Re: [ACEsthetics] new patient today

Right, so the guy only has $25K for now?  Great.  Next quesiton....how many months will it take to save the next $25K.  Works for me at that green count, it the next installment is 12-18 months away.  Otherwise, call me when you've got the 50.  Like I said, "project car", no room in my shop.
 
Steve Markus
The Centre for Dentistry at Haddon
209 White Horse Pike
Haddon Heights, NJ 08035
www.SmileSouthJersey.com
856 SMILE S J
 
From: Rick Coker
Sent: Tuesday, February 05, 2013 9:57 AM
Subject: Re: [ACEsthetics] new patient today
 
Well, my new Institute- "The Center for Compromised Dentistry" is just starting to fill, we can put your name on a waiting list! <g>
 
Think about it, you have a wax up, a scanner, so if you have a need or desire to open the bite a couple of mm, how hard would it be to have a Ultimate quadrant created? Two teeth at a time, whatever. Easier with Ceramage, which handles like a regular composite and could be press fit with a stent over a model. If you don't have to prep, how easy could that be?  And even if you do, you know how long Luxatemp temps last when they are bonded on? Yeah, way too long!
 
So you could do the upper arch in porcelain, the lower in ceramage at a much lower cost, and then do the lower in six months or a year. Informing and interacting all the way!
 
Not hard to think about it, right?
 
Rick


On Tue, Feb 5, 2013 at 8:37 AM, Ed Suh <edsuh@nc.rr.com> wrote:
go into more detail with that Rick...  NO doubt we have some pretty cool materials that are out there... 
 
would you redesign a quad (at the new bite) at a time? 
 
wouldn't the rest of the arch be out of occlusion if you only did one arch?
 
"replace the material"?  if the lava ultimate "breaks" or "wears out" then do we just keep making new ones?
 
once the patient has paid to "rebuild" his/her new bite, then do you then go back and redo the restorations into a more "final" material? 
 
what would happen if the patient decided to not "complete" the rehab mid course?  or decided to move?  would you just adjust all the work down to the patient's initial MI?
 
I like the different options...  just trying to work out the paradigm in my head...
 
 
 
 
 
 
On Feb 5, 2013, at 9:08 AM, Rick Coker wrote:

With some of the new materials that lie between porcelain and luxatemp- Ceramage by Shofu, Lava Ultimate by 3M, you can build a tooth relatively inexpensively, even a quadrant at a time at that new bite, and then eventually replace the material as it wears out (and if it wears out!). We aren't limited to one material here!
 
Rick


On Tue, Feb 5, 2013 at 8:03 AM, David Hamel <hameldds@gmail.com> wrote:
I like that Rick.
 
Also an idea ran through my mind would be to ask him what he plans on doing to keep it from breaking again?  I suspect his answer would be something like, "well, the last one lasted 30 years..."  Now, maybe we could go with a 30 year old car analogy somehow.  So you think the only thing that has changed in 30 years is the bridge got older??  Is that what would happen to a car that you only drove an hour per day for 30 years?
 

Dave

David Hamel DDS
1200 Broadway
Marysville, KS 66508
KDA Past President 2010
 
 
 
 


 
On Feb 5, 2013, at 7:52 AM, Rick Coker wrote:

It is a great question, Ken, and one that all of us seem to struggle with.
 
My general outline for something like this would probably be:
1. Solve his immediate problem with a nice temporary bridge, as good as I can do. But tell him you won't do the final until his jaw problems are solved, but then you have to do some study in order to determine what sort of "fix" that might require.
2. After his examination, we would explain that he needs to wear some sort of orthotic appliance, some way to help ease the symptoms he is experiencing. You could use an NM orthotic, an NTI, a Kois appliance- just get him comfortable.
3. After seeing him for a few months and getting him comfortable with both your office and his bite, you take his models and show him the wear and tear he has experienced. I would say something like this: "Putting a new bridge here is like putting ONE new tire on your car- it really won't last too long or do what you want." This is a rebuild job and after he trusts you, he can begin to evaluate his options.
 
Today, with some of the new materials we have, you can do a full mouth treatment in stages, open the bite and place long lasting temps (fixed orthotics) and get the job done, if that is the way he wants to go, or you can just do a new Lava bridge and tell him good luck!
 
My contention is that he knows he has a lot that needs to be done, but wants to feel comfortable with who can treat his case.
 
Rick


On Tue, Feb 5, 2013 at 7:42 AM, Ken siegel <kensiegel@onlymyemail.com> wrote:
But.  What do you do for the immediate problem?
Kenneth Siegel, D.M.D.
Dental Excellence of Blue Bell
706 Dekalb Pike
Blue Bell, Pa 19422
 
From: Rick Coker <riccoker@gmail.com>
Reply-To: Rick Coker <riccoker@gmail.com>
Date: Tuesday, February 5, 2013 8:35 AM
To: Steve Markus <smarkus147545@comcast.net>
Cc: Ken Siegel <kensiegel@onlymyemail.com>, gnr <ACEsthetics@googlegroups.com>

Subject: Re: [ACEsthetics] new patient today
 
Folks, this is a great analogy, and great analogies don't grow on trees. I will be using this! Makes so much intuitive sense!
 
Good job, Steve.
 
Rick


On Mon, Feb 4, 2013 at 8:08 PM, Steve Markus <smarkus147545@comcast.net> wrote:
Are you into classic cars?  Just doing the bridge, without looking at everything else would be like trying to restore a classic car one quarter panel at a time.  Just off the top of my head.  For a woman: trying to do the bridge would be like buying a sleeve for the bridal gown this year, the trail next year, etc.  Let them connect the dots.
 
Steve Markus
The Centre for Dentistry at Haddon
209 White Horse Pike
Haddon Heights, NJ 08035
www.SmileSouthJersey.com
856 SMILE S J
 
From: Ken siegel
Sent: Monday, February 04, 2013 11:03 AM
To: gnr
Subject: [ACEsthetics] new patient today
 
So we had a consult this morning for someone new to the area that had porcelain break off of his front bridge.  We took photos and showed it to him on the BAM (big ass monitor) like Mac and Joleen tought us.  I spent maybe 5 minutes with him but my TC spent time showing him his photos and discussing what we all see.  Has some TMD symptoms so also showed him Curtis's presentation on TMJ.  He had no idea how bad things are so seems motivated.  So my question is, how do you get him to want to do his whole mouth when he was just concerned about the broken bridge.  He had no idea how much was going on until he saw the photos.
Kenneth Siegel, D.M.D.
Dental Excellence of Blue Bell
706 Dekalb Pike
Blue Bell, Pa 19422
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Director, Academy of Comprehensive Esthetics
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http://www.google.com/profiles/riccoker.
903-581-1777
 
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Director, Academy of Comprehensive Esthetics
www.tyler-smiles.com, www.tylersleep.com
http://www.google.com/profiles/riccoker.
903-581-1777
 
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http://www.google.com/profiles/riccoker.
903-581-1777

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