Over the Shoulder From Start to Finish

Gary Vaughn, CDT, CTO

Gary Vaughn, CDT, CTO

President Ronald Reagan was known to have displayed a plaque on his desk in the Oval Office that read: “There is no limit to the amount of good you can do if you don’t care who gets the credit.” Over the course of my life, I have seen this quote play out in many forms. Several weeks ago this quote flashed back in my memory as I had the privilege to participate in our latest PAC Over-the-Shoulder Program. On September 23rd, 20 doctors and team members gathered at the Newport Hyatt Regency for an all day lecture and case review at which time smile design principles, preparation design, temporization, and laboratory communication were shared by PAC Clinical Director, Dr. Thomas Dudney and myself. The very next morning we were able to demonstrate the concepts taught in those lectures at an Over-the-Shoulder teaching environment.

Several weeks prior to the program, the patient selected for the course, a female in her early 50s came to figures1-4the office of Dr. Michael Spitzer in Newport Beach, CA to be evaluated and diagnosed for treatment. The patient presented with aging, yellow veneers on the maxillary central incisors, which was her primary concern. As is typical in most every diagnosis, the primary concerns of a patient are rarely the only challenge presented with a case. Upon examination, in addition to the main concern, buccal corridors on either side of the maxillae were deficient, particularly on the patient’s left side, with the absence of tooth #12 and #14 (Figures 1-4). This was not your average veneer case. At the very least it needed a multidiscipline approach. The PAC is committed to teaching concepts that can be used in all aspects of restorative dentistry designed and finished aesthetically.  Understanding that #12 and #14 were missing, the option of implants had been entertained by the patient for some time. However, with the wedding of her son rapidly approaching, she was highly motivated to achieve a beautiful, bright new smile quickly. With insufficient time for the healing process, implants were out of the question, at least for now. Our remedy, which could serve in the short term should she decide to have implants later, or on the long term if she felt comfortable with our solution post delivery, was to fabricate a four unit zirconia bridge, with two ovate pontics, cut back and layered with e.max porcelain (Ivoclar Vivadent). Careful selection of the zirconia and e.max ingots would be paramount but we were confident with the selections we now have available, we could match and compliment the adjacent anterior e.max veneers, as well as provide a stable, balanced occlusion for now. Tooth #10 was also rotated, which only added to the spacing deficiency presented with a missing first bicuspid. The lateral incisors both appeared to be relatively shorter than desired, due to the prominence of the central incisors most likely brought about by the compensatory eruption.

figures5-7 Dr. Spitzer performed a thorough exam, took impressions and photos, and obtained a stick bite. These items were sent to Corr Dental Designs, where a diagnostic wax-up was created. Preparation guides and a temporary matrix were fashioned around the wax-up to assist in providing the desired transformation (Figures 5-7).

Dr. Mark Olson, who recently relocated his practice from Rocklin to Newport Beach, graciously offered the PAC use of his brand new  office. With the anticipated crowd returning Saturday morning after Friday’s lecture, it would have been impossible to accommodate all who wanted to observe within the confines of the operatory at one time. Therefore, we arranged for Brandon Miyasaki, who has helped the PAC with special video projects in the past, to travel from Sacramento and set up our video camera in the operatory directly over the reclined patient’s mouth.  This would enable us to stream the feed into the comfort of Dr. Olson’s patient waiting area on to a “bigger than life” video monitor. In this way, Dr. Dudney was able to describe in words and show in real time, all of the techniques and protocols of the previous day’s lectures. Doctors and team members were also able to rotate through the operatory in small groups to observe first hand throughout the procedure. Dr. Olson’s chairside assistant Geni skillfully supported Dr. Dudney in the clinical process. I demonstrated the use of a stick bite along with the Kois Facial Analyser from Panadent.  Within a few short hours, some old dentistry was removed, caries addressed, and the case was prepped, complete with beautiful new temporaries matching the diagnostic wax-up, through the use of a matrix supplied by the laboratory. Photos were taken of the patient with the new smile which served as a valuable tool over the next several weeks for the patient to “test drive” her new smile and work out any possible function issues (which ended up being non-existent in this case) as well as determine any aesthetic preferences that needed to be addressed (Figure 8-10).figures8-9

Because of the logistics of our Over-the-Shoulder program the case was handed off to Dr. Spitzer, one of our Program Directors in Southern California, and who had overseen the original patient screening.  Several weeks later, the patient and I returned to Dr. Spitzer’s office for delivery of the new restorations. There Dr. Spitzer was assisted by Maria chairside, in the removal of the temporaries and trying in of the case. To achieve a perfect match, Dr. Spitzer tested several different try-in pastes until it was ultimately determined by committee that a plus 3 try in material from the Ivoclar Veneer kit was the answer to us achieving the desired shade. I might note that at this point, many of you reading this article may cringe at the prospect of “handing off” a patient. I can only assure you that the protocols taught by the PAC, which are implemented  over and over, every day, by our skilled instructors foster a seamless transfer from one skilled professional to another. Through that trust and confidence, we are assured that each doctor will deliver the desired result. In this particular case, because all the prep work had been performed in Dr. Spitzer’s office weeks earlier, the patient was already figures10-11completely confident in a stunning outcome, as you can see for yourself was the result (Figure 11).

Many thanks to Lissa Bisson for providing the necessary materials and travel arrangements. Doctors Dudney, Olson and Spitzer, Geni, Maria, Brandon Miyasaki, our patient Wendy, all of the skilled technicians of Corr Dental Designs and Garrett Caldwell, CEO of the PAC, and any and all others I may have forgotten. Hence, the phrase, “There is no limit to the amount of good you can do if you don’t care who gets the credit.”

If you have questions about this article or if you would like to send a case, please contact the Pacific Aesthetic Laboratory Group at www.pacificaestheticdentalstudio.com, Gary Vaughn, CDT, CTO (916) 786-6740, or via email gvaughn@thePAC.org.

By | 2016-10-31T00:22:27+00:00 October 31st, 2016|Dental|0 Comments

About the Author:

No Comments

  1. LarryKer July 25, 2019 at 10:40 am - Reply
    Your comment is awaiting moderation.

    Kudos. A lot of material.

    what helps viagra work best viagra ace inhibitors
    cheap viagra
    names for generic viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  2. LarryKer July 25, 2019 at 10:50 am - Reply
    Your comment is awaiting moderation.

    Awesome info. Thank you.

    topic 3642 viagra walnuts viagra
    viagra 100mg
    canadian generic viagra – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  3. LarryKer July 25, 2019 at 11:40 am - Reply
    Your comment is awaiting moderation.

    Incredible a lot of amazing advice.

    prices viagra generic norvasc viagra adverse reaction
    generic viagra online
    lakshmi snow white viagra girl – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  4. LarryKer July 25, 2019 at 12:29 pm - Reply
    Your comment is awaiting moderation.

    Amazing material. Thanks a lot!

    viagra research viagra and avalide
    buy viagra
    tiesto viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  5. LarryKer July 25, 2019 at 1:17 pm - Reply
    Your comment is awaiting moderation.

    Awesome info, Thanks a lot!

    viagra tricks viagra no prescription in usa
    generic viagra online
    buy viagra in vegas – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  6. LarryKer July 25, 2019 at 2:05 pm - Reply
    Your comment is awaiting moderation.

    Regards! I value it!

    viagra adverse events funny viagra names
    buy viagra online
    subaction showcomments viagra smile older – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  7. LarryKer July 25, 2019 at 2:54 pm - Reply
    Your comment is awaiting moderation.

    Fantastic postings. Many thanks.

    viagra usage reviews medication online viagra
    generic viagra 100mg
    cheap drugs viagra cialas – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  8. LarryKer July 25, 2019 at 3:45 pm - Reply
    Your comment is awaiting moderation.

    Cheers, I appreciate it.

    viagra mercury drug buy viagra for less
    generic viagra online
    viagra action – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  9. LarryKer July 25, 2019 at 6:16 pm - Reply
    Your comment is awaiting moderation.

    Incredible all kinds of terrific advice.

    does pink viagra really work poppers as viagra
    viagra for sale uk
    viagra tylenol – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  10. LarryKer July 25, 2019 at 7:07 pm - Reply
    Your comment is awaiting moderation.

    You actually explained this effectively.

    viagra dangers viva viagra commercials
    viagra for women
    viagra low price – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  11. LarryKer July 25, 2019 at 7:58 pm - Reply
    Your comment is awaiting moderation.

    Very good content. Kudos!

    scam doctor viagra alternative cvs walgreens viagra cialis
    generic viagra 100mg
    which is best viagra livetra cialis – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  12. LarryKer July 25, 2019 at 8:49 pm - Reply
    Your comment is awaiting moderation.

    Amazing info. Appreciate it.

    generic viagra online fast delivery free herbal viagra samples
    generic viagra 100mg
    viagra funny – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  13. LarryKer July 25, 2019 at 9:39 pm - Reply
    Your comment is awaiting moderation.

    You suggested that very well.

    viagra purchase in united states viagra help jet lag
    generic viagra 100mg
    bayer viagra sales – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  14. LarryKer July 25, 2019 at 10:29 pm - Reply
    Your comment is awaiting moderation.

    Many thanks, An abundance of write ups!

    viagra prices ciao buy now viagra url
    viagra for sale uk
    does female viagra work – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  15. LarryKer July 25, 2019 at 11:20 pm - Reply
    Your comment is awaiting moderation.

    Many thanks, I appreciate this.

    lifestyle viagra lisonpril viagra
    buy viagra online
    viagra hong kong – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  16. LarryKer July 26, 2019 at 12:10 am - Reply
    Your comment is awaiting moderation.

    Fine advice. With thanks.

    viagra enter email address viagra sample free
    viagra 100mg
    viagra and ssri – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  17. LarryKer July 26, 2019 at 1:01 am - Reply
    Your comment is awaiting moderation.

    Appreciate it! Ample data.

    viagra side effects back muscles what is the safe viagra dosage
    viagra pills
    viagra young guys blue pill – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  18. LarryKer July 26, 2019 at 1:51 am - Reply
    Your comment is awaiting moderation.

    Kudos! Lots of posts!

    3 generic meltabs viagra viagra resept
    viagra 100mg
    viagra buy pharmacy – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  19. LarryKer July 26, 2019 at 2:42 am - Reply
    Your comment is awaiting moderation.

    Really a lot of amazing information!

    viagra substitute what really works viagra side effects dangers
    buy viagra
    viagra $139 – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  20. LarryKer July 26, 2019 at 3:34 am - Reply
    Your comment is awaiting moderation.

    Thank you. Lots of data.

    viagra alcohol viagra stay hard after coming
    generic viagra 100mg
    sexual dysfunction plateau viagra – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  21. LarryKer July 26, 2019 at 4:24 am - Reply
    Your comment is awaiting moderation.

    Amazing tons of very good info!

    wal-mart china viagra which is better viagra levitra cialis
    cheap viagra
    buy discount viagra online a href – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  22. LarryKer July 26, 2019 at 5:14 am - Reply
    Your comment is awaiting moderation.

    Kudos. Loads of write ups.

    viagra with mastercard generic soft viagra
    viagra pills
    comparison viagra regalis levitra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  23. LarryKer July 26, 2019 at 6:03 am - Reply
    Your comment is awaiting moderation.

    Truly a lot of wonderful data!

    viagra experiences viagra free sites results search
    viagra pills
    medicaid viagra – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  24. LarryKer July 26, 2019 at 6:54 am - Reply
    Your comment is awaiting moderation.

    Well voiced of course. .

    edinburgh viagra tid search charles compare cialis vs viagra
    viagra without a doctor prescription
    kamagra or viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  25. LarryKer July 26, 2019 at 7:44 am - Reply
    Your comment is awaiting moderation.

    Amazing plenty of great knowledge!

    where to buy viagra in england adipex meridia online phentermine prescription viagra
    generic viagra 100mg
    viagra with other drugs – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  26. LarryKer July 26, 2019 at 8:35 am - Reply
    Your comment is awaiting moderation.

    Many thanks. An abundance of write ups!

    moo moo edinburgh viagra tid news generic viagra vega sildenafil citrate
    viagra without a doctor prescription
    mix regalis and viagra – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  27. LarryKer July 26, 2019 at 9:26 am - Reply
    Your comment is awaiting moderation.

    Reliable content. Regards!

    using viagra with cialis viagra with levitra
    buy generic viagra
    buy pharmaceutical viagra – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  28. LarryKer July 26, 2019 at 10:18 am - Reply
    Your comment is awaiting moderation.

    Lovely stuff, Thanks.

    cheaper viagra when does patent for viagra expire
    buy viagra
    viagra shop uk – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  29. LarryKer July 26, 2019 at 11:10 am - Reply
    Your comment is awaiting moderation.

    Kudos! Very good information!

    $2.00 calias viagra press releases coma viagra
    viagra online
    on line viagra – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  30. LarryKer July 26, 2019 at 12:03 pm - Reply
    Your comment is awaiting moderation.

    You actually said it terrifically.

    edinburgh uk pages viagra find sites female uk viagra
    cheap viagra
    find viagra free sites news computer – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  31. LarryKer July 26, 2019 at 12:55 pm - Reply
    Your comment is awaiting moderation.

    Thanks, Terrific information.

    viagra without prescription cheap a penis on viagra
    generic viagra
    high from viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  32. LarryKer July 26, 2019 at 1:47 pm - Reply
    Your comment is awaiting moderation.

    Cheers, A lot of advice.

    get viagra online in canada japanese viagra with the red rocket
    viagra without a doctor prescription
    generic viagra wholesale 100mg – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  33. LarryKer July 26, 2019 at 2:39 pm - Reply
    Your comment is awaiting moderation.

    Really a lot of good data.

    time-release viagra viagra boring pages edinburgh affects boring
    buy viagra online
    viagra 3 – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  34. LarryKer July 26, 2019 at 3:32 pm - Reply
    Your comment is awaiting moderation.

    You actually said that wonderfully.

    patent expiration date viagra pfizer patent extension viagra
    viagra for women
    viagra now – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  35. LarryKer July 26, 2019 at 4:26 pm - Reply
    Your comment is awaiting moderation.

    You reported this superbly.

    will viagra work for my wife viagra los angeles mastercard
    buy viagra online
    is cialis beter dan viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  36. LarryKer July 26, 2019 at 5:18 pm - Reply
    Your comment is awaiting moderation.

    Nicely put, Thanks.

    viagra beneficial side effects is it safe to use viagra
    viagra pills
    viagra wwe – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  37. LarryKer July 26, 2019 at 6:10 pm - Reply
    Your comment is awaiting moderation.

    You actually said this adequately.

    sildenafil citrate vs viagra viagra efects for women
    buy generic viagra
    best prices viagra – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  38. LarryKer July 26, 2019 at 7:02 pm - Reply
    Your comment is awaiting moderation.

    You said this really well!

    up viagra teens cheap drugs viagra cialas
    viagra without a doctor prescription
    viagra capsule – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  39. LarryKer July 26, 2019 at 7:54 pm - Reply
    Your comment is awaiting moderation.

    You actually mentioned that fantastically.

    viagra side effects and blog best viagra alternative
    buy generic viagra
    viagra womans – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  40. LarryKer July 26, 2019 at 8:47 pm - Reply
    Your comment is awaiting moderation.

    You expressed this well.

    viagra beim zoll viagra bought in mexico
    buy viagra
    canadian cheap viagra – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  41. LarryKer July 26, 2019 at 9:41 pm - Reply
    Your comment is awaiting moderation.

    Helpful knowledge. Many thanks.

    generic viagra tadalafil warning get free viagra now
    viagra 100mg
    where to buy viagra on line – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  42. LarryKer July 26, 2019 at 10:35 pm - Reply
    Your comment is awaiting moderation.

    Superb postings, Thank you!

    diary of a viagra housewife generic online pharmacy viagra
    viagra without a doctors prescription
    craigslist toronto viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  43. LarryKer July 26, 2019 at 11:28 pm - Reply
    Your comment is awaiting moderation.

    Thanks, I appreciate this!

    viagra lolo can viagra prevent premature ejaculation
    viagra without a doctor prescription
    does viagra increase erection period – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  44. LarryKer July 27, 2019 at 2:09 am - Reply
    Your comment is awaiting moderation.

    Cheers! Quite a lot of write ups!

    hrx viagra generic viagra in the usa
    viagra online
    viagra insurance medben – https://genericviagramsl.com

    Geraldfag
    DwayneCef
    Kevinrit

  45. LarryKer July 27, 2019 at 3:02 am - Reply
    Your comment is awaiting moderation.

    Thanks a lot. Ample material.

    viagra tutorial non persription viagra
    viagra 100mg
    viagra online canda – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  46. LarryKer July 27, 2019 at 3:55 am - Reply
    Your comment is awaiting moderation.

    Very good info. Cheers.

    25 and on viagra bite 100mg viagra inhalf
    viagra generic
    viagra cialis levitra best – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  47. LarryKer July 27, 2019 at 4:47 am - Reply
    Your comment is awaiting moderation.

    Thanks a lot! I value this.

    g postmessage viagra guest reply find viagra edinburgh sites posted
    generic viagra
    search viagra viagra find edinburgh free – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  48. LarryKer July 27, 2019 at 5:39 am - Reply
    Your comment is awaiting moderation.

    Nicely put. Regards.

    persuasive essay viagra viagra perscriptions
    cheap viagra
    viagra pulse rate – https://genericviagrantx.com

    Geraldfag
    DwayneCef
    Kevinrit

  49. LarryKer July 27, 2019 at 6:30 am - Reply
    Your comment is awaiting moderation.

    Truly a good deal of good advice.

    viagra commercial website email sign up viagra
    viagra without a doctor prescription
    generic purchase viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

  50. LarryKer July 27, 2019 at 7:21 am - Reply
    Your comment is awaiting moderation.

    You have made your position pretty nicely!.

    how can i enhance viagra buy viagra and overseas
    viagra generic
    most effective way to use viagra – https://genericviagrarcp.com

    Geraldfag
    DwayneCef
    Kevinrit

Leave A Comment