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neuromuscular bite correction : implants : aesthetic improvement
From: Arturo R. Garcia
Sent: Wednesday, April 04, 2007 4:21 AM
Subject: [roots] recent case completion
I just finished taking the portrait for this case today.
I was very excited to get the final photos of this case.
Unfortunately it was not a Norm Huefner style session,
but honestly I had a hard time getting this guy to relax
and smile. The fan on his hair was of no use!
Anyhow, this was a fun, interesting case. It took me over
1 year to finish it between phase 1 clean up, neuromuscular
bite correction and stabilization to putting restorations
on his implants.
Along the way I learned how to place implants with Leo Malin
at LVI and placed his. I improved my endo learning daily on
the ROOTS forum and took care of all of his. He was a very
good patient and did well all along the way.
He did not have a lot of money, but borrowed and cashed out
some retirement funds to do this case. My share of struggles
along the way and while not everything came out ideal, I was
happy overall. If I had to do it again I would make some
changes like putting in an implant in the lower left. Could
it be I am bridge adverse now? Now that I have been spoiled
by Leo and his implant mania? Has the endo/implant algorithm
gripped me like a vise?
He was happy. So happy he brought in his girlfriend and we are
working her up for a functional/aesthetic improvement too.
Arturo, I am definitely not worthy. I bow to you,
excellent case! - DanS
No bowing necessary and thanks for the kind words.
If anyone should bow it would be me. I have learned so
much from ROOTS with regards to not only endo but many
other things. Much of that was applied tom this case
Arturo, Nice case indeed. But may i wonder why do you do
all teeth that white only? It would look much more
realistlic and harmonious if you play with shades and
colorants as well as with teeth irregularities.
Just my quiet thoughts... Dmitri
Hi Dimitri, Excellent question. IMO each culture has its
own standards for aesthetics or what looks good.
And then add to that the fact that each individual has
their own concept of what looks right for them. So I wind
up delivering what satisfies those requirements. I have
done a lot of similar rehabs on patient 70 + years old and
not one of them has asked me to make their teeth look as
old as they do. In fact, sometimes I try to politely tell
them that they should not have the lightest color available.
He wanted perfect, white, straight teeth and I happily gave
it to him. To me it is a vanity issue- its what the patient
thinks is right for them.
I have been to many international aesthetic dental meetings
where there were presenters form the US and Europe and other
parts of the world. When the Americans presented their cases
there was a buzz in the room amongst the dentists from other
countries discussing how the teeth were too white and looked
fake. Then when the other dentists would present their cases
there would be a buzz in the room amongst the American dentists
discussing how the teeth looked to dark and that Americans
would never want teeth that have natural irregularities in them.
And they’re both right about their own situations.
I have a friend who did an aesthetic/functional rehab for an
immigrant from Russia. She had gold metal crowns and
bridgework all over her mouth- even the anteriors. Not to
mention a lot of arsenic root canals. When she was in Russia
she was happy with that look. When she came to the States
she felt out of place and became unhappy enough with her look
to do something about it.
Oh well. To quote a line from one of my favorite movies “
Vanity- it’s my favorite sin”. Anybody remember that one? - Arturo
Great response, I couldn't agree more. Here in Brazil I think
we are in the 'in between' zone. Patients usually don't want
their teeth to tell their age, but they don't like bright
white smiles either - Beautiful case, btw. Leo
Manufacturers have had to develop extra light and extra
extra light shades of composite resin that don’t exist in nature.
People are causing damage by constantly and perpetually
bleaching the hell out of their teeth. Vita had to add additional
shades to their shade guide
I recently did 4 crowns on a little old lady in her late 70’s
who insisted on toilet bowel white, all 4 max incisors, while
the rest of her teeth were more like Belgian chocolate.
My entire staff tried to diplomatically talk her out of it
at try-in and at insertion. She insisted, and since it was
her mouth, her decision. I made her promise one thing: to not
tell anyone else who had done the work for her! Six months
later she is in for recall. I go in to check her, ask how she
likes her knew crowns. She states, and I quote, “I love them,
but do you think they are too white.” I’m on the 15th
floor of a medical building in downtown Philadelphia.
Little old lady almost met the pavement below through the window!
We are going to see a multitude of issues from the bleaching
and bondology in the u.s. a decade down the road as a result
of this obsession with toilet bowel white. Good news on this
forum: a multitude of pulps will not survive the onslaught.
The conservative veneer preps of yesterday have turned into ¾
wraparound crowns. We used to be able to do conservative
veneer preps and not place temps. Virtually impossible in
the brave new world.
And you folks think endo is dead. As long as bondology is
around, endo is safe sound and growing. - Gary
All external bleaching has an effect on the pulp...this was
demonstrated back in teh 60's...but the good news was, it was
reversible. The question is, long term, is it? - Joey D
Arturo, I get your point... i have met such patients... nothing
wrong with providing patient with what he wants...
I was just wondering :-)
I saw one cosmetic case rescently done on one of my "single-visit
patients". She had all-ceramic restorations form second
bi to second bi on upper arch (done in the US, which fact she had
pointed with special pride and arrogance). Exactly the
"tolet bowel" stuff... Well, after talking to her and getting
some impression of her personality i thought the dentistry
she had is just a mere punishment... she doesn't deserve any
better. It's not "ethical" to thiink this way, may be... but
it just how it really is - Dmitri
Am I the only one that wonders why the lower incisors were
extracted? Just curious since they didn't look bad on the pre-
tx fmx - Mark
Hey Mark, I’m confused here. The case I showed did not have
any lower anteriors extracted. Are you referring to another
case? - Arturo
Sorry Arturo. The way you have your x-rays laid out, I thought
you'd extracted lower incisors. Apparently I'm looking at
implants in molar regions but the films are laid out in a
pattern suggestive of lower incisor films. Never mind
me....I'll go away. :-)) - Mark
sorry but... i see a buch of things that were not necesary in
this case... at least its my humble opinion, did you get
enough money for a new Hummer .......Arturo??? -Dr Alexander Garcia
Hey Alexander, Please explain what you feel was unnecessary
in this case? - Arturo