TOWNIE CLINICAL: An All Empress Gnath Case By Curtis L. Pontynen, DDS

I am a FACE (Foundation for Advanced Continuing Education––see the FACE discussion forum [at www.dentaltown.com]) trained dentist in Saratoga, California. This case applies “gnathologic” functional standards and methods to an aesthetically demanding situation. Some people have gotten the impression that we at FACE focus on perfect function and ignore aesthetics. This is a misconception. Our treatment goal is a predictable and beautiful long-term result. Gold is still more reliable than porcelain, of course, but we also love Empress. Since it is made from a wax-up, very precise functional results are possible compared with anything feldspathic.

I was asked [by fellow Townie Socalsam] about CR, CO [and] NM differences. “CR” means that the condyles are seated in anatomic position, superior on the y-axis, middle of the fossae on the x-axis, middle of the fossae on the z-axis.

“CO” is whatever jaw position the teeth dictate when they are in maximum intercuspation. “NM,” if I have it right, is a joint out of socket position that seems most relaxed for the jaw muscles on any given day. Not really a repeatable position that one could build a case to. Since the joint heads for the socket when the masticatory muscles fire during use, the back teeth will hit first if a case has been built to an out of socket position. This drives the condyles back onto the distal wall of the fossa. Not very comfortable or healthy, in my experience.

This is a controversial discussion, of course, since many popular teachers in dentistry will tell you that all this mechanical analysis is unnecessary.

Conclusion
An understanding of jaw function as a whole is what made this outcome possible. If you have an interest in learning more about predictable complex dentistry, talk to any of the FACE people on the message boards at www.dentaltown.com. Special thanks to technicians Jim Patterson, CDT and Joe Zigulis.

Townie Comments

salparadise	Posted 2/22/2004 12:55 pm
That is beautiful. Did the patient go through a long-term temp phase to ensure the occlusal scheme was OK for him?
scowarn	Posted 2/22/2004 9:55 pm
Looks great. I have a case I am completing with an acquired Class III caused by a CR slide. I will post it soon. It really shows the importance of mounting/evaluating a case in CR.
jersey2ther	Posted 2/23/2004 5:39 pm
I usually just sit back and comment to myself, but this case was met with definite obstacles and they were all executed nicely. I’m certainly impressed or should I say, “Empressed”.
drrick	Posted 2/23/2004 8:20 am
I have treated quite a few cases like this with a combination of ortho and restorative. In those cases I opened the bite with the ortho as opposed to the posterior onlays, then finished with veneers or porcelain crowns. The ortho is completed in 6 to 9 months then the restorative is completed. (Actually I have a class 3 ortho/restorative combo case somewhere in the cosmetic section of the message boards.) It was nice to see you using ortho prior to restorative in this case. I prefer fixed brackets to Invisalign since they are faster, less expensive, you have more control, and IMHO you can get a nicer result much more easily. If the patient wants an invisible alternative I use lingual braces. Once again, very nice case.
cerecfriend	Posted 2/25/2004 8:08 am
Very nice work. This is craftsmanship. Once again, very nice case.

About the author:

Dr. Curtis Pontynen graduated from Loma Linda University in 1985. He spent his first 15 years of practice in rural northern California and has considerable experience in most aspects of practical general dentistry. Since 1992, Dr. Pontynen has maintained strong ties to the Foundation for Advanced Continuing Education (FACE) in Burlingame, California. This group teaches dentists about the relationship between the teeth and overall jaw and joint function and gives them methods for carefully planning and executing complex dental treatment. In 1999, his interest in complicated dental cases and comprehensive diagnosis and treatment drew Dr. Pontynen to relocate his practice to Saratoga,California.