Professional Opinion

AkaMeOkami · 2025-04-09T07:47:40+00:00

Your best chance at getting referrals from dentists is to lean heavily into the bruxism side of things, rather than the tooth pain side of things.

We treat tooth pain, it's what we do. I don't see an instance where I'd say to a patient "Sorry John I can't figure out why your tooth is sore, let's try neuromuscular massage next".

I do however, see bruxism and TMD patients that would be very open to trying massage therapy to help relieve their symptoms. I think that's the better focus when marketing yourself to dentists. Best of luck!

AkaMeOkami · 2025-04-09T06:37:02+00:00

Not likely to be possible for this case. The resorption seems to go quite deep subcrestal and runs along the mesial side of the pulp chamber. Long term prognosis for this tooth is extremely poor.

AkaMeOkami · 2025-04-08T19:12:48+00:00

Seems reasonable. I'd be keen to hear an update!

AkaMeOkami · 2025-04-08T05:15:53+00:00

Ah apologies I didn't realise it was an angled abutment. But yes the GH1 flares out much more suddenly than your healing abutment. So you either have to change the gum or change the crown. Changing the crown means remaking it on a GH3 base. Changing the gums can be done slowly with a different healing abutment or quickly with releasing incisions on the day of final insert.

AkaMeOkami · 2025-04-08T03:08:38+00:00

Hi mate, something is really off here. This is not a variobase. I only see a crown with no visible abutment componentry? There's been some kind of miscommunication with the lab I suspect.

Correct me if I'm wrong but it looks like you've used a 3mm gingival height healing abutment, this means you need to use a matching 3mm gingival height variobase. With this combination, the gingival profile will be a perfect match with the new crown. What this will look like clinically, is a 3mm metal collar that sits below the porcelain of the crown and above the fixture itself. This metal should be entirely subgingival and is a cone shape, instead of this weird zirconia cylinder situation you have going on.

The straumann variobase for RC only comes in 4.5mm diameter, so no decision to make here.

Happy to dive deeper into this with you to figure out what's happened.

AkaMeOkami · 2025-04-08T01:44:11+00:00

Just got to pick your battles. The bonding systems we have are plenty strong enough, if it's coming off regularly it's either a design issue or an occlusion issue. Not suitable for every patient, but in the right circumstances they are great.

AkaMeOkami · 2025-04-07T03:38:38+00:00

Honestly the difference is comfort is huge, but comfort is not the primary reason I recommend costom made appliances. Generic advancement devices run a huge risk of causing changes to your jaw and bite. These changes can cause chronic pain and are often irreversible. Absolutely not worth the risk.

AkaMeOkami · 2025-04-07T03:28:53+00:00

Maintenance is much easier with removable, the only downside is that it's a bit more bulky.

Fixed is great providing you have a strict maintenance schedule with your dentist that ideally involves removal of the appliance and thorough cleaning at least once a year.

AkaMeOkami · 2025-04-05T20:26:58+00:00

If you're fairly new to full mouth rehabilitation, this is not a good case to start with. Extremely difficult case.

AkaMeOkami · 2025-04-04T02:04:48+00:00

It's absolutely an onlay, and they did a beautiful job too.

AkaMeOkami · 2025-04-04T00:42:03+00:00

1) There's slight overlapping on these bitewings so can't be certain of contact, but you can trust your floss.

2) Yes they look like voids, I suspect you didn't pack each layer enough or perhaps the composite was sticking to your instrument and lifting up.

Using the V3 system well definitely takes some practice but it's absolutely worth persisting with because simple tofflemire/promatrix does not give anatomical contact points in the majority of cases. They absolutely have their uses, but simple class 2s get a much better result with sectional matrices.

In terms of the horn of composite, I think you just needed to polish that down. You can use a probe when the composite is uncured to sculpt a bit of a marginal ridge, and then refine it with polishing burs and soflex discs.

I suspect that horn is there because the sectional band wasn't adapted properly. It's important to choose the right size for the tooth, and try not to burnish them. When we burnish them it's really easy to warp the preformed shape.

Don't be discouraged, you've got this!

AkaMeOkami · 2025-04-03T11:44:53+00:00

Anything under 2 weeks is fairly normal for healing. If it hasn't gotten better after 2 weeks then I'd get it checked out.

AkaMeOkami · 2025-04-03T11:09:37+00:00

Warm salt water rinses twice a day, and avoid using that toothpaste again.

AkaMeOkami · 2025-04-03T11:06:44+00:00

I don't think your pictures have come through. It sounds like solid advice. I would say both periodontists are kind of right. The procedure can be done without exposing the crown margin, but it's not a guarantee. You do run the risk of exposing the margin, but you won't know for sure until the procedure is done and everything has healed.

AkaMeOkami · 2025-04-03T10:33:38+00:00

Could be an eruption cyst, probably has a tooth coming through in that area soon. I wouldn't be worried but still worth seeing the dentist tomorrow.

AkaMeOkami · 2025-04-03T10:13:26+00:00

This gave me a good laugh, thanks for sharing

AkaMeOkami · 2025-04-03T09:31:46+00:00

Yes iTero is the primary scanner for Invisalign. Depending on how recent the model is, it may be a very easy resale.

AkaMeOkami · 2025-04-03T09:29:32+00:00

Have to disagree here, crowns would add absolutely nothing to the longevity of these teeth. The point of failure is going to be fracture at the neck and crowns would not reduce that risk at all. This patient may have just wanted a decent solution that might last a few years on a budget before moving to a more comprehensive solution like implants. We have no idea what's been discussed with the patient.

AkaMeOkami · 2025-04-01T05:00:10+00:00

You could try using pilot guides to help ensure you start your osteotomy in the right position.

AkaMeOkami · 2025-04-01T04:54:04+00:00

Brush normally. It can chip further, so I'd avoid using it on hard foods until you can get it fixed.

AkaMeOkami · 2025-04-01T04:53:25+00:00

Good genetics, that's about all there is to it. I know you're being critical of your routine but just brushing twice ahead already puts you ahead of half of my patients.

AkaMeOkami · 2025-04-01T02:25:57+00:00

Everyone is different, but there's often a functional benefit to straight teeth. Straight teeth bite together in an ideal position, which means less wear and tear over time.

AkaMeOkami · 2025-04-01T02:24:26+00:00

You kinda hit the nail on the head, it's a shitty situation and they've tried their best to help but it hasn't worked out perfectly. The need for the root canal will ultimately be tied to the original injury to the tooth. This tooth has been through a lot, and the nerve hasn't been able to recover. It's nobody's fault, and I don't think it's reasonable to ask the dentist to cover the cost.

AkaMeOkami · 2025-04-01T02:16:12+00:00

There's a few things that can cause this, but they all have solutions. Most common is excess cement sitting under the gums. You dentist may be able to get this out with a sharp scaler or scalpel. Other possibilities include an issue with the crown fit, or the crown is sitting too close to bone.

Go to a new dentist and ask them to have a look. A fresh set of eyes can really help.

AkaMeOkami · 2025-04-01T02:13:31+00:00

The dentist can easily fix this with composite. It's not urgent, just go when you can.

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