Townie Clinical Presentation: Don’t Do the Dew

Several months ago, I received a phone call from a friend and colleague of mine asking me to reserve time for his son, who likely needed some restorative work. His son lived away from our area and had indicated to his father that he had dental problems needing attention. The son was going to be home visiting for a week, and during that time desired to get as many of his dental problems treated as possible.

The initial examination revealed dental disease that had progressed to a surprising extent–far beyond his father’s expectations. The patient admitted to constant sipping of Mountain Dew throughout the hours he was employed at a computer terminal, which resulted in consumption of 3-4 32 oz. beverages per day. His dental disease was out of control and the patient had given up hope (and his toothbrush). Cessation of drinking Mountain Dew, or any other soda, was our first recommendation.

It was obvious that his problems could not be treated in the seven days that he was to be home. This time was spent gathering diagnostic information and treatment planning. We also worked diligently on instruction of proper oral hygiene techniques and instituted a regimen of PerioGard and PreviDent 5000 Plus in an attempt to improve his oral tissues to a reasonable state of health. However, the subgingival decay hindered a complete return to gingival health before proceeding with the restorative treatment. We also completed the needed endodontic treatment.

With mounted models, radiographs, and photographs a treatment plan was devised after consulting with the patient’s father (a dentist) and the laboratory at which the final restorations were to be made. The treatment plan included 28 crowns, 10 build-ups, and 2 root canals. Crown placement included full gold crowns on the second molars, Captek crowns on all other posterior teeth, and authentic all porcelain crowns for all of the anterior teeth.

---

Treatment by Appointment:
Appointment 1:		Diagnostic and hygiene appointment.
Appointment 2:		Root canal therapy #30 & OHI.
Appointment 3:		Root canal therapy #19 & OHI.
Appointment 4:		Preparation 2-5, 28-31.
Appointment 5:		Preparation 18-21.
Appointment 6:		Preparation 12-15. Final impression of maxillary posterior teeth.
Appointment 7:		Final impression of mandibular posterior teeth.
Appointment 8:		Delivery of provisional restorations for all posterior teeth.
Appointment 9:		Delivery of posterior crowns with FugiCEM.
Appointment 10:		Study model impressions taken for wax-up of anterior work.
Appointment 11:		Preparation of 6-11.
Appointment 12:		Delivery of crowns 6-11 with LUTE-IT.
Appointment 13:		Preparation 22-27.
Appointment 14:		Delivery of 22-27 with LUTE-IT.
Appointment 15:		Post-op Photographs and hygiene appointment.

---

Pre-treatment

Post-treatment

Diagnostic Wax-up

Preparation

Case Challenges
Tissue management: The subgingival decay made tissue management very challenging. After appointment 4 (above) I had to search the pages of DentalTown to find some help. I ordered a new electrosurgery unit from Parkell, and some Expa-syl from Schein for delivery the next day. While these two items helped tremendously, I had a funny feeling that my usual impression technique was going to come up short due to the deep subgingival preparations. Utilizing the DentalTown search engines, I accessed Rod Kurthy’s Laminar Impression technique that so many have raved about. It worked great on very difficult impressions to obtain!

Occlusion: Take another look at the pre-op photos…they are in full occlusion leaving an anterior open bite. I debated whether to close his vertical to improve the anterior esthetics, but decided to leave his VDO the same.

Access: This is just one of those cases where you wish you had more room to work. Sequencing: Prior to 06-26-02 the patient lived 1500 miles away, which was a determining factor. He now resides locally.

Esthetics: The patient was extremely pleased with the final result; however, it was a challenge to produce an outcome with teeth that are not overly elongated, given the anterior open bite and the original length of the teeth.

This was a challenging and exciting case that stretched my abilities and facilitated the opportunity to utilize some new techniques and technology. Thanks to a great patient who endured more than most could; the lengthy appointments and all they entailed were physically and mentally exhausting. Thanks to Kristine Jenssen for great assisting. Thanks to Jeff Banet, CDT of Derby Dental Lab (800-745-6781) in Louisville, Kentucky for his outstanding work!

If you would like to review all the photos on this case and comments from the Townies, please log onto www.dentaltown.com, click Todays Active Cases banner (under Townie Talk to the right of the screen) and search by user name, kdaledds. You can also do a search for ‘Dew’.

---

Dr. Kenneth Dale has been in practice in Floyds Knobs, IN, since 1989. He is a member of the American and Indiana Dental Associations. Ken regularly attends continuing education conferences and stays current on all the latest dental materials and techniques. Dr. Dale can be contacted at (812) 923-8180 or by email at mail@daledds.com.