Smile Rehabilitation Strategies

Takeaways from the DR Clinical Series

I wish to enlist few takeaway points from Dr.Deepa's webinar series, which I learned from her first two webinars on Smile Rehabilitation Strategies :-

1. It helped me understand difference between smile designing and smile rehabilitation. Smile Design is when only the alignment of the anterior teeth are changed / diastemas are closed, without any change in functional occlusion. A smile rehab is one in which along with the above, there are changes in the functional occlusion with respect the anterior guidance, overjet or overbite.
2. Concept of anterior guidance and mutually protected occlusion has been imbibed in our brains so well by Dr. Deepa, that before initiating any case we check for it first.
3. Placing even a single crown needs a check list of multiple factors as it's not only a crown being restored but infact, a system .
4. Inlays are used when the cusps of the tooth are preserved in the cavity preparation and do not need indirect coverage.
5. Onlays are used when the cusps of the tooth have been undermined by caries or have been lost in extension of the cavity preparation, hence requiring complete coverage with an indirect restoration.
6. Precision attachment is a predictable approach for FPD incase of absent distal abutment.
7. Alveoloplasty can and should be done if vertical height of bone is not adequate.
8. Monophase impression technique refers to making impressions using medium body polyvinysiloxane. As it's a medium body, it's a single stage impression. It is less technique sensitive, as it simply needs to be syringed in a tray. It's less cumbersome as the impression can be made by the operator alone without the need for an extra pair of hands, as compared to the putty - wash system.
9. Sectional impression technique must be applied if bony undercuts are present .
10. Cases can be treated conservatively without the patient undergoing bilateral full mouth rehabs by raising VD selectively - subject to a few conditions.
11. VD can be raised selectively or on one side only in few cases. For example, where the patient has an acceptable vertical dimension on one side and a collapsed bite on only the other side, often displaying a cant in the occlusal plane, when viewed from the frontal.
12. CAD CAM and DMLS prosthesis are superior compared to conventional technique, because of precise impressions and precise fit.
13. Shade selection needs proper time and perfect communication with the lab plays a vital role to get the desired outcome.
14. Evaluating right Value is most crucial. Check shade in Monochrome, select shade in white light.
15. Aluwax is the preferred wax for bite registration always, as it is very hard when set, and thus does not distort in transport or due to the ambient heat, the way modelling wax does. Additionally, it is a hard and brittle wax which breaks if casts are placed wrongly on it, thereby indicating a simple repeat bite registration, instead of incorrect mounting and resultant prosthesis misfits.
16. Pink porcelain can be incorporated in FPD design to cover soft and hard tissue deficit.
17. Last webinar was an eye opener - how to handle occlusal discrepancies like rotated premolars, repeated fracture of crowns or an opposing crown invading the interocclusal space with no space of indirect restorations- these are the most encountered cases and she did simplified our trouble shooting tasks .
18. Curve of Spee holds a very important criteria in rehabilitating an occlusion. Curve of Spee give us the correct plane of occlusion, when viewed from the saggital, with an upward curve from the canine to the molars. The steeper the curve, the more will be the cuspal inclination and the greater will be the condylar guidance. This means that the patient can, in effect exert a greater masticatory force when chewing. Conversely, the masticatory force can also be decreased in certain patients such as bruxers or those complete denture patients with a resorbed ridge, by decreasing the Curve of Spee.
19. Composites can be used in Selective FMR. Composites when used in selective FMR are usually meant to serve as long term provisionals, after which they are to be replaced by permanent indirect restorations. This is often done to deal with the budgetary constraints of patients. But there are certain cases, where it may last longer than average, provided the functional occlusion is correct and the patient is co- operative and willing to follow post - operative instructions.
20. A lot more, but one very important lesson I learned from Dr.Deepa is the importance of "Documentation". Her well documented webinar series are a proof that she preaches because she practises it.

We hope to learn more and more from Dr Deepa and DentalReach!

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