Implant # 30

From: Fred Barnett
To: ROOTS
Sent: Saturday, February 28, 2009 6:23 AM
Subject: [roots] final photos for implant #30

from a 2nd year resident....Fred

Attached are the finals of a case I have posted before.   It is nice to be able
to see it to completion.  I had my patient come in after the restorative was placed
by her GP to take photos and of course check the occulsion.  I am a true believer
that occulsion is king, and it can very, very easily destroy a beautiful case.
In the photos you can see the lateral interferences picked up at today's
appointment.   After I removed them, I removed the sweeping protrusive interference.

- Jared T. Buck, D.D.S.






Great follow up.  The occlusion is the key, always, but especially with
implant prosthetics.  It is awesome to have endudes looking at it too.  If
I had restored this case I would have taken a clue form the large cervical
abfraction of #3 and looked at it as #3 being 50% responsible for #30
failing.  It takes tremendous excess, pathologic force to help those
things to happen- a max molar w a large cervical abfraction and a failed
mand molar.  Its hard to tell from the buccal view only but #3 looks
slightly out of postion (still) and could have very sharp, malpostioned
cusps.  If that were the case and I had restored this case I would have
coronoplastied #3 to create a better occlsual shape and postion.  Then I
would restore #30 to that.

It never ceases to amaze me how dentists can expect even a perfectly
placed and restored implant to survive any better long term when it is put
into the exact same hostile occlsual force environment that helped cause
the previous tooth to fail.  And teeth are far better at handling force
than implants.

So endudes ecnourage your restoring dentist to handle this or even better,
to avoid having to handle that blank look on their face when you try to
explain it to them and since they probably wont even notice it, just do it
yourself and polish it up nicely so those diamond tracks dont show :-).

It's all about creating value for your referral base's patients ;-)!

Arturo

Thanks for your comments Arturo.  Endudes need to be much more than
'white line' mavens  ;-)) - Fred

Am I missing something here?   Is that radiograph showing the crown on the
molar endo for real?  Just looks different than what I was taught was
clinically acceptable, but then there are lots of new philosophies out
there that weren’t around 40 years ago, when I was in dental school- Terry

The crown is less than ideal ;-)   - Fred

I would love to see the restorative dentist try and floss that burger.
Best have the patient using an irrigation device of some sort.  Ah, just
makes me feel better when I see that other dentists are as bad as I am - Terry

I’m not sure what I’m missing here, but given the position of that tooth
in the arch, the mesial inclination, the position of the opposing 2nd molar
in the arch, the excellent marginal fit, I’m not sharing the position that
this is a poorly done crown or that it is not cleanable by usual means - gary

I'm with you Gary---perhaps the premolar seems a bit suspect,
but tough to say, i wasn't there - Kendel