Diagnostic Opinion - Kois RISK PROFILE PERIODONTAL BIOMECHANICAL FUNCTIONAL DENTOFACIAL MEDICAL PRECAUTIONS Low Moderate High
PERIODONTAL (Gum and Bone) Risk Assessment__Low __Moderate __High General Prognosis__Excellent __Good __Fair __Poor __Hopeless Based on the specific prognosis: most teeth are in this category Specific: Individual Teeth Excellent Good Fair Poor Hopeless Please List Diagnostic Opinion: Perio - Kois
Diagnostic Opinion: Biomechanical BIOMECHANICAL Risk Assessment__Low __Moderate __High General Prognosis__Excellent __Good __Fair __Poor __Hopeless Based on the specific prognosis: most teeth are in this category Specific: Individual Teeth Excellent Good Fair Poor Hopeless Please List
Diagnostic Opinion: Functional - Kois FUNCTIONAL Risk Assessment__Low __Moderate __High General Prognosis__Excellent __Good __Fair __Poor __Hopeless Based on the specific prognosis: most teeth are in this category Specific: Individual Teeth Excellent Good Fair Poor Hopeless Please List
Diagnostic Opinion: DentoFacial. DENTOFACIAL Risk Assessment__Low __Moderate __High General Prognosis__Excellent __Good __Fair __Poor __Hopeless Based on the specific prognosis: most teeth are in this category Specific: Individual Teeth Excellent Good Fair Poor Hopeless Please List
Risk Profile Summary - Kois PERIODONTAL BIOMECHANICAL FUNCTIONAL DENTOFACIAL MEDICAL PRECAUTIONS Low Moderate High
Guidelines - Kokich Creating Overjet/Overbite
Kokich Guidelines Creating Overjet/Overbite Procline/Retrude Maxillary Incisors Intrude Maxillary/Mandibular Anterior Teeth Retract Mandibular Incisors: (Facial of mandibular incisors should be over chin – see Ceph.) Uneven gingival margins, intrude or extrude. Maxillary Incisors should be parallel relative to lower lip – see Ceph) Maxillary Facial Incisal Inclination should be vertical to the Incisal plan for good light reflection – See Ceph
Guidelines - Spear Vertical wear (Rat) Constricted envelope of function. Need greater Overjet. Horizontal and incisal wear – (Cow) Need greater Centric Freedom
Frank Spear Worn Dentition Most cases do not require VDO opening. Check if posterior teeth are worn or missing; if no, need to get space in the anterior with modest opening prn.
Spear – Worn Dentition-Contd. Set 8UAS; check for wear, gingival margins, vertical uprightedness. 1Should it be proclined, retruded, intruded, 2APF or combination. 3For vertical check anterior facial angulation 4relative to occlusal plane. 5Usually a space problem so ortho is valuable. 6Apply same parameter to LAS
The Gummy Smile - Robbins Five questions. 1Face height: Repose, from Glabella (mid-brow) to base of nose = Base of nose to inferior border of chin. (Middle third of face should equal the lower third of face. DX: Lower third of face longer – VME Tx: Orthognathic surgery.
The Gummy Smile – Robbins Five questions 2Lip length: Repose from base of nose to inferior border of the maxillary lip In young adult: Females mm In young adult: Males 22-24mm Dx: Short or hyperactive upper lip Tx: Behavior modification / Botox. LIP Mobility 6-8mm
3Gingival Line: Draw from Canine to Canine. Should engage centrals and cuspids. Dx Concave – Dentoalveolar Extrusion. Tx. Orthodontic, intrusion, Esthetic Crown Lengthening, Segmental osteotomy. The Gummy Smile - Robbins Five questions.
The Gummy Smile – Robbins Five questions 4Length of the maxillary central incisor: 10-11mm Dx Less than 10mm Microdontia, Wear, APE In repose Emma 3-4mm of incisal edge of maxillary centrals in young female and 2mm in young males.
Bill Robbins DDS The Gummy Smile. Five questions 5Feel the CEJ in the sulcus: DX: Cannot feel CEJ – APE Tx: Esthetic Crown lengthening Surgery.
Bill Robbins DDS-Esthetic Evaluation Face Height _______________________ Lip Length _______________________ mmLip Mobility _____mm Dental / Facial Midline _____________ R/L Central Exposed in Repose _________ mm Gingival Line to Upper Lip in Full Smile _______________ +/- mm Distal Extent of Smile (Tooth#) ___________ R _________ L Incisal Edges to Lower Lip (Follows Smile Line, Covered by Lip)___ Buccal Corridors – Negative Spaces Y/N _ Length of Maxillary Anteriors – (Chart) Tissue Levels – (Chart) Angle of Incisal Plane – (Chart) Incisal Wear – Y/N Tooth #s _____________________________ CEJ Located Y/N ______________________________________ Posterior Occlusal Plane (OK, Step Up, or Step Down) _________ Tooth Color ___________________________________________ Tooth Alignment (Spacing, Overlap) ________________________ DR. NOTES
Summary of Concerns Interesting issues related to this case that warrant discussion prior to treatment? Wear Expectation Are there phasing issues? Depending on treatment plan chosen, see treatment outline below. Are there conflicts between what is best and what the patient wants or will tolerate? Possible cost, depending on treatment plan chosen
Diagnosis and Prognosis AAP Type: AAP Hopeless: #s Guarded: #s See risk factors. Good: The rest, assuming homecare improvement, and patient pursues prescribed treatment.
Comprehensive Dental Care includes Disease control Caries, Endodontic Periodontal and gingival infection Reconstructive Dentistry Tooth/Teeth, Bridges, partials, crowns, implants Periodontal: pocket reduction, regeneration, normal periodontal architectural configuration Esthetic enhancement Maintenance Professional and patient
Facilitating a Patients Choice for Better Dentistry Determine patients desired expectation Complete a comprehensive exam to delineate risk factors Educate patient – how their risk factors affect their desired expectations (communication) Discuss means to reduce risk factors – treatment needed and alternatives, plus timing and staging Determine if patient can accept the price of treatment and work with them in this regard.
A comprehensive result includes: Class 1 OcclusionNo Pockets Normal skeletal relationshipNo recession No missing teethAdequate KT Good tooth position Normal positive soft tissue architecture Normal occlusal landmarksCRO – No occlusal interferences No cariesStable anterior guidance Normal dental anatomyNo mobile teeth Good sealed marginsStable healthy TMJs Good crown formAdequate bone support.
A Comprehensively Treated Case Should be: The easiest to Maintain The easiest to restore The most esthetic And produce the most predictable long term result.
Comprehensive Care Periodontics Periodontics Restorative Dentistry Predictability Function and Esthetics.
Delivering a Successful Outcome includes: Comprehensive Exam Diagnosis Comprehensive Ts Planning Case Presentation Team Tx planning Long-term predictable Tx and Results.
Treatment Plan Break out time - 30 min Group A Ideal, costs are not a factor Group B Ideal, costs are a factor Group C The best you can do, costs and time are major factors. Outline Goals/Objectives of Treatment