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Community Treatment Planning Lounge

In this launch of series for a new forum opportunity for the Dentalxp community, Drs. David Garber and Henry Salama share some of their practice's protocols for collecting the necessary patient information to design and develop esthetically oriented treatment plans. A case presentation is utilized as an example. Comments, suggestions and questions related to treatment planning the case are encouraged to be posted on the forum, some of which will be discussed at a follow-up presentation along with the actual treatment of the patient.

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David Garber, DMD David Garber, DMD
Dr. David Garber has a dual appointment at the Medical College of Georgia School of Dentistry, in Augusta Georgia, as Clinic...
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Henry Salama, DMD Henry Salama, DMD
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Online Videos / General / Practice Management / Community Treatment Planning Lounge

Questions & Comments
barry manson - (3/21/2017 8:21 AM)

thank you so much! outstanding Barry

Mohammad Khandaqji - (10/21/2014 10:23 PM)

I noticed asymmetry in the patient's face with pronounced massater muscles, which may indicate imbalance occlusion. Occlusal equilibration and anterior guidance management required. Orthodontic extrusion of 7, 8, 9, and 10 to increase the papillae hight. Remove the crown and the abutment from #11 and place epithelial and connective tissue graft with custom temporary, abutment and crown. After healing, extract tooth numbers 7, 8, 9, and 10 and place immediate implants with immediate out of occlusion loaded temporaries to sculpt the tissue. After a few months, obtain the impression for 7, 8, 9, 10, and 11 custom implant abutment to manage the inappropriate angled implant, replaced tooth #11 and veneer #6 to manage the tooth size discrepancy. Thank you Dr. Garber and Dr. Salama's

Nikhil Kulkarni642 - (2/8/2012 7:08 AM)

this case surely needs perio and occlusal assessment...i would ask why is there so much bone loss when the oral hygiene is not bad..
therefore i would look into pocket measurement and occlusal assessment...probably traumatic occlusion or rather trauma from occlusion might be the cause..
is there no mutually protected there canine guidance...whats the incisal guidance....these are the first questions I would ask myself...
from the pa's and opg I thought the centrals are calcified....and the amalgam in the apex is has had no root treatment of any sort..
and ofcourse what is the cost which the patient is willing to bear..
i would say the future of the anteriors is bleak from the evidence presented..hence prolong as long as you can would be the strategy...eventually the patient may need extensive restoration with GBR and implants....
but till then, if we were to buy time I would probably suggest the following treatment...
Perio splinting of the anteriors, root planing and curettage with gingivectomy and emdogain to improve the perio health...wait till it heals and stabilises....
probably some direct composite veneers would do the job with restoring the incisal length to follow the lower lip..explain the limitations of the treatment to the patient and prepare her for the exo implant treatment in a few years time....
looking forward to the outcome.....

Jay Lutsky - (2/7/2012 2:46 PM)

Two issues stand out to me. First, the centrals require more length. Possibly with veneers if they are stable or splinted crowns if mobile. Second, and most importantly, what do you think about managing the area of #10-11 by a) extracting the resorbed lateral in conjunction with a connective tissue graft and then cantilevering #10 off of the implant #11 with a new 2-unit bridge? Drs. Salama & Graber, your feed-back is appreciated.

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