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Special Issues
July/August 2018
Volume 39, Issue 3

Minimizing the Difficulty of Complex Cases Through Teamwork

Jeff Trembley, DDS

Complex restorative cases can be successfully managed with proper support. First, accurate records are needed, such as impressions, radiographs, facebow and bite records, and high-resolution photographs. Next, good “allies” are necessary, such as an experienced laboratory technician/ceramist whose interest in success aligns with the clinician’s and local specialists who can help manage the plan and treatment. In the present case, with proper records in hand, the author relied on his lab tech/ceramist “ally” (Macstudio By MicroDental Laboratories, macstudio.com) to supply materials to manage the entire case, including reduction guides, temporary stints, and a maxillary wax-up to increase the patient’s vertical dimension of occlusion (VDO). An initial minimal preparation day to remove old fillings and restorations and seat new temporaries served two purposes: a test drive for the patient’s new VDO and a guide for crown lengthening. Crown lengthening of teeth Nos. 9 through 11 to balance the tissue was performed by a periodontist “ally” (Robert Pulliam, DMD, MS, Nashville, Tennessee). After that, all that was needed was an afternoon of refining preparations, recording the VDO accurately, and replacing the temporaries.

Key Takeaways

Accurate records and photographs serve as the foundation upon which a restorative case is built.

A dependable laboratory partner in whom a clinician trusts with his or her records is indispensable.

Consultation with specialists on the front end of a case will help clinicians avoid missteps and often stimulates ideas not previously considered.

About the Author

Jeff Trembley, DDS
Private Practice
Nashville, Tennessee

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