Every patient has a story that makes their case unique. When we embrace their path to treatment and make an effort to understand their motivations, we can provide even more excellent care.

A great example of this simple lesson came in the form of my patient Anne. I knew Anne well, as she ‘grew up’ in our practice and had been a regular patient for many years. This fact added an unexpectedly challenging element to her case. I knew I needed to re-familiarize myself with her interests and background instead of taking our past relationship for granted.

Restorative Case For a Future Hygienist

Anne is nineteen and currently training to become a dental hygienist. Her personal dental experiences spurred her interest in the field. She’s excited to provide patient care that improves both oral health and self-image.

All of these details about Anne informed how I approached her treatment. Her primary esthetic concerns were a peg lateral #7 and a congenitally missing #10. She also had canted axial alignment, mottled enamel, and uneven gingival zeniths with a high smile line.

We decided on comprehensive restorative treatment approach that would correct these problems and provide her with a result she could readily show off. The treatment consisted of orthodontics, an implant for #10, and periodontal surgery to reposition gingival levels. We also moved ahead with occlusal equilibration and a diagnostic wax up.

To round out the case, we did tissue sculpting on #10 in addition to esthetic/functional testing and refinement via provisionals. Anne got beautiful e.max veneers on #5, 6, 7, 8, 9, 11 and 12. Finally, she got an implant supported e.max crown on #10.

Matt Roberts CDT handled the lab side of Anne’s case and did a stellar job. She can now go forth confidently into her career and help others embrace treatment that can change their lives.

What case put a smile on your face recently? We’d love to hear what you think in the comments! 

The Carolina bridge is an all-porcelain bonded pontic that can be used as an interim prosthesis and for many other valuable purposes.

In my last blog, I discussed why I love the Carolina bridge and its many applications as a restorative alternative. Now, I’ll provide an overview of the design and how to begin a case using the bridge.

Carolina Bridge Design

The design of the Carolina bridge bypasses problems found in Maryland bridges and adhesion bridges. The all-porcelain Carolina bridge is very esthetic because there is no metal substructure. There is also incredible light penetration.

Maryland bridges, on the other hand, are not esthetic due to the the graying created by metal wings. All-porcelain pontics, such as the Carolina bridge, often can be used when tooth anatomy comes before or restricts the prep and placement of a Maryland-type bridge. Also, it is easier to repair the proximal resin composite retaining connectors of Carolina bridges.

Carolina Bridge Case Technique

A case that illustrates a Carolina bridge technique is one where an adolescent patient presented with a missing maxillary right lateral incisor. A team consisting of a periodontist, an orthodontist, an endodontist, and a restorative dentist determined that a dental implant would be the best treatment once the patient reaches maturity.

The team decided to orthodontically submerge the endodontically treated root to best preserve the bony site for implant placement. They selected a Carolina bridge as the best interim prosthesis because the occlusal relationship was favorable and there was sufficient crown length of the abutment teeth.

At the first appointment, shade selection was determined and an elastomeric impression was made of the anterior segment. A working case, an impression of the opposing arch, and a bite registration were created. An all-porcelain pontic was fabricated of feldspathic porcelain by the laboratory. At the second appointment, the involved abutment teeth were fully cleaned and rinsed.

The pontic was trial positioned to assess the shade accuracy and the adaptation of the pontic to the residual ridge. Once the accuracy of the shade and fit was verified, the pontic was readied for cementation.

A silane coupling agent was placed on the etched proximal surfaces of the porcelain pontic to improve the bond strength. Preparation of the abutment teeth was done by lightly roughening the proximal surfaces with a coarse, flame-shaped diamond stone. At this point, the pontic was ready for bonding into the edentulous space.

Dr. Heymann will be a featured lecturer at the Pankey 2018 Annual Meeting in Nashville, TN.