Houston we have a problem.....full mouth recon
ACTUALLY we don't but I thought this might get your attention and also it is a tribute to the patient in this case. Meet John he is a NASA engineer, a real rocket scientist and one the nicest guys you will ever meet. One day I actually bumped into him on a flight from Chicago to Denver and I asked him what he did at NASA and he said that if the astronauts utter those words "Houston we have a problem" he is the guy that they call. John lives in my city but works in Houston every week so he is only home on Friday - Sunday mornings and is a vibrant 75 year old man. You can see from his before photos that he has severe attrition/wear. He does not report any history of GERD or any intestinal disease. I had patched up a few teeth over the years and always discussed the need for FMR. He finally committed to the treatment.
The treatment plan given his work schedule and limited availability was to get a FM wax-up done, do the upper arch in one sitting and place over provisionals which he would wear for a minimum of 3 months to asses the new vertical etc. I TENS and took a bite and got the wax-up completed. You may notice from his before photos that his incisal edge position is actually not bad.
So we called in CADSmiles and he helped with the case since I wanted to get the uppers completed in one day and the provisionals in place on the lowers. Having him do the design and post-mill contour freed me up to prep the lower arch. Eddie has a great approach to these larger cases and they are divided into smaller segments all of which has been discussed on these forums several times. This case was done all with Celtra Duo LT A2 just polished and fired. Not going to win AACD and I did learn several things from this case but the patient was happy with the outcomes. The uppers have been in service for 1 year and the lowers were completed 7 months ago.
On 8/3/2018 at 11:25 am, Aaron Tinkle said...Just curious, but why Celtra and not eMax or posterior zirconia?
Hey Aaron - e.max would have certainly been an option here but I really like the way Celtra mills and the primary thing here was speed for the case, the polish and then just set in the oven saved a lot of time in the processing phase. If my memory serves me correctly Eddie moved his flight up as he was done quickly.
I did not even consider zirconia in the posterior due to the fact that most of the preps back there were very non-retentive and I would have worried about them coming off, I preferred the idea of bonding everything in but bonding in all those restorations is a lot of work IMO.
On 8/3/2018 at 1:49 pm, Andrew Hall said...On 8/3/2018 at 11:25 am, Aaron Tinkle said...Just curious, but why Celtra and not eMax or posterior zirconia?
Hey Aaron - e.max would have certainly been an option here but I really like the way Celtra mills and the primary thing here was speed for the case, the polish and then just set in the oven saved a lot of time in the processing phase. If my memory serves me correctly Eddie moved his flight up as he was done quickly.
I did not even consider zirconia in the posterior due to the fact that most of the preps back there were very non-retentive and I would have worried about them coming off, I preferred the idea of bonding everything in but bonding in all those restorations is a lot of work IMO.
Thanks Andrew. Great job on this case.
On 8/3/2018 at 1:49 pm, Andrew Hall said...On 8/3/2018 at 11:25 am, Aaron Tinkle said...Just curious, but why Celtra and not eMax or posterior zirconia?
Hey Aaron - e.max would have certainly been an option here but I really like the way Celtra mills and the primary thing here was speed for the case, the polish and then just set in the oven saved a lot of time in the processing phase. If my memory serves me correctly Eddie moved his flight up as he was done quickly.
I did not even consider zirconia in the posterior due to the fact that most of the preps back there were very non-retentive and I would have worried about them coming off, I preferred the idea of bonding everything in but bonding in all those restorations is a lot of work IMO.
Very impressive case and execution. I do wonder, what drove this 75 year-old man to pursue this treatment?
On another note, it is my understanding that zirconia can be be bonded. Here's the link to an article, and a quick grab of the text.
https://www.dentaltown.com/magazine/articles/6892/all-about-zirconia
"Our testing showed that you can bond to zirconia and the zirconia bond is the same as bonding to lithium disilicate at 24 hours and after 5-month water storage and 10,000 thermocycles."
Very impressive case and execution. I do wonder, what drove this 75 year-old man to pursue this treatment?
On another note, it is my understanding that zirconia can be be bonded. Here's the link to an article, and a quick grab of the text.
https://www.dentaltown.com/magazine/articles/6892/all-about-zirconia
"Our testing showed that you can bond to zirconia and the zirconia bond is the same as bonding to lithium disilicate at 24 hours and after 5-month water storage and 10,000 thermocycles."
I can only hope to have as much passion for life as this 75 y/o man - I forgot to mention that we did the first phase of this case on a Friday and after the appointment he advises me that he has to fly to Brazil on Sunday to present as a keynote speaker. In my humble opinion this generation is living longer and values their health plus they have the discretionary income to finally do it since the kids are out of the house, college, weddings, house are all paid for......age should not be a limiting factor for treatment options and we should talk to all patients about optimal care.
I enjoyed that article and appreciate you sending it - this is certainly new territory to address bonding zirconia. I can only imagine with it's popularity there will only be more research in this arena. In fact we had Dr Campbell at our study club last night talking about Katana and he was also referencing some similar literature/research on this topic. Thanks again...
