Darin O'Bryan, D.D.S. If you asked most of your patients if money was no object would they fix their teeth, the vast majority of them would say yes. We all have patients in our practice that need our services and want to have the best that dentistry can do for them. How many times have you talked to a patient and they realize they have needs that should be addressed but financially they just can not afford the multitude of crown and bridge that are necessary? With the current economic trend more people are being frugal with their discretionary income. I don't know about you but I don't have a ton of patients with a bunch of cash set aside to fix their teeth. How can we make it possible for them to have the quality care they want and make it feasible financially?
For the patient that wants the best but can not afford complete restorative care at this time it is necessary stage their therapy over time. Long term provisionals with composite are an ideal way to accomplish this objective. This is a technique that I have used in my office for a number of years with excellent results.
Once the patient's restorative needs are determined an ideal wax up is created. The wax up is then duplicated in stone and a vacuform matrix is created. The matrix is trimmed to the gingival margin for easier clean up. Caries removal is done on teeth with disease. Restorations can either be left or removed depending on their condition. For metal crowns retention grooves can be cut into their surface. Crowns with a porcelain surface can be abraded and then conditioned to bond to the resin.
Once this is done the patient is isolated and the proper bonding protocol followed for the underlying structure. The matrix is then filled with composite and seated on the arch. The gross excess is moved away form the gingival margin or and the whole thing is cured. The teeth are then sectioned if so desired with fine finishing burs, cera-saws or contact EZ and finishing strips. The same is then done for the opposing arch if needed. Now you can refine the occlusion and work out of any pathway interferences.
There are a number of benefits to staging a patients therapy in this way. It allows the patient to have the crown and bridge work done over the course of years if necessary. If they are an insurance mind-set patient now their insurance will cover the crowns one or two a year. It is also a great way for the patient to test drive their new occlusion and pathways of function. If the patient has GERD's or acid reflux it is also a way to verify control of the condition before moving on to more costly procedures.
Now biocopy is your friend. One, two or the entire thing can be duplicated with biocopy. If this is a patient that can only afford or wants to only do 1-2 crowns a year then you can leave the others until such time as their insurance rolls or the patient decides to do a few more crowns.
The combination of the composite mock up and CEREC is a powerful tool that allows the delivery of ideal dentistry over time with amazing results.
