From: "Arturo R. García D.M.D."
To: "ROOTS"
Sent: Saturday, March 12, 2011 12:38 AM
Subject: [roots] Recent case 3-11-11

This was an interesting case that was in for follow up last week.  A great
pt to work with and a nice lady who always had a smile on her face, even
when she did not have a smile she was happy about or comfortable with.

8 and 9 were hopeless as were the lowers.  The ext sites were grafted for
ridge preservation.  The lower arch did not need grafting.  Our own
implant expert Dr. Rick Kline placed 6 Implant Direct RePlant implants on
the lowers.  This was restored with a screw down, hybrid final prosthesis.
The upper is all eMax including a 6 unit bridge from 6-11.  She had
decayed cervical abfractions on almost all her upper teeth.  There's even
a root canal in this case.  #13 turned into a carious exposure and a RCT
because of one of those decayed abfractions.  Its a lot closer to the pulp
from the side than it is from the top. It had a funky apex and I think I
got most of it, hopefully all of it.

I took a neuromuscular bite using a J5 Myomonitor TENS and K7 Evaluation
System.  Using this bite, we had Bob Clark and Williams Dental do an upper
arch wax up and a lower denture type temporary prosthesis. We used this to
fabricate an immediate load, screwed down, full arch lower temporary
prosthesis.  That same day of surgery I used the wax up to create the
upper orthotic including pontics over 8 and 9.  I bonded some Ribbond to
the teeth first to provide support for the orthotic and strength for the
pontics.  The she wore the lower temp hybrid and upper orthotic for 4
months while the implants healed and the bite stabilized. Then we got the
nlower hybrid to the final try in and prepped the upper teeth for
porcelain at the same visit.  the inserted the lower final prosthesis at
bthe same visit as the upper porcelain.

The pt is very happy and I like the case, but I want to do some
recontouring when she comes back for her 3 mo hyg visit. - Arturo