RBB Recementation Protocol - Adjusting Pontic Occlusion
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- Опубликовано: 7 авг 2024
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Thanks for being part of my mission to make occlusion tangible!
Rather than bore you about mechanoreceptors and give you 67 definitions of centric relation, I'm going to show to real-world clinical applications of Occlusion.
For the (this) August edition I share with you a clinical video above, with my full commentary, of a recent Resin Bonded Bridge Recementation. You get to see this video before anyone else :)
0:00 Introduction
0:30 Air abrasion of RBB
1:00 Old cement removal
3:00 RBB try-in
3:20 Panavia bonding Protocol
6:38 Removal of excess cement
7:00 Occlusal adjustment
9:02 Learn Resin Bonded Bridges
At the end of the video, observe my protocol for ideal occlusion on RBBs:
1. Visual Inspection - can the patient achieve Maximum Intercuspal Position (MIP)? If Yes, great, the bridge has likely been fit back perfectly.
If not - then the fit was 'off' slightly. (or maybe the occlusion sucked before and that's why it debonded in the first place?)
If the RETAINER/ABUTMENT is proud - was this intended (ie. intentional, perhaps a Dahl technique?)
...or unintended?
If unintended - consider selective enameloplasty of opposing tooth plus/minus Adjusting the abutment/metal/zirconia itself.
When Adjusting opposing teeth, here are the simple rules I follow:
A. Communication
- Tell your patient ahead of time that teeth fit together like a lock and key. If you change the lock, you also may need to change the key. A change in one arch may need a change in the upper arch for things to fit well.
- Tell the patient you will smooth and reshape a corner of the opposing tooth - it will be quick and nowhere near the nerve
B. Execution
- Enamel is King. Can you take something off from the opposing restoration to reduce how much enamel you need to remove?
- DON'T just flatten cusps and gouge in to fossae/cingulums
- Instead, follow the existing contour of the tooth where it permits
- Go incremental with fine burs (like red) - when you get close to perfect, you can use a course soft flex disc or white stones
- Don't expose dentine - consider another approach if you're in danger of exposing dentine.
2. Pontics for RBBs should have no excursive contacts. They can have light contacts in MIP.
Using two colours of articulating paper, take a look (towards the end of the video) the simple way to identify undesirable excursive contacts but maintain the occlusal stop!
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Man I love these commentaries, invaluable, please keep doing them
thanks Ayman! Appreciate feedback like this!!
Thank you for sharing amazing video!
This stuff is so invaluable.. Keep it up
Thanks Jaz for posting this ! Very informative. Love it 👌👌 keep doing them man 🙏
Really great video Jaz. Informative and super helpful. Thank you!
thanks Jess!!
Great practical tips. Thank you for posting Jaz. Looking forward for more such helpful videos ..
thank you Laxmi!
Hi Jaz
Do you like the panavia tooth primer? I find it wets the enamel too much so stopped using it,
Obviously you use it. Do you apply it and then bone dry the tooth?
hey bud - tooth primer is an essential part of the protocol. I do air dry it for 10 seconds until I see no pooling
@@protrusive
And does the enamel look dry again or moist?
@@amit.thedentist6843 not dry, a little thin film of moisture
Jaz I had a patient that had a temp Maryland bridge made. It failed and thus recemented with PolyF, probs not the best decision as now I have to take it off 4 months later to scan so the lab can construct the permanent. Any tips on how to try and remove without completely destroying? Thanks so much
I think you'll be fine! PolyF is great but could be worse like removing a bridge bonded with resin cement.
Plenty of ultrasonic energy on the metal abutment and at the tooth-cement interface - tie some floss around bridge to prevent swallowing
Get some forceps, support abutment tooth with finger and torque off the bridge- you got this!
@@protrusive I can’t thank you enough Jaz! Did this today and worked a charm. Super grateful as I wouldn’t of thought to have used the forceps at all would of been there all day with ultrasonic I think lol. Much appreciated 👍🏽
@@daniellenichols105 the fact that you A. implanted advice and B. reported back speaks wonders about you. Thank YOU so much
@@protrusive Thats very kind! Super grateful for your words of wisdom
Hi Jaz, would you go for no prep id lower central is missing? one or two winged RBB?
dear friend, without any further info my answer is: cantilever (one wing) and no/min prep (ie. sometimes to de-triangulise a tooth to get a longer connector and no black triangle) Regards - Jaz
@protrusive Thank you! One wing even if the neighbouring teeth are periodontally affected?
What are the risks of no prep ?
@mam.a1229 with this update info then no, there is a string case or fixed-fixed for periodontal splinting.
Main risk of no prep is not having a path of insertion or clear final seat position, but there are ways to mitigate eg a seating lug
@protrusive thanks mate! The abutments have clinical attachment loss and gum recession but mob around 1mm.
Same opinion?
@@protrusive also seating lug with compromised aesthetics or prep ?