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neuromuscular bite correction : implants : aesthetic improvement

From: Arturo R. Garcia
Sent: Wednesday, April 04, 2007 4:21 AM
Subject: [roots] recent case completion

I just finished taking the portrait for this case today.  
I was very excited to get the final photos of this case.
Unfortunately it was not a Norm Huefner style session, 
but honestly I had a hard time getting this guy to relax
and smile. The fan on his hair was of no use!

Anyhow, this was a fun, interesting case.  It took me over 
1 year to finish it between phase 1 clean up, neuromuscular
bite correction and stabilization to putting restorations 
on his implants.

Along the way I learned how to place implants with Leo Malin 
at LVI and placed his.  I improved my endo learning daily on
the ROOTS forum and took care of all of his.  He was a very 
good patient and did well all along the way.

He did not have a lot of money, but borrowed and cashed out
some retirement funds to do this case.   My share of struggles
along the way and while not everything came out ideal, I was 
happy overall.  If I had to do it again I would make some
changes like putting in an implant in the lower left.  Could 
it be I am bridge adverse now?  Now that I have been spoiled
by Leo and his implant mania?  Has the endo/implant algorithm 
gripped me like a vise?

He was happy.  So happy he brought in his girlfriend and we are 
working her up for a functional/aesthetic improvement too.
- Arturo

X Ray 
Package Arturo, I am definitely not worthy. I bow to you, excellent case! - DanS No bowing necessary and thanks for the kind words. If anyone should bow it would be me. I have learned so much from ROOTS with regards to not only endo but many other things. Much of that was applied tom this case - Arturo Arturo, Nice case indeed. But may i wonder why do you do all teeth that white only? It would look much more realistlic and harmonious if you play with shades and colorants as well as with teeth irregularities. Just my quiet thoughts... Dmitri Hi Dimitri, Excellent question. IMO each culture has its own standards for aesthetics or what looks good. And then add to that the fact that each individual has their own concept of what looks right for them. So I wind up delivering what satisfies those requirements. I have done a lot of similar rehabs on patient 70 + years old and not one of them has asked me to make their teeth look as old as they do. In fact, sometimes I try to politely tell them that they should not have the lightest color available. He wanted perfect, white, straight teeth and I happily gave it to him. To me it is a vanity issue- its what the patient thinks is right for them. I have been to many international aesthetic dental meetings where there were presenters form the US and Europe and other parts of the world. When the Americans presented their cases there was a buzz in the room amongst the dentists from other countries discussing how the teeth were too white and looked fake. Then when the other dentists would present their cases there would be a buzz in the room amongst the American dentists discussing how the teeth looked to dark and that Americans would never want teeth that have natural irregularities in them. And theyre both right about their own situations. I have a friend who did an aesthetic/functional rehab for an immigrant from Russia. She had gold metal crowns and bridgework all over her mouth- even the anteriors. Not to mention a lot of arsenic root canals. When she was in Russia she was happy with that look. When she came to the States she felt out of place and became unhappy enough with her look to do something about it. Oh well. To quote a line from one of my favorite movies Vanity- its my favorite sin. Anybody remember that one? - Arturo Great response, I couldn't agree more. Here in Brazil I think we are in the 'in between' zone. Patients usually don't want their teeth to tell their age, but they don't like bright white smiles either - Beautiful case, btw. Leo Manufacturers have had to develop extra light and extra extra light shades of composite resin that dont exist in nature. People are causing damage by constantly and perpetually bleaching the hell out of their teeth. Vita had to add additional shades to their shade guide I recently did 4 crowns on a little old lady in her late 70s who insisted on toilet bowel white, all 4 max incisors, while the rest of her teeth were more like Belgian chocolate. My entire staff tried to diplomatically talk her out of it at try-in and at insertion. She insisted, and since it was her mouth, her decision. I made her promise one thing: to not tell anyone else who had done the work for her! Six months later she is in for recall. I go in to check her, ask how she likes her knew crowns. She states, and I quote, I love them, but do you think they are too white. Im on the 15th floor of a medical building in downtown Philadelphia. Little old lady almost met the pavement below through the window! We are going to see a multitude of issues from the bleaching and bondology in the u.s. a decade down the road as a result of this obsession with toilet bowel white. Good news on this forum: a multitude of pulps will not survive the onslaught. The conservative veneer preps of yesterday have turned into wraparound crowns. We used to be able to do conservative veneer preps and not place temps. Virtually impossible in the brave new world. And you folks think endo is dead. As long as bondology is around, endo is safe sound and growing. - Gary All external bleaching has an effect on the pulp...this was demonstrated back in teh 60's...but the good news was, it was reversible. The question is, long term, is it? - Joey D Arturo, I get your point... i have met such patients... nothing wrong with providing patient with what he wants... I was just wondering :-) I saw one cosmetic case rescently done on one of my "single-visit patients". She had all-ceramic restorations form second bi to second bi on upper arch (done in the US, which fact she had pointed with special pride and arrogance). Exactly the "tolet bowel" stuff... Well, after talking to her and getting some impression of her personality i thought the dentistry she had is just a mere punishment... she doesn't deserve any better. It's not "ethical" to thiink this way, may be... but it just how it really is - Dmitri Am I the only one that wonders why the lower incisors were extracted? Just curious since they didn't look bad on the pre- tx fmx - Mark Hey Mark, Im confused here. The case I showed did not have any lower anteriors extracted. Are you referring to another case? - Arturo Sorry Arturo. The way you have your x-rays laid out, I thought you'd extracted lower incisors. Apparently I'm looking at implants in molar regions but the films are laid out in a pattern suggestive of lower incisor films. Never mind me....I'll go away. :-)) - Mark sorry but... i see a buch of things that were not necesary in this case... at least its my humble opinion, did you get enough money for a new Hummer .......Arturo??? -Dr Alexander Garcia Hey Alexander, Please explain what you feel was unnecessary in this case? - Arturo
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