TOWNIE CLINICAL
Heavy Mountain Dew consumption leads to
Challenging Restorative Case
Kenneth Dale, DDS
S
everal months ago, I received a phone call from a
friend and colleague of mine asking me to reserve
time for his son, who likely needed some restorative
work. His son lived away from our area and had indicated to
his father that he had dental problems needing attention. The
son was going to be home visiting for a week, and during
that time desired to get as many of his dental problems treated
as possible.
The initial examination revealed dental disease that had progressed to a surprising extent–far beyond his father’s expectations. The patient admitted to constant sipping of
Mountain Dew throughout the hours he was employed at a
computer terminal, which resulted in consumption of 3-4 32
oz. beverages per day. His dental disease was out of control
and the patient had given up hope (and his toothbrush).
Cessation of drinking Mountain Dew, or any other soda, was
our first recommendation.
It was obvious that his problems could not be treated in the
seven days that he was to be home. This time was spent
gathering diagnostic information and treatment planning.
We also worked diligently on instruction of proper oral
hygiene techniques and instituted a regimen of PerioGard
and PreviDent 5000 Plus in an attempt to improve his oral
tissues to a reasonable state of health. However, the subgingival decay hindered a complete return to gingival health
before proceeding with the restorative treatment. We also
completed the needed endodontic treatment.
With mounted models, radiographs, and photographs a treatment plan was devised after consulting with the patient’s
father (a dentist) and the laboratory at which the final
restorations were to be made. The treatment plan included
28 crowns, 10 build-ups, and 2 root canals. Crown placement included full gold crowns on the second molars,
Captek crowns on all other posterior teeth, and authentic all
porcelain crowns for all of the anterior teeth.
Case Challenges
Tissue management: The subgingival decay made tissue
management very challenging. After appointment 4 (above)
I had to search the pages of DentalTown to find some help.
I ordered a new electrosurgery unit from Parkell, and some
Expa-syl from Schein for delivery the next day. While these
two items helped tremendously, I had a funny feeling that
my usual impression technique was going to come up short
due to the deep subgingival preparations. Utilizing the
Before treatment
Treatment by Appointment:
Appointment 1: Diagnostic and hygiene appointment.
Appointment 2: Root canal therapy #30 & OHI.
Appointment 3: Root canal therapy #19 & OHI.
Appointment 4: Preparation 2-5, 28-31.
Appointment 5: Preparation 18-21.
Appointment 6: Preparation 12-15. Final impression of maxillary posterior teeth.
Appointment 7: Final impression of mandibular
posterior teeth.
Appointment 8: Delivery of provisional restorations
for all posterior teeth.
Appointment 9: Delivery of posterior crowns with
FugiCEM.
Appointment 10: Study model impressions taken
for wax-up of anterior work.
Appointment 11: Preparation of 6-11.
Appointment 12: Delivery of crowns 6-11 with LUTEIT.
Appointment 13: Preparation 22-27.
Appointment 14: Delivery of 22-27 with LUTE-IT.
Appointment 15: Post-op Photographs and
hygiene appointment.
Continued on page 54
52 DentalTown Magazine
December 2002
TOWNIE CLINICAL
Don t do the Dew
Continued from page 52
DentalTown search engines, I accessed Rod Kurthy’s Laminar
Impression technique that so many have raved about. It worked
great on very difficult impressions to obtain!
Occlusion: Take another look at the pre-op photos…they are in
full occlusion leaving an anterior open bite. I debated whether to
close his vertical to improve the anterior esthetics, but decided to
Continued on page 56
leave his VDO the same.
Diagnostic Wax-up
Pre-treatment
Post-treatment
54 DentalTown Magazine
Preparation
December 2002
TOWNIE CLINICAL
Don t do the Dew
Continued from page 54
Access: This is just one of those cases where you wish you had
more room to work.
Sequencing: Prior to 06-26-02 the patient lived 1500 miles
away, which was a determining factor. He now resides locally.
Esthetics: The patient was extremely pleased with the final
result; however, it was a challenge to produce an outcome with
teeth that are not overly elongated, given the anterior open bite
and the original length of the teeth.
This was a challenging and exciting case that stretched my abilities and facilitated the opportunity to utilize some new techniques and technology. Thanks to a great patient who endured
more than most could; the lengthy appointments and all they
entailed were physically and mentally exhausting. Thanks to
Kristine Jenssen for great assisting. Thanks to Jeff Banet, CDT
of Derby Dental Lab (800-745-6781) in Louisville, Kentucky for
his outstanding work!
If you would like to review all the photos on this case and comments from the Townies, please log onto www.dentaltown.com,
click Todays Active Cases banner (under Townie Talk to the right
of the screen) and search by user name, kdaledds. You can also
do a search for ‘Dew’.
56 DentalTown Magazine
After treatment
Dr. Kenneth Dale has been in practice in Floyds Knobs,
IN, since 1989. He is a member of the American and
Indiana Dental Associations. Ken regularly attends continuing education conferences and stays current on all
the latest dental materials and techniques. Dr. Dale can
be contacted at (812) 923-8180 or by email at
[email protected].
December 2002