Steps of a Full Mouth Reconstruction
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- Опубликовано: 26 ноя 2019
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You are a rockstar sir! Hats off to your working techniques!
Thank you! I hope you subscribe to DentistryMasterClasses.com. This is my best material.
Thank you Dr. Cutbirth!
You are welcome.
Want to take your practice to the highest level of technique and productivity? Then click here bit.ly/33lOmnN for: An organized library of all the Dental Minute Videos. Complete, Comprehensive Cases not seen in Dental Minute Videos plus important Technical Reference Articles
great video as usual!!!! big fan!!! you mention that in phase four you prep the occ stops, which are the molars.
1- do you the right side upper and lower in one seat- and then deliver and then and only then the left side-so you wont lose the vertical dimension? or one full arch at a time and then deliver?? Because your video shows top and bottom in temps at the same time...if thats the case how did you not lose your vertical dimension?
thanks
By the time the molar teeth are prepared, the vertical dimension is stabilized/secured by the restored cuspids and bicuspids. So the molars are no longer responsible for maintaining the working vertical dimension. When a full mouth restoration is done, it may not be necessary to increase the vertical dimension. The vertical dimension is only increased if vertical dimension has been lost. Watch the video in the DentistryMasterClasses.com library on increasing vertical dimension and signs of vertical dimension loss.
How to increase vertical dimension? I couldn't find your video, could you help please.
Subscribe to DentistryMasterClasses.com. It has an organized library of all videos plus many other complete comprehensive cases not seen in Dental Minute Videos.
Are you restoring the dentition in centric relation, i.e. you don't want a CR-CO slide? Are the wax ups you are fabricating in CR? You did not mention centric relation in the full mouth reconstruction. Thank you.
I did not rewatch the video, but absolutely the wax up for a full mouth reconstruction would be done in CR. Restoring into CR vs. Centric Occlusion is a philosophical issue if you are not restoring multiple teeth. If the patient has a CR-CO slide and they are asymptomatic, i.e., no TMJ pop and click, no limitation of mouth opening, no deviation of the mandible upon mouth opening, no facial muscle pain, etc., do you equilibrate the patient into CRO? Ideally, the answer is yes, but we all do a crown or 2 or some other restoration without equilibrating the patient into CRO. That is one of the many reasons I perform a comprehensive exam and separate consultation of 99% of my new patients prior to "definitive dental treatment" except for emergency treatment. Remember, if you discuss something with a patient ahead of the procedure, and have it written down and explained prior to the procedure, it is a reason. If the patient has a problem, such as developing facial pain and/or disfunction after the procedure, and you did not discuss in words and writing that possibility prior to the procedure, it is an excuse. I am giving monthly webinars to the dentists subscribed to DMC.com on topics like this one. I am actually doing one next week.
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Awesome video sir. Thank you very much.. Sir may I know about the contents that I will get by joining the membership of your channel?
Click on the DMC.com site and it lists the content. Subscribe. You will find the content invaluable for elevating your practice. Watch all the videos on comprehensive cases as well as the new patient exam and consultation.
@@centerforardI'll do that.. thanks a lot Sir..
I just learned from your website that you're in Waco, is this correct?
I'll take the 3hr drive for a phase 1.
Yes.
Sir Stevan, I am a member of your website but could not ask questions there. The steps of FMR become a little confusing in phase 3 onwards. I want you to please clarify the following.
1- After preparation, impression, bite registration, and provisonalization of lower incisors to bicuspids, do we have to repeat the upper alginate impression with a new facebow with provisional restorations?
2- After the cementation of lower final restorations, we do an upper impression, Bite record between upper prepared teeth and lower final restorations. Do you also take at this step a new facebow record of upper prepared teeth and lower alginate impression with final restoration?
If you have no serious training in occlusion, principles of aesthetics and restorative dentistry, it is hard to master a full mouth from a video and certainly not from a conversation or written explanation. I am sad my hands on teaching center in Dallas shut down after 20 years during covid. I suggest you watch the several videos on full mouth reconstructions in the library of DMC.com. A big factor is whether or not the vertical dimension must be opened. Full mouth reconstructions are like heart transplants. If you are trained in doing them, it is a systemic restorative process. If you are trying to learn how to do it from scratch from a video. no matter how good the video, you can get into real problems.
I see a video..I watch and learn...read the comment's..sometimes there are really good critics and ideas to top up the video...its way easier and sweeter learning a man's 36 + years of experience in a 10 minute video....
I agree.
Are there any resources to find practices that offer pro bono services such as this?
I doubt it, unless there is some government agency. A regular dentist has significant overhead to keep his practice going, including salaries, lab bills, rent, electricity, etc., just like you do with your house or business. The dentist would go broke if he offered these services for free, because all these salaries, etc. must be paid.
@@centerforard thank you. Your work is exceptional.
In my opinion, if you give a night guard after a full mouth reconstruction it means you failed. You have to design the teeth the way they don't damage themselves while the patient is sleeping. When I do full mouth reconstruction I always use full-contour 3D (shaded) crowns and bridges so don't experience any chipping of the ceramics, not to mention I don't recon veneers are the way to go eighter as they tend to chip quite often without a night guard. I would never like to go sleeping in my bed with anything on my teeth as it is disturbing. I would rather not do any teeth reconstruction if I knew I had to put plastic in my mouth till the end of my life so I don't do things to my patients that are hard to accept for me. But well that is my point of view.
I agree that a correctly restored dentition is self protecting, however, these patients destroyed what nature gave them. They are prone to destroying the ceramic materials (even zirconium). The nightguard is just additional protection. Definitely a good idea to protect the tens of thousands of dollars invested.
@@dartstar100 Never seen a full contour crown or bridge with adequate thickness of the material broken. Sometimes full cryconium crown breaks if too much drill prepartion after synetrization is required.
Have you ever seen a crowned tooth shear off? Would you call that a failure?
Do you use a gauge before inserting every crown to ensure it is thicker than 1mm? Is the milling process so precise that it never overmills the crown?
And though I don't use zirconia for bridges, I have seen more than one fail by fracturing at the connector. I have even seen a PFM bridge fail the same way. Nothing lasts forever, the night guard is just added insurance that things last longer. And at a minimal cost.
Maybe I'm just cautious or just more jaded.
@@dartstar100 I don't know what word shear off means - my vocabulary says "destroyed, torn apart" so let me know....
Yes, the milling process is extremely precise. I do milling by myself so I know the diameters in exocad are same after milling and sintering. Not to mention I do my milling machine calibration quite often and the discrepancies are less than 0,02 mm.
The truth is that you can never have precise restoration if you use a dental lab. I experienced it many times with a bunch of laboratories. The reasons I know are:
1. making stone models - you have to go completely digital, forget about plaster, no other option to get most of the precision nowadays technology can offer. I scan impressions as intraoral scanners still can't appropriately do its work when it comes to full mouth restoration. I don't know any lab that has the knowledge to scan impressions properly. It really demands time and patience to get a proper impression scan.
2. You have to use fresh drills in your milling machine. Most labs make more than 100 units using the same drills set. I don't exceed 50. You as a dentist can't check the wear of the drills in the milling machine.
3. You can sinter a 3 units bridge in 2-3 hours if you go for the so-called fast sintering process. Many technicians use that option as it saves time but the outcome is a strain full teeth restoration which can break. Normal sintering time is 7-10 hours
4. You have a lot of manufacturers and brands of zirconium blanks. They all need different times and temperatures. Guess what happens in the lab. They collect all of the millings of a day and put into the furnace then choose the highest temperature of all of the blanks and here they go. Again you can't check it as a dental practitioner.
5. Long span bridges require adequate stabilators to be milled together with the restoration. Stabilizators require blank space which can be used for additional crowns or bridges so most of the technicians make it as small as possible or design very stupid shapes which in fact don't stabilize the whole restoration during sintering. That is why you can get a horseshoe restoration that does not fit.
6. The biggest sin of a lab is that they mostly do the sinterization overnight so the preferred sinterization time is 12 hours approximately. Long span bridges require 20-24 hours. How can you check how long time your 14 units bridge was in the furnace. If you ask a technician yeah you will get any answer you desire.
Please mention I am talking about full contour cyrconium multilayer, no ceramics at all. I have never seen it fractured if the design was right and the whole process was performed adequately to the manufacturer's guidelines. You need 0,5mm minimum thickness not 1mm to get such results. I had some problems with European zirconia manufacturers but since I have been using only Chinese zirconium blanks it is just a pleasure to be a dentist.
@michael. Interesting outlook. I would greatly appreciate you uploading a video or sharing a few before and afters. I think we could all benefit from your perception in some way.