Veneer case and a bunch of lasers - Laser Dentistry Forum

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October 17, 2003 at 7:06 am #2795 Reply

Glenn van As
Spectator

Hi there folks: This lady had veneers placed by me around 2 years ago and this was a lengthy treatment that involved osseous recontouring at the periodontist and then veneers to build up very narrow and tiny teeth with multiple diastemas.

The original veneers were done in another office and they had alot of recurrent decay…..I might have photos somewhere kicking around.

I replaced them for her and prescribed a NG but it wasnt worn religiously and her parafunctional habit reeked havoc with the veneers until she first cracked and then eventually broke in half one of them.

I had to remove them and boy oh boy had the tissue ever grown up over the very deep subgingival margins which were healthy looking but quite deep under the tissue.

I had a tough time retracting them afterwards (biologic width infringement wasnt a worry as the tissue was healthy prior to me removing the veneers) and I finally got the impression with a putty /wash impression .

Now the fun part……after a couple of days she mentions to me that one tooth is longer than the other, and it is true, on the temps one was longer and I got her in and removed and reshaped the temps to try and make them even and then tried some biostimulation to get the tissue even with both sides.

Yesterday I cemented the veneers and on tryin when she had a look (she has a very high smile line) she notice right away that one veneer was longer than the other, not incisally but gingivally…………oh god.

Well I measured them on the model and they were the same in length so I decided to measure them in the mouth and the left central was longer than the right.

Well only one thing I could think of after feeling that the margin was 1.5mm under the tissue was to slowly plane or shave some tissue away to make the two even and hope the margin wasnt gonna be exposed…….

Well it worked so far.

I took some final pics and had her back today .

Interesting that she mentioned the laser diode retraction (CW 1.0 watts) was way more sore than the soft tissue erbium removal at 30 Hz and 40 mj with a 400 micron tip……..in slight non contact.

Hope you like the case and I posted a couple of one day healing photos at the end. Color match was good and patient is happy that the centrals are longer but I suspect with time that the tissue will again “grow” up over the margins but hopefully it will grow on both centrals.

Glenn

First off are the prep photos then the insert photos with one day healing ( todays pics).

October 17, 2003 at 7:16 am #6110 Reply

Glenn van As
Spectator

Part with the insertion is below…….gotta sleep now.

Glenn

October 17, 2003 at 4:04 pm #6109 Reply

ASI
Spectator

Hi Glenn,

Nice recovery and esthetic result.

Almost a need for a labial frenectomy?

What did you used for the biostimulation?

Good stuff as usual. You are using a different format for the photos now, 6 as opposed to 8.

Thanks.

Andrew

October 18, 2003 at 1:18 am #6117 Reply

Swpmn
Spectator

Nice 3/4 crowns!!!!!!!!!!!

Al;)

October 18, 2003 at 4:51 pm #6112 Reply

Glenn van As
Spectator

Thanks Andrew and yes as you saw yesterday a frenectomy could be done but the patient isnt too keen on it right now but who knows with some persuasive discussion!!

Allen……..they were technically 3/4 crowns but those were the teeth originally before any preps were done, as they were very very small.

Hope that helps and here are two healing photos (2 days) from yesterday.

Glenn

[img]https://www.laserdentistryforum.com/attachments/upload/DSCN1278_resize.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/DSCN1275_resize.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/DSCN1280_resize.JPG[/img]

October 18, 2003 at 6:13 pm #6108 Reply

dkimmel
Spectator

Glenn,
When we see posted cases from this group of lasers users it is real easy to say , “Nice Case”.
Thing is looking at the under the scope post op views, ” Its a hell of a nice case”!!
The first cases that I have seen you post have been good but you have really pushed to get better. You can tell! The hard work is paying off!
David
( You can send the cash in small bills. I prefer US dollars!)

October 18, 2003 at 10:54 pm #6115 Reply

Kenneth Luk
Spectator

Glenn,
Excellent result.
I’ll have to take up more courses and improve my techniques before getting a microscope.
Otherwise, I may quit dentistry looking at my work under such mag.
Ken

October 18, 2003 at 11:30 pm #6111 Reply

Glenn van As
Spectator

Ken and David……you guys sure made my day. You know its easy to be critical when you look at your work at 16 X power and I try my best. Occasionally they work out great and there are some ………ooops I dont like that one but in general the scope gives me a decidely large advantage over those not using anything.

I enjoy the microscope in that it allows me the chance to do good work, whereas before for me it was just a shot in the dark.

I hope that with time more people will see the scope less as a novelty and more as a necessity.

In keeping with that theme if anyone is interested , the Academy of Microscope Enhanced Dentistry meeting is in a couple of weeks in Scottsdale Nov 6-8th at the Sunburst resort.

For anyone in the area or those thinking of scopes who might want to check it out , the web page is at <a href="http://www.microscopedentistry.com

Take” target=”_blank”>http://www.microscopedentistry.com

Take care and thanks for you ever so kind words…….I am learning as I post on how to improve my dentistry.

Its a slow long process.

Glenn

October 19, 2003 at 7:03 am #6116 Reply

Kenneth Luk
Spectator

Hi Glenn,
It seems that you’re covering most part of dentistry without much referrals!
Is there any field that you don’t lay your hands on , like full dentures ? 😉
Ken

October 19, 2003 at 3:15 pm #6113 Reply

Glenn van As
Spectator

Hi Ken: I am a general practitioner who has spent alot of time in CE trying to improve my skills. I took 10 years of orthodontic training from a gentleman who was the department chair at the University of Detroit and University of California at San Francisco. This helped me alot in understanding growth and development and gave me a good basis to determine the kinds of cases I could treat and those that were asking for trouble. After a while I started tackling more difficult cases. I dont have success with everything but I try alot of different things.

Over the years I have been involved in endodontic study clubs (because of the microscope), prosthodontic, implant study club just to name a few.

I dont do alot of impacted third molars, implant surgery, periodontal surgery, or full mouth reconstructions.

I would like to do a little more of the last three, and will be tackling some things after I feel a little more confident in those areas.

Thanks for the kind words, the variety makes for interesting days as I have alot of different things going on but it increases the overhead in your practice as well.

In addition I am trying to do more dentistry on less patients (quadrant dentistry) so that I am not bouncing around chairs like a pinball dentist.

Hope this helps….

Glenn

October 19, 2003 at 6:50 pm #6107 Reply

Anonymous
Guest

QUOTE

Quote: from Glenn van As on 11:15 am on Oct. 19, 2003
…the University of Detroit…
Glenn

Good Choice, Glenn.
Now if we can just get you convinced about which hockey team to root for… :biggrin:

HOME DETROIT RED WINGS
VISITOR VANCOUVER CANUCKS
Game Summary

Thursday, October 16, 2003
Attendance 20,066 at Joe Louis Arena
Start 7:37 PM ET; End 9:58 PM ET
Final
HOME 3 VISITOR 2

Winning Goal 18:54 DET R. WHITNEY (1)

October 19, 2003 at 8:30 pm #6114 Reply

Glenn van As
Spectator

I know another game we dominate for two periods and throw away with poor goaltending.

THe gap is getting smaller and smaller and you losing Hatcher and the Blues losing MacInnis are TWO HUGE blows

Yzerman is on his last legs (literally) he looks awful sore.
Federov is gone…..big loss
Larionov is gone …….little loss
Robitaille is gone

Who are your centermen again…….

Chelios is getting on , so is Shanahan, Hasek, Hull are all getting up there. They have to do it now. The Canucks still have a young team and all their stars are below 30…..Naslund, Jovo, Bertuzzi, Ohlund so we will see what happens in the next year or two.

BUt…….you did win this one, but I know the Wings thought they were in a game and the game was excellent I heard.

Cya

Glenn
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