by Dr. John Nosti
I remember that feeling of my first day in private practice. Exciting for the freedom of not being in the educational environment any longer, while also having the feeling of anxiety for not having that “educational shoulder” to lean on. I felt that I had a great educational background from my dental school, Rutgers School of Dental Medicine, and my GPR at Lehigh Valley Hospital, but still with that great education the “red flags” that patient’s like Fred would present with were not readily apparent to me until I extended my knowledge base and pursued continuing education in occlusion.
Fred presented to my office because he was told I was a nice guy and I wouldn’t hurt him. He clearly was someone that wasn't unfamiliar with the dental chair.
His Chief Complaint’s were the broken tooth #4, and the “black gap” between the central incisors.
Prior to my occlusion training, I would have focused on his Chief Complaints and presented a plan for a new crown on #8, composite bonding on #9 and crown #4. Because of my occlusion training it has allowed me to see things differently. I learned to avoid restorative failures by NOT focusing on chief complaints but diagnosing the chewing system. It caused me to ask more questions--
What is causing the “black gap”?
Why is there wear present on the incisal edges of his anterior teeth?
How long has the patient had abfraction lesions and recession and have they always been that severe?
Was the previous bridge on #10-11-12 designed correctly?
For instance when the crown #8 was seated, was it always longer?
Was his chewing system actually shortening the life-span of the dentistry he previously had placed?
Why was there metal on the lingual of the central incisor?
Were these the same questions you were asking?
Even though his chief concern, were only a few areas, a conversation about the wear and long term
ramifications were discussed to get his new dentistry to last. Let's be clear, this wasn't a "cosmetic case" or someone who came to me for a smile makeover. He was referred and had a couple of challenges, that if addressed individually may have failed. This was a functional case driven by changing his occlusal scheme, like the majority of the cases I have treated. The side benefit was that that his dentistry looked great but certainly wasn't his motivator for restoring this arch nor mine for treatment planning it.
Treatment included new crowns on 4, 5, 8, 13.
Bridge 10-11-12 with pontic on #11.
Being able to see this case years later, that is protected, functional and still looks great reminds me of what a service my occlusion training has been to my patients and my peace of mind in treating them predictably and with confidence. Now - I'm privileged to support doctors in their occlusion journey with Clinical Mastery Series.