Monday, February 9, 2009

Help on this case

What you are looking at are casts and diagnostic photos of a patient that started with the practice several years ago. In the photo above, the 2nd PM is actually #4.
Here's a little history...
The patient presented with extensive caries and fractured teeth. RCT #s 4 & 5 necessary and post placement. The crowns were in occlusion and functional approximately 3 years. Tooth # 12 has a floating pontic. Teeth #'s 8, 9 & 10 are veneered, #s 10 & 11 are crowns. She has had several fractured teeth which required extraction.
Every 3 months she is seen by a periodontist.
Teeth #'s 4 & 5 fractured at the alveolar crest and were extracted. Implants have been placed. She states her mother also fractured her PMs.
I hesitate to restore her implants with the occlusal issues. Where to begin?
My observations are these-
1. She appears to have immediate disclusion on protrusion- interference noted in the posterior.
2. Deep bite with lingual and facial wear.
3. No stable posterior occlusion.
4. Repeated fracturing of teeth.
5. Left side- all the crowns have fractured porcelain.
6. No pain.
1. Here envelope of function seems violated- is that right and where do I even begin on this one?
2. Do I temporize the implants and place her in a splint?
3. Do I place her in partials and expect to temporize the anterior teeth to work out occlusion?
4. Do I punt this one to a prosthodontist?
5. What do I tell the patient as to why this occurred?