge.  After assessment we can decide how to restore.  Fixed, removable, both.  We can also access all the risk factors going on.   On someone with a high history of dental failure I may consider removal of the teeth and do implants if I feel their failure is cavities related mostly.  Perio is a different risk factor that would be considered differently.

Phase 3:  Restorative plan.

-Could be definitive, temporary, or whatever the patient wants.  Sometimes the patient wants to have it one and done so we make sure everything is healthy and good to go.   Sometimes
patients want to hang onto what they got as long as possible so we do a different approach knowing some stuff may still continue to fail.

But I must say each case is different so its hard to have a good system down on these