RBB Recementation Protocol - Adjusting Pontic Occlusion
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2 سال پیش
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Rather than bore you about mechanoreceptors and give you 67 definitions of centric relation, I'm going to show to real-world clinical applications of Occlusion.
For the (this) August edition I share with you a clinical video above, with my full commentary, of a recent Resin Bonded Bridge Recementation. You get to see this video before anyone else :)
0:00 Introduction
0:30 Air abrasion of RBB
1:00 Old cement removal
3:00 RBB try-in
3:20 Panavia bonding Protocol
6:38 Removal of excess cement
7:00 Occlusal adjustment
9:02 Learn Resin Bonded Bridges
At the end of the video, observe my protocol for ideal occlusion on RBBs:
1. Visual Inspection - can the patient achieve Maximum Intercuspal Position (MIP)? If Yes, great, the bridge has likely been fit back perfectly.
If not - then the fit was 'off' slightly. (or maybe the occlusion sucked before and that's why it debonded in the first place?)
If the RETAINER/ABUTMENT is proud - was this intended (ie. intentional, perhaps a Dahl technique?)
...or unintended?
If unintended - consider selective enameloplasty of opposing tooth plus/minus Adjusting the abutment/metal/zirconia itself.
When Adjusting opposing teeth, here are the simple rules I follow:
A. Communication
- Tell your patient ahead of time that teeth fit together like a lock and key. If you change the lock, you also may need to change the key. A change in one arch may need a change in the upper arch for things to fit well.
- Tell the patient you will smooth and reshape a corner of the opposing tooth - it will be quick and nowhere near the nerve
B. Execution
- Enamel is King. Can you take something off from the opposing restoration to reduce how much enamel you need to remove?
- DON'T just flatten cusps and gouge in to fossae/cingulums
- Instead, follow the existing contour of the tooth where it permits
- Go incremental with fine burs (like red) - when you get close to perfect, you can use a course soft flex disc or white stones
- Don't expose dentine - consider another approach if you're in danger of exposing dentine.
2. Pontics for RBBs should have no excursive contacts. They can have light contacts in MIP.
Using two colours of articulating paper, take a look (towards the end of the video) the simple way to identify undesirable excursive contacts but maintain the occlusal stop!
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2 سال پیش
در تاریخ 1401/05/21 منتشر شده
است.
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