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.

Questions:

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?

First Splint

Ok, I made my first splint.  Scared, thrilled and definitely converted.

TMD patient, continuous headaches and popping (early) bilaterally.  Marked tenderness in the cervical mm.

Delivered the splint with the lowest expectations possible...  As I was adjusting, she kept popping in protrusive so I finished up the posterior adjustments and decreased the protrusive slope- MAGIC!!!  The popping stopped.  The patient's eyes widened and I used Herb's phrase- Isn't that interesting.  She's a convert.  Now I'm going to experiment (should I say that?) through adjustment.  Everyone who said you learn through the splint was right.  I have already learned so much.

One caveat, I made them for free over Thanksgiving.  That has definitely got to change. 

As an update on all the situations that were discussed at Pankey, I have not found the ideal position or office to acquire.  I did get an offer but it was going to take 10 yrs to buy out and I want something a little sooner- I'm no spring chicken;)

I've got photos to post and will download (hopefully) this weekend.  You all know how slow I am to get these things together.  Any comments would be appreciated.

Jennifer

NTI

Was wondering what to tell a patient that is wearing a NTI splint for two years. She has some clicking and I do not think that will help her in the long run. She is a bit attached to it some I think it going to be hard to get it out of her hands and I do not want to approach it in the wrong way, she moved here and still likes her old dentist that gave it to her...
Hope all is well with the rest of you, I came back to a storm of fun office antics with crying and everything inbetween...
Jim T

Does anyone have the phone number for ordering Dr. Herb's mixture for the medicine to use intraorally?

Here is the first entry on the our blog.  I'll get the Rx for the strong topical as soon as I can.  It was great to learn with everyone.  Let us know if you are planning on taking another course and when.  Have a great week.

Jennifer