From mildly relaxed to
"I thought I was asleep"
You can be as relaxed as you wish.
FROM Glenn van As
Its so easy to take a stock photo from their library cut and paste it and say VOILA .....look how good you LOOK.Let me see from her photos what you can do.In cases like this I will often extract if the midlines are to far off . A millimeter one way or the other is ok to try and work out but anything else is tough.I often will wax up at the lab what I think out loud will happen.DICOM is here in Vancouver and when I travel to all the meetings I often see the guys on the planes.
David Gane the owner of Dicom is a dentist in White Rock about 30 miles from me.I like the programs capabilities but find that it takes forever to load. I have another program on Trial called ACDSee for archiving and very basic editing (Crop ,brighten etc) of photos but NOTHING for doing what DICOM can do with bleaching and changing fillings etc.
As for the case hold on.........
The upper midline is shifted to the Right by 4 mm or so.IS she missing the upper right lateral or is the tooth adjacent to the right central the lateral.I cant tell whether the tooth number 7 is the lateral or the canine. If it is the Canine I see that you have 3 anterior teeth instead of 4 and that the Right lateral was either congenitally missing or extracted for crowding and then it was a midline shift in the maxilla that has contributed to the "tom Cruise " look.If this is the case then I would probably extract teeth 8, 9 and 10 and make the edentulous space fit four teeth that were smaller.If needed I would shave the left canine down a bit to give a little more space.
Sometimes in a cases like this without seeing study models, another option is to extract one premolar on the left side and use ortho to correct the midlines by bringing everything over to the left. This option is better if the tooth number 7 is in fact the lateral and not the canine, otherwise it still looks funny after the ortho as there is an asymmetry.
I looked at the photos closely and it does appear that the 7 is missing and so I would exo the front 3 teeth and make her a 6 unit bridge with smaller teeth. IF you want to treat the bicuspids with nicer crowns that will help with the buccal corridor. As for the lower I think that I would start her on bleaching and do some enamoplasty on the incisal edges first to even them out and see if that is enough.......I hate doing veneers on lower incisors as my experience has not been good with longevity visa vie fractures.
If you have a chance to take some radiographs and send them to me and show me the occlusion on both left and right sides I might be able to give you a better idea.
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Hi Danny Boy,
Just took a look at the pictures. You need to correct the midline by either
ortho or extractions or both. I can't tell more without pictures of study
models. If I can be of more assistance, please let me know.
Yours in Better Dental Health,
Jim Donley, DDS
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Hiya Danny
I havent done any photo enhancing...but here is what i would recommend for
that patient of yours Wilder....23,27 are in x-bite.......shorten them up-....if necessary do the root canals..is the Pulp holy?....bring them back into alignment if the patient allows you with 6 veneers or crowns down below.............I betcha that a good height for the lowers with cosmetic contouring alone would follow the level of # 25...so shorten up 22-27......canting in the incisal 1/3's of the cuspids and #23 (isnt that the one in x-bite?...not #22)........bleach them.....give it a trial run before the veneers.....change out the restoration on the cervical of #22...trim some off the mesial and distal of 23 and 25 to narrow them, then bond a bit on the facials of 24 and 26 to bring them in line...you may want to leave a little illusion of crowding but not much....do NOT root plane #23....take the bite down...knock off any subgingival calculus, curette any granulation tissue (there probably wont be much), extreme oral hygiene instructions, and i bet the contour of the gingiva will improve by itself ....and keep an eye on the attached gingiva of 27....it will probably improve after cosmetic contouring reduces the heavy bite forcing the tooth facially Above.....between 6 and 9 there is a crown that looks like neither a lateral or central....get both those crowns off 8 and 9.....get the electrosurge out or the laser and make the gingiva look right for 2 centrals.....get the widths and mesial alignment appropriate to each other......do it in luxatemp first....do a mock up....cut down the mesial of 9....build up the mesial of 8.....having shortened down below...you can now lengthen 8 and 9 to look right......shorten up #6 to shape it like a lateral.....5 already is actinglike a cuspid......try shortening 6 with a black magic marker first and look at it without the microscope at normal speaking distance- 3 feet.....you may even want to blunt the incisal tips of 5 and 11.........change the composite on 11.....bleach them.....let the gums respond nicely and explain to her that this is just the exploratory holding pattern.... next she will want to take a 2nd mortgage so you can do those 11 empress units and replace those posterior bridges or do it in phases Rather than phot enhance ....play with some flowable composite and a magic marker right in the patient's mouth....it has a lot more impact than any photo just my opinion
;-)
Howard Hoffman
EEErrrr, sorry,
not familiar with the american system. I.meant to take out the upper left central incisor, in Germany 21, in your country it should be #9, no?dirk zipprich schrieb:
> Danny, Glenn,
> this Wild Thang seems to be a real tough case. Midline deviation is so
big that without the extraction of#17 you will loose in any case. I use wax ups and mock ups in these cases, so I can discuss things with my Tech and patient, but not in this case. #17 is in the way. My first guess would be:> Extraction of #9, Laminates on #5,#6 and #7 (hope I have the right
numbers, we call them different), enlarge #7 mesially but be sure to emphasize the mesial facette to keep it (optically) thin enough, galvanoceramic bridge #8-x-#10, laminate #11, new K&B for the rest of the upper.> It will be really tough to close the black triangles in the lower front,
Magne would suggest 3/4crown full ceramic, bringing the contact down close enough to the bone to regenerate papilla following the Tarnow-rule..> I disagree with the esthetic analysis as the incisal line of the upper
front doesn´t match the lower lip. Imho this lady seems to need som really big and sexy central incisors. Under no circumstances would I show this digital illusion to the patient unless you are 101% convinced you can reach this result. And your technician is good enough.> Very nice case.
> Nice to dicuss about it with you.
>> Best regards,
Dirk----------------------------------------------------
Sent: Friday, May 25, 2001 6:06 PM
To: Bob Schulhof
Subject: RE: Dicom to the rescue for Danny Boy
I
know. It would take models.
There will be options. If
the anteriors are going to be restored it will make it easier, as you might be
able to turn a lateral into a central etc.
The arch form needs to be changed so that the result looks good.
I will look at it if they want to send me the models.
I will need the facial midline marked on the teeth, and a pan or
PA’s.
Dave