34Diagnostic Opinion - Kois RISK PROFILEPERIODONTALBIOMECHANICALFUNCTIONALDENTOFACIALMEDICAL PRECAUTIONSLow Moderate High
35Diagnostic Opinion: Perio - Kois PERIODONTAL(Gum and Bone)Risk Assessment__Low __Moderate __HighGeneral Prognosis__Excellent __Good __Fair__Poor __HopelessBased on the specific prognosis: most teeth are in this categorySpecific:IndividualTeethExcellentGoodFairPoorHopelessPlease List
36Diagnostic Opinion: Biomechanical Risk Assessment__Low __Moderate __HighGeneral Prognosis__Excellent __Good __Fair__Poor __HopelessBased on the specific prognosis: most teeth are in this categorySpecific:IndividualTeethExcellentGoodFairPoorHopelessPlease List
37Diagnostic Opinion: Functional - Kois Risk Assessment__Low __Moderate __HighGeneral Prognosis__Excellent __Good __Fair__Poor __HopelessBased on the specific prognosis: most teeth are in this categorySpecific:IndividualTeethExcellentGoodFairPoorHopelessPlease List
38Diagnostic Opinion: DentoFacial. Risk Assessment__Low __Moderate __HighGeneral Prognosis__Excellent __Good __Fair__Poor __HopelessBased on the specific prognosis: most teeth are in this categorySpecific:IndividualTeethExcellentGoodFairPoorHopelessPlease List
39Risk Profile Summary - Kois PERIODONTALBIOMECHANICALFUNCTIONALDENTOFACIALMEDICAL PRECAUTIONSLow Moderate High
41Kokich Guidelines Creating Overjet/Overbite Procline/Retrude Maxillary IncisorsIntrude Maxillary/Mandibular Anterior TeethRetract 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
42Guidelines - Spear Vertical wear (Rat) Constricted envelope of function. Need greater Overjet. Horizontal and incisal wear – (Cow) Need greater Centric Freedom
43Frank 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.
44Spear – Worn Dentition-Contd. Set 8UAS; check for wear, gingival margins, vertical uprightedness.Should it be proclined, retruded, intruded,APF or combination.For vertical check anterior facial angulationrelative to occlusal plane.Usually a space problem so ortho is valuable.Apply same parameter to LAS
45The Gummy Smile - Robbins Five questions. 1 Face 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 – VMETx: Orthognathic surgery.
46The Gummy Smile – Robbins Five questions 2 Lip length: Repose from base of nose to inferior border of the maxillary lipIn young adult: Females mmIn young adult: Males mmDx: Short or hyperactive upper lipTx: Behavior modification / Botox.LIP Mobility 6-8mm
47The Gummy Smile - Robbins Five questions. 3 Gingival Line: Draw from Canine to Canine. Should engage centrals and cuspids.Dx Concave – Dentoalveolar Extrusion.Tx. Orthodontic, intrusion, Esthetic Crown Lengthening, Segmental osteotomy.
48The Gummy Smile – Robbins Five questions 4 Length of the maxillary central incisor:10-11mmDx Less than 10mm Microdontia, Wear, APEIn repose “Emma” 3-4mm of incisal edge of maxillary centrals in young female and 2mm in young males.
49Bill Robbins DDS The Gummy Smile. Five questions 5 Feel the CEJ in the sulcus:DX: Cannot feel CEJ – APETx: Esthetic Crown lengthening Surgery.
53Summary of ConcernsInteresting issues related to this case that warrant discussion prior to treatment?WearExpectationAre 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
54Diagnosis and Prognosis AAP Type: AAPHopeless: #’sGuarded: #’sSee risk factors.Good: The rest, assuming homecareimprovement, and patient pursues prescribed treatment.
55Comprehensive Dental Care includes Disease controlCaries, EndodonticPeriodontal and gingival infectionReconstructive DentistryTooth/Teeth, Bridges, partials, crowns, implantsPeriodontal: pocket reduction, regeneration, normal periodontal architectural configurationEsthetic enhancementMaintenanceProfessional and patient
56Facilitating a Patient’s Choice for Better Dentistry Determine patient’s desired expectationComplete a comprehensive exam to delineate risk factorsEducate patient – how their risk factors affect their desired expectations (communication)Discuss means to reduce risk factors – treatment needed and alternatives, plus timing and stagingDetermine if patient can accept the price of treatment and work with them in this regard.
57A comprehensive result includes: Class 1 Occlusion No PocketsNormal skeletal relationship No recessionNo missing teeth Adequate KTGood tooth position Normal positive soft tissue architectureNormal occlusal landmarks CRO – No occlusal interferencesNo caries Stable anterior guidanceNormal dental anatomy No mobile teethGood sealed margins Stable healthy TMJ’sGood crown form Adequate bone support.
58A Comprehensively Treated Case Should be: The easiest to MaintainThe easiest to restoreThe most estheticAnd produce the most predictable long term result.
59Function and Esthetics. Comprehensive CarePeriodonticsPeriodonticsRestorativeDentistryPredictabilityFunction and Esthetics.
60Delivering a Successful Outcome includes: Comprehensive ExamDiagnosisComprehensive Ts PlanningCase PresentationTeam Tx planningLong-term predictable Tx and Results.
62Treatment Plan Break out time - 30 min Group A Ideal, costs are not a factorGroup B Ideal, costs are a factorGroup C The best you can do,costs and time are major factors.Outline Goals/Objectives of Treatment