Working With the Lab on Extreme Parafunction: Part 2

July 6, 2018 Lee Ann Brady DMD

A patient presented to my practice with upper and lower implant hybrids and a long history of fracturing. I myself struggled with needing to replace her dentures regularly up until the point I decided something had to change.

Parafunction, Occlusion, and a Low Smile Line

The patient clearly needed some type of intervention. I looked at mounted models and evaluated her history of extreme parafunction to determine what we should do next. She had been restored in her hybrids with canine guidance and relatively steep anterior guidance. In light of all these factors, I recommended resetting the upper hybrid, opening her vertical, and both shallowing and balancing her occlusion.

These adjustments would hopefully make a big difference in her ability to maintain dentures for longer periods of time. There wasn’t much space to open vertical, but with the little we had we managed to lengthen the time between fractures from months up to once a year. That was a huge achievement on its own, but we knew we could do more. We had also made her an occlusal appliance that went over her upper hybrid. She consistently wore it, which was beneficial.

I shared this story with Wiand of Wiand lab and he was able to give me an important breakthrough. He asked me how high her smile line was and I told him it was very low. He had an idea that made all the difference. We took upper and lower impressions of the hybrids, bite records, facebow, fixture level impression on the upper arch, and gathered shade information.

Wiand lab removed everything from the original bar. Then, I had them send the entire case to Gold Dust Dental Lab. There, they waxed the upper to full contour over the bar. After this, the case was returned to Wiand, where an injection-molded composite was used to fabricate a one-piece upper over the patient’s original bar.

This seems to have finally done it for keeping my patient out of the dental chair. No maintenance has been necessary since. By relying on the advice of my fantastic partners in both dental labs, I was able to help a tricky patient. The lesson here is that patients who are hard on their teeth will be hard on restorations. Similarly, implants aren’t going to magically resolve issues for occlusally high-risk patients.

 

Related Course

Pankey Scholar 15B

DATE: September 4 2025 @ 6:00 pm - September 6 2025 @ 3:00 pm

Location: The Pankey Institute

CE HOURS: 0

Dentist Tuition: $ 3495

Single Occupancy with Ensuite Private Bath (per night): $ 345

“A Pankey Scholar is one who has demonstrated a commitment to apply the principles, practices and philosophy they learned through their journey at The Pankey Institute.”   At its core,…

Learn More>

About Author

User Image
Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Working With the Lab on Extreme Parafunction: Part 1

July 4, 2018 Lee Ann Brady DMD

It’s impossible to go through a dental career without continuously encountering cases that challenge our clinical skills. Nor do I think that would be a good thing, as stagnation and complacency can lead down a slippery path to less optimal dental care. Even an expert has something more to learn.

The case I’m going to discuss here is a perfect example of why collaboration is so important in the dental practice. No matter how much I think I know about the techniques for tricky restorations, I’m always surprised by how much there truly is left to understand or adjust.

It’s important to rely on our peers and lab partners for case breakthroughs and insights. They can see things from a different perspective and give you exactly what you need to provide an exceptional outcome for patients. Even just the act of talking through impressions on a patient’s circumstances can lead to unexpected realizations.

A Case of Fracture, Wear, and Parafunction

This case frustrated me for quite a while before I understood how to solve it. The patient presented with upper and lower implant hybrids from another dentist. An examination revealed the problem she had visited my office for, which was fracturing of the upper right lateral denture tooth.

She was no stranger to the irritation of fractures. She shared with me that she had a long history of wearing down and fracturing her teeth. I was immediately interested in taking the time to understand the cause of this consistent fracturing.

The patient had multiple single unit implants placed for replacement of individual teeth. Her condition then worsened to the point where she had her remaining teeth removed. Implants were used for dentures with locator attachments, but this didn’t last long. The problem persisted and resulted in the need for more implant placements.

Upper and lower hybrids were created, yet still she went through 4-5 replacements of upper lateral and canine denture teeth. After seeing me, she and I had to replace upper anterior denture teeth several times over the course of a year. That meant removing the hybrid and replacing the screws each time.

To be continued …

Related Course

Direct Composite: Predictable, Easy and Beautiful

DATE: October 25 2024 @ 8:00 am - October 26 2024 @ 4:00 pm

Location: The Pankey Institute

CE HOURS: 14

Regular Tuition: $ 2195

Single Occupancy with Ensuite Private Bath (per night): $ 290

Achieving Predictable and Stunning Anterior Results Direct composite is something we do every day in our practices. Yet, they can sometimes be frustrating when we don’t get a tight contact…

Learn More>

About Author

User Image
Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR