Dental cases I don’t agree with

Wheaton family dental practice

Dental cases I don’t agree with

#11 This needs replacemtn to the exact same degree the authors need to write this article. They couldn’t find decay to replace or a broken tooth? I’ll see 100 teeth worse than that by noon on any given day and not even think about touching it. Total over treatment.

#10 One of those cases where they are clearly just trying to do something cool without thinking about the end result for the patient.  Why not just prep the facial and actually make it match #9?  Esthetics is the only reason to replace the gold anyway.  If you are going to do something, do it right the first time.  AGD Gen Dent 06/13
cerec crown
Just do a regular crown and not try to be fancy.
#9 Wrong material used and or poor design of one tooth.  You NEED to get 8 and 9 to look the same.  This guy just spent big bucks and every time he smiles all anyone can see is the blazing white #8.  Should have made the zirconia abutment less facial (which could have been reduced at any time) OR shown this picture to lab tech and had them remake #8 OR ask them to make a color correcting coping (but that would require more room so is redundant).  Plus the whole point of the article was matching an implant to natural teeth!!!  FAIL
implant crown

#8Pontic site development site for case with low lip line and that would have much better result by lasering tissue, forming an ovate site, and then using ovate pontic.  The final results look like nothing was done to preserve anything.  All this did was add risk of one of the retained roots blowing up down the road.  Bad idea, unwarranted, and bad result.  Real tri-fecta!


Another case of  why pull them all?  From AACD


Figure 1

Initial radiograph shows a fractured instrument in the mesiobuccal root canal and an intracanal post in the distal canal of a strategically important mandibular right second molar (A). After the fractured instrument and the post had been removed, root canal cleaning and shaping were completed (B). The root canals were filled, and the tooth was restored with a core; it can serve as an abutment (C).
In no way did you increase the longevity of this “strategically important” tooth; in fact the longevity was significantly decreased!!  It appears that this case was done originally long ago and is fine (no info is given as to if this tooth is symptomatic or not).  Based on the xrays and the description I am assuming a bridge or partial  is being planned and they wanted to ensure a solid foundation.  If either plan is followed through with I would predict that gouged out molar to fracture in short order.  This is a case of “the enemy of good is great”.  Took a bad situation and made worse.  At this point I would hemisect this molar and make 2 crowns.

Why pull them all?

Granted a pano doesn’t give all the information and neither does the article, but I see many teeth that look great.

#19-21 all look fine.  #22 looks pretty good.  And #30 may be fine also, mesial bone loss maybe??

Also pulling hem all and restoring with bar OD now eliminates all proprioceptive response and with nothing under the maxillary denture the patient is going to destroy the premaxilla.  This contraindication (lower implant supported prosthesis vs max denture) can be found in many articles.

Either add 4 implants under maxillary denture with locators if patient insists doesn’t want teeth anymore or do fixed implant supported bridges on mandible where they are needed and maintain some natural teeth for proprioception.


AACD case disappointing.

This lady spent probably around $80,000 and I guarantee she looks like she is 10-20 years older.

A primary contra-indication for a fixed maxillary implant supported prosthesis is severe anterior bone loss.  Why?  Well you can not have both a bulk of material to properly support the lip and make the restoration cleansable.  In these types of cases either a Marius bridge or an overdenture is called for.  Maybe the patient signed a form saying she would except a sunken lip in exchange for having something that she can not take out, but I doubt that.  Now they wisely never show a face shot or profile shot, but you can see the significant loss of lip support in her lateral cephs.  I immediately noticed the deficient lip on the cover and when I read the title I knew exactly why it was that way.

Original denture with radiographic markers imbedded within.  Notice full natural upper lip
Interim denture.  Notice even better lip support
Now look at this old lady.  Absolutely no upper lip support.  What a shame.  I would love to see her before and after full face shots.


All on 4 without following the surgical protocols in a maxilla against a implant supported prosthesis

Those implant are not distal enough to NOT angle them.  #1 Why weren’t they angled as that is the protocol.  #2 the left one could be placed more posterior by 4-5mm.
Fortunately for both the surgical doc and restorative they are working with a lab guy that knows his stuff.  It appears the 1.5x A-P spread was not violated.  Notice the premolars have to flare out to buccal so that they can hide the buccal corridor since they can not place a molar
Luke Kahng saved this case with his skill.  Issues are the teeth now have to flare to buccal to ensure limited dark space in posterior buccal (also to compensate for the class III which was likely created by poor planning of the lower).  Also even with Luke’s best efforts there is still black areas on both sides of the buccal corridor.  It is of course worse on the side that the most posterior implant is so far anterior (#5 implant should have been placed angled or at least more posterior as there is bone available in #4 site)

This case would have been a slam dunk if the surgeon had placed implants where they should have been.  It appears to me even if the restorative doc was presented with this case to start he should have insisted on an implant in #4 also, there appears to be room.  They state in the article that she was class III to start with.  I would like to see a lateral ceph because I am guessing she is class III because that is the pattern of bone loss.  I also am guessing the lowers were restored right above the existing resorbed bone making it very difficult to restore the uppers properly (I do not know that for sure but is is highly likely and would fit with the poor planning pattern seen in this case).  Against a mand implant supported prosthesis this case is at a much higher risk of failure.

#4 Hybrid bridge framework case

This one isn’t that bad but not sure why the metal was included at all??  I’ve never seen anything like that and can only assume it is done to allow for a smaller more natural looking connector between the pontic and the abutment teeth.  If that is the case then this is a rather ingenious plan.  This may just be my ignorance of the bridge technique.  I have been unable to locate anything supporting such a configuration.

#5 Locator overdenture

These implants are placed far too distal.  Ideal location is canine to lateral incisor.  Premolar location creates a seesaw effect with the denture.

Bryan Bauer, DDS, FAGD     

Wheaton General and Cosmetic Dentists

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