You can gather accurate functional and esthetic information using the Panadent Dento-Facial Analyzer for restorative cases. I’ve found this tool particularly effective compared to alternatives such as the Facebow or stick bite.

If you haven’t done so yet, make sure to check out the introduction to this series on the Dento-Facial Analyzer. It includes background information, armamentarium, and key reasons why the device can elevate patient care.

Without further ado, the Dento-Facial Analyzer technique:

Essentials of Dento-Facial Analyzer Technique

Once you have the white disposable plate – which is actually the piece you will send to the lab once the record is captured – snapped onto the Dento-Facial Analyzer, use VPS tray adhesive to lightly coat the plastic tray. You are only going to do this from about the canine position posteriorly because you aren’t going to put silicone on the anterior portion of that bite plate.

Next, attach the vertical reference bar to the Dento-Facial Analyzer. Without bite registration on it, take it to the patient’s mouth and seat the central incisors exactly against the white plastic in the front labially.

Verify that you can hold this level to the horizon in two planes of space and that you can touch the patient’s teeth. If not, you might need to build up the posterior.

If you’ve verified this, put bite silicone on the plate from the canine position back, then seat it again, making sure the central incisors are seated labially against the white plastic …

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I’ll round up this fun technique with Part 3 in the series coming soon.

For a hands-on lesson in the Dento-Facial Analyzer from our talented educators, check out our Essentials 1 Pankey course. Also, watch this video for a quick refresher or pre-course overview.  

The Dento-Facial Analyzer is a marvelous tool I use in the practice to mount maxillary models. It has made a huge difference in my practice of dentistry and is one of my favorite tools to teach.

Introduction to the Dento-Facial Analyzer

For the critical aspects of diagnostics and sending info to the lab for the completion of a restorative case, mounting models appropriately is so important. They must be mounted in three planes of space referenced to hinge access to capture esthetic information including incisal plane and occlusal plane relative to the horizon.

Traditionally, this has been accomplished by utilizing a Facebow, Earbow, or by actually capturing hinge access position. Now, we have the option of using the Kois Dento-Facial Analyzer to capture both functional information and esthetic information that we would normally get with a Fox’s bite plane or stick bite. All of this functionality is managed with one simple device.

The Kois Dento-Facial Analyzer was designed based on scientific information gathered by Dr. John Kois, which shows that the distance from the incisal edge position of the maxillary central incisors to hinge access on average is 100 mm. Most people fall within a range of 5 mm to the average, therefore this is the assumption made when the device takes a record.

The armamentarium for record capturing with the Panadent instrument includes the analyzer, bite registration silicone in a gun with a tip, VPS adhesive used in an impression tray, and disposable bite plates that snap onto the analyzer (from the device manufacturer Panadent).

You can use bite registration silicone, Panadent bite tabs, wax, or VPS heavy body impression material to capture the record …

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I’ll continue this review of the Dento-Facial Analyzer technique in Part 2, coming soon! And don’t miss one of my recent Pankey Gram favorites from Dr. Bill Gregg on an occlusion-focused hygiene exam. Read it here for his insightful tips.

For an in-person, hands-on lesson in the Dento-Facial Analyzer, check out our Essentials 1 Pankey course. You can also watch this video for a quick refresher.  

Replacing a failed restoration starts with a careful examination of the patient’s needs, desires, and current oral health. My patient in this case presented with a six unit anterior bridge, decay, and many esthetic issues. After an esthetic evaluation and comprehensive exam, it was time to move on to treatment planning.

Failed Restoration: Treatment Plan

To treatment plan this case, I relied on an advanced facially-generated treatment planning system for communicating with the rest of the team. Communication is essential to a reliable outcome.

First, a diagnostic work-up was generated. Then, the interdisciplinary team together developed a final treatment plan and sequence, with the incisal edge position of the upper right central as reference.

We chose orthodontic extrusion of the upper teeth to handle proclination in the anterior and the gingival discrepancy. Additionally, we treatment panned the maxillary right canine for over-extrusion by 2 mm. This was done to achieve adequate restorative ferrule through crown lengthening, not to mention re-treatment endodontic therapy with post and core.

We talked about implant therapy, but ultimately it was not a workable solution. Root proximity on the upper right and the gingival tissues meant it wasn’t ideal as a first option. For the final treatment, we decided on placing a six unit anterior bridge. I then discussed the outcome with the patient and she decided conservative therapy for the posterior esthetics of direct composite veneers was best. This enabled us to create consistent contour and shade.

Next up was the lab, which made a pre-orthodontic wax-up based on periodontal surgery and planned tooth movement. I gave them the proper information by using PowerPoint and digital photography with the proposed tooth positions. After this, the post and core endodontic re-treatment was done for the upper right canine.

To be continued…

What’s your approach to treatment planning? 

A comprehensive exam is the first step in a long line of decisions that can end in case success or failure. For this case, my patient presented with a litany of problems and dental concerns.

Failed Restoration: Patient History

When I first encountered the patient, she had a six unit anterior bridge with temporary cement. She came to my practice because she was unhappy with how her dental work looked and was interested in a permanent restoration that would truly suit her goals.

She had a checkered dental history beginning with orthodontic treatment for a diastema between the maxillary centrals and a left maxillary lateral that fractured down to the root and had to be removed. After a FPD was placed for the tooth removal, her diastema reopened and the right maxillary was also lost to fracture.

That wasn’t even it for the patient’s woes. She was given a bridge that made her very unhappy and also had to have endodontic therapy on the upper right canine. Despite multiple placements, the restoration was never to her liking.

Esthetically, the patient wanted to remedy her uneven gingival margin, the length of the upper right canine, the relative size of laterals and centrals, and the color match. The latter was difficult to remedy because of tetracycline staining from her childhood. Finally, she was also displeased with the thick feeling of the bridge.

All of this together painted a picture of a patient in need of serious help.

Failed Restoration: Evaluation & Exam

My esthetic evaluation confirmed many of her concerns. I completed it intraorally and with diagnostic photographs. The patient presented with tooth proportion asymmetries, inadequate tooth display at rest on one central, an uneven incisal plane, and gingival discrepancies.

Her comprehensive exam revealed normal TMD joints, but also showed posterior wear. She had muscle pain and headaches yet no muscle tenderness. I put her on six weeks of appliance therapy, which led to the discovery that she had a habit of ‘power wiggling.’ I was then able to obtain an accurate centric relation bite record.

I removed the anterior bridge for radiography of the abutments. It became clear that her maxillary right canine had a lot of decay and inadequate ferrule.

To be continued…

Amidst all the details that must be managed day in and day out at a dental practice, I’d like to bring to light something I find super important that is often neglected. Let me begin by asking a question: When is the last time you took a good look at your perio probes? I mean a really good look!

My guess is you will find different shapes, sizes, colors, materials, ages, and markings. Maybe this doesn’t seem like the worst tragedy in the grand scope of the world, and yet, having even two different probes in the office can set the stage for lack of continuity in your patient diagnoses. 

Why Perio Probes Matter

It does seem like there are as many choices in probes these days as there are stars in the sky, so how can you make the best decision when it comes down to buying?

Although I do recognize the need and desire to have options, at the end of the day I encourage you to consider which probe provides the LEAST probable chance of creating error. Although I have used (and observe people using) a huge variety of probes, my favorite by far is the UNC-15. Due to markings at every mm up to 15, there is virtually no guesswork in capturing and documenting data with a high level of accuracy.

As you make the decision of exactly which probe you will use exclusively in your practice, please also consider calibrating all dentists and hygienists on an ongoing basis. It is typically easy to notice that probing techniques will vary from person to person. Watching and learning from each other with the ultimate goal of having everyone in agreement about how you will probe is invaluable.

Lastly, remember that an accurate periodontal diagnosis can only be made when a comprehensive periodontal assessment is completed and documented. Your probe is designed to be used for measuring pocket depths, recession, bleeding, pus, and attached gingiva. Oh, and don’t forget to check for mobility and furcations while you’re at it.

Here’s to a future of more accurate and calibrated perio probing in your office!

The Pankey Institute has positively changed how I practice dentistry. My work–life ‘flow’ would not be what it is today if I had not integrated the philosophy and dental training. As Dr. LD Pankey said: “A tooth never walked in the door.”

I too have integrated my own personal touch at the practice and have said, “We don’t treat strangers in our practice.” I get a little chuckle from patients at times when I say this. I also get a warm and welcoming look because they can connect with those words. This statement is an invitation that helps them open up.  

Better Cases From a Better Practice Philosophy

My training at Pankey and learning about LD Pankey’s Practice Philosophy has given me insight into how to create, formulate, and execute my own. I strive to live that philosophy with my dental team and my patients. We have created a practice culture that allows me to do many comprehensive cases.

I integrate concepts of restorative dentistry that have resulted in a rewarding outcome for both the patient and dentist. Appreciation and gratitude from the patient along with pride and care from the team have continued to fuel me to deliver the best dentistry with my best self.

It all starts with a comprehensive exam. For the case shown in these pictures, I utilized a thorough examination complete with understanding, listening, and hearing what the patient’s goals were. This was followed by a focus on airway, occlusion, TMJ, and restorative and esthetic goals. Digital photography, mounted study casts, evaluation of occlusion, wax up, and communication with the patient and the laboratory enabled me to create a smile that the patient was very comfortable with both in function and in form.  

Treatment consisted of an occlusal equilibration to improve occlusal interferences, which had caused fremitus on #7 and instability in occlusion and discomfort. I placed a porcelain crown on #8 and veneers on #7, 9, and 10. The patient was also given take home whitening trays.  

The patient’s final comments were: “I love my new smile and my bite is comfortable” and “Oh, did I tell you that since the dental work was completed, my jaw has felt more relaxed and comfortable?”

The hygiene exam can be a dreaded topic in the dental practice, especially if you’ve been dodging the issue for a while. Depending on your state, there may be specific rules or regulations about how the hygiene exam should be conducted. After meeting these rules though, it’s up to you to determine what style of hygiene exam best suits your goals.

Hygiene exams can complicate your relationship with hygienists if you don’t have an open dialogue about why you conduct them the way you do. There isn’t one right or wrong way to do things. That’s what makes it such a challenge for clinicians.

Conducting a More Effective Hygiene Exam

Commitment to your purpose should help you decide on how you want a hygiene exam to go. Most importantly, don’t do something you dislike simply because you think it’s the only option. Your obligation is to meet your patients’ needs while fulfilling your ethical or moral responsibility.

Patient expectations are where things get tricky. It doesn’t necessarily matter if your style is to put most of the responsibility in your hygienist’s hands or if you prefer to enact a thorough exam yourself. What does matter is that your patient knows what to expect and that you meet that expectation.

If you want to meet with patients for an in-depth exam, then schedule that time. If your hygienist will handle the majority of the exam, give them the tools and the training they need to feel confident. By the same token, if you want to check in on patients, but don’t want to do more than visit, then don’t even put on your gloves.

In the end, you can choose a combination of hygiene exam processes. Just keep your patients and your team informed.

How do you conduct hygiene exams in your practice and why? We’d love to hear from you!

The best dentists I know mastered the art of examination and discovery first. They learned to understand their patients’ conditions and how they relate to one another.

Leadership Through Discovery & Complexity

In that process of discovery, highly competent dentists learn to navigate complexity by confidently using reference points. These guide their understanding of what they discover. They train their eyes to see the details of esthetics, tooth structure, function, and periodontal type and status. Their fingers learn to feel the dynamic nature of the patient’s functional system.

They use every available form of imaging and records that add meaning to their discovery. Ultimately, they intentionally, systematically, and thoroughly develop a diagnosis that can determine the treatment plan. They manage complexity by moving toward simplicity.

Absolute and relative reference points serve as guides in designing the optimal scheme for the patient. When the patient’s teeth, gingiva, bone, functional scheme, and esthetics have been lost, those reference points tell you where to start and where to end. They both establish and limit what needs to be created.

Managing Complex Cases

Dentists at this level possess a very sound understanding of the dental functional system and a very detailed understanding of dental esthetics. They specially focus on how these two systems relate to one another.

They also understand their role in coordinating, guiding, and leading their interdisciplinary team in managing the complex case. To be certain, every member has a strong voice in developing and executing the treatment plan. Leadership in knowing your work really becomes visible in this process.

Someone has to decide where the case is going and how it is going to get there. There are many voices in the process, but at the end of the day that someone has to be you the leader, who also happens to be the first and final designer of the beautiful smile that is being restored to health.

As dentists, we tend to see our regular patients far more often than other doctors. This means we have the opportunity to be the first point of detection for diseases like oral cancer.

The Updated Demographic of HPV and Oral Cancer

Oral cancer is on the rise. What does this mean for dentists? First and foremost, it means understanding how the demographic of oral cancer has changed. At one point, it was associated with lower socioeconomic groups, smokers and poor nutrition/oral hygiene.

These associations with oral cancer have changed dramatically. One of today’s largest at-risk group is young, educated non-smokers.

New research has lead to the discovery of many different types of oral cancer. The majority of oral cancer cases are associated with HPV. Thankfully, HPV related oral cancers are highly treatable with chemotherapy and radiation.

Nowadays, oral cancer is more survivable and treatment is less detrimental to quality of life.

Why Early Detection and Prevention Matters

Early detection and prevention are the areas where dentists can have the most significant impact.

Early detection is crucial to improving the chance of survival and how treatment proceeds. One way to facilitate early detection is to offer oral cancer screenings at the beginning of every hygiene visit and exam. The best exam combines visual and technological assessment.

If you detect or are suspicious of oral cancer, you must actively refer your patients. It’s better to be safe than sorry, so there’s no reason to be concerned if you refer them to an oral surgeon and they aren’t diagnosed with oral cancer. Simply be upfront with patients about the likelihood that everything will be fine.

Prevention is the most powerful tool in our arsenal. It is our responsibility, along with the pediatric medical community, to promote and discuss the HPV vaccine with parents of our younger patients. Encourage them to vaccinate both sons and daughters for the prevention of oral cancer.

What early detection measures do you implement in your patient exams? Please let us know your thoughts in the comments!