Dr. Kevin Groth
I find it remarkable how certain events in life can lead to opportunities that are seemingly unrelated. My introduction to Dr. Robert DiPilla, Detroit PAC Director, and the Pacific Aesthetic Continuum started with a job as a summer swim coach during dental school. Fast-forward two years, the PAC is hands down the most influential experience I have come across in the early stages of my career. I have a much clearer vision of the dental profession and my knowledge continues to grow with every PAC course and study club.
One aspect that drastically changed was my patient examination, shifting from an individual tooth perspective to a more comprehensive functional evaluation. Previously I would identify problem teeth and correct the issue, but I now find myself questioning why these issues are taking place and how it can be appropriately corrected.
This change of mindset was critical in the diagnosis and treatment plan for my first full mouth case with the PAC. Debi came to my office with quite a few issues. Her initial exam revealed several anterior chipped teeth, missing upper molars, and broken down, decayed premolars. She reported her teeth wearing down more in the last couple years and never had these issues prior. Initially I probably would have treated the decay and considered the wear to be in relation to grinding (Figures 1-4). Thanks to the PAC education, I was able to determine her wear pattern to be due to the lack of posterior support, and not bruxism. Without upper posterior molars, Debi placed more stress on her anterior teeth which cannot take on the functional load molars assume.
First we needed to get Debi out of pain. Teeth #4, 17, and 18 were extracted, root canals were done on teeth #19 and 20, and the remaining decay removed. We next needed to get posterior support with implants planned for sites #2, 4, and 14, but our analysis showed Debi had limited room occlusally to restore the implants. She needed to be opened up with a full mouth reconstruction and the PAC course was a perfect opportunity to help fulfill her needs.
Our primary goals were to add vertical dimension for implant crowns, correct the sharp edges with a more feminine appearance, widen the buccal corridor, modify her gingival architecture, correct axial inclination, and of course, whiten her teeth – Debi’s primary goal. A Kois Deprogrammer was used to capture the bite in CR. Composite mock-ups were placed on the lower teeth at this position and served as a guide to better understand her function – we had a couple months to go before the course. Debi was very comfortable at this new established bite. A composite mock up was done on teeth #7-10 to check an appropriate length for the incisal edge position and Corr Dental Designs used these mock ups for their diagnostic wax-up.
Debi came into the Detroit PAC course last Spring with a lot unknowns. A few hours later she was in tears of joy and these were only the temporaries! We captured a great video of the moment and you can see it on the PAC’s Facebook page. The end result turned out just as expected and she could not be happier with her teeth. Debi was already a bubbly person, but I can honestly say she has a new energy in life, and it is a direct reflection of her smile (Figures 5-8).
The satisfying part with this case for me was being able to go start to finish with little guidance. Obviously, I had the PAC Instructors around as a safety net, but the reality was that they sat back and watched it all unfold without issue. This was the first time everything came together for a large restorative case, and none of that would have been possible without the influence of Dr. DiPilla, Corr Dental Designs, and the Pacific Aesthetic Continuum. I am incredibly grateful for this opportunity, especially considering it began with a job as a summer swim coach!
If you have questions about this case or would like to send a case, please contact Gary Vaughn, CDT, CTO at [email protected] or at (916) 786-6740. Visit The Pacific Aesthetic Laboratory Group online at www.pacificaesetheticdentalstudio.com.
One aspect that drastically changed was my patient examination, shifting from an individual tooth perspective to a more comprehensive functional evaluation. Previously I would identify problem teeth and correct the issue, but I now find myself questioning why these issues are taking place and how it can be appropriately corrected.
This change of mindset was critical in the diagnosis and treatment plan for my first full mouth case with the PAC. Debi came to my office with quite a few issues. Her initial exam revealed several anterior chipped teeth, missing upper molars, and broken down, decayed premolars. She reported her teeth wearing down more in the last couple years and never had these issues prior. Initially I probably would have treated the decay and considered the wear to be in relation to grinding (Figures 1-4). Thanks to the PAC education, I was able to determine her wear pattern to be due to the lack of posterior support, and not bruxism. Without upper posterior molars, Debi placed more stress on her anterior teeth which cannot take on the functional load molars assume.
First we needed to get Debi out of pain. Teeth #4, 17, and 18 were extracted, root canals were done on teeth #19 and 20, and the remaining decay removed. We next needed to get posterior support with implants planned for sites #2, 4, and 14, but our analysis showed Debi had limited room occlusally to restore the implants. She needed to be opened up with a full mouth reconstruction and the PAC course was a perfect opportunity to help fulfill her needs.
Our primary goals were to add vertical dimension for implant crowns, correct the sharp edges with a more feminine appearance, widen the buccal corridor, modify her gingival architecture, correct axial inclination, and of course, whiten her teeth – Debi’s primary goal. A Kois Deprogrammer was used to capture the bite in CR. Composite mock-ups were placed on the lower teeth at this position and served as a guide to better understand her function – we had a couple months to go before the course. Debi was very comfortable at this new established bite. A composite mock up was done on teeth #7-10 to check an appropriate length for the incisal edge position and Corr Dental Designs used these mock ups for their diagnostic wax-up.
Debi came into the Detroit PAC course last Spring with a lot unknowns. A few hours later she was in tears of joy and these were only the temporaries! We captured a great video of the moment and you can see it on the PAC’s Facebook page. The end result turned out just as expected and she could not be happier with her teeth. Debi was already a bubbly person, but I can honestly say she has a new energy in life, and it is a direct reflection of her smile (Figures 5-8).
The satisfying part with this case for me was being able to go start to finish with little guidance. Obviously, I had the PAC Instructors around as a safety net, but the reality was that they sat back and watched it all unfold without issue. This was the first time everything came together for a large restorative case, and none of that would have been possible without the influence of Dr. DiPilla, Corr Dental Designs, and the Pacific Aesthetic Continuum. I am incredibly grateful for this opportunity, especially considering it began with a job as a summer swim coach!
If you have questions about this case or would like to send a case, please contact Gary Vaughn, CDT, CTO at [email protected] or at (916) 786-6740. Visit The Pacific Aesthetic Laboratory Group online at www.pacificaesetheticdentalstudio.com.
