Handbook of Composite Prosthodontics:
Under construction, publication expected Spring 2020. This is a new assemblage of procedures unified by the use of mounted casts, centric and excursive occlusal registrations, laboratory wax-up, transparent stents, and subsequent restoration of the full dentition, both anterior and posterior in composite resin, to full contour, following a transparent stent guide through which resin is cured to a predetermined outcome.
This method can be used to restore severely degraded dentitions either on a final basis or as a transitional platform towards conventional crown-based treatment. This gives the clinician an opportunity to trial the outcomes for esthetics and TMJ comfort before the commitment to greater expense is undertaken.
When well planned and correctly diagnosed, the treatment can be surprisingly rapid; an entire mouth can be rehabilitated, often in one day, to the predetermined laboratory wax-up based on a facebow record and articulator-mounted models. Many patients with severe attrition can tolerate treatment without anesthesia due to pulpal shrinkage in response to the progress of attrition, and as well, little dentin preparation may be necessary.
If vertical dimension is not increased but rather the mandible is re-positioned distal to a pathological acquired anterior habitual occlusion, then the treatment is eligible for insurance coverage under the policy umbrella of most dental plans, and this brings treatment into an affordable zone for many patients. Repositioning to a centric occlusion without occlusal interferences and muscular triggers may end a lifelong pattern of parafunction.
Obviously this is appreciated by patients. From the practitioner’s viewpoint, the treatment offers simplicity and a direct route to completion, a generous fee remuneration, and only one major communication with the laboratory. Thus it becomes feasible to treat several cases a month rather than just several a year, bogged down in multiple laboratory communications and steps, as they must be in fixed prosthodontics.
Cases must also be completed by addressing the etiology, addressing the removal of acid exposures or protection of the restored mouth with a protective nightguard. Followup is essential with recalls.
This treatment is a practice-builder through word of mouth, as the transformation for the patient is deeply life-changing, ending shame due to a “broken” smile, in itself a huge emotional release, one which is noticeable by all the people in their social circle.
In tight dental markets and hard times this will keep a dental practice flourishing at times when both high-end elective procedures as well as need-based dentistry might dwindle. It is difficult to quantify the satisfaction of being able to perform this work for the public.
Obviously, completing the case correctly to keep this kind of radical treatment from descending into a nightmare of failed and un-remunerated maintenance.