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Wednesday, June 5, 2013

Re: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs ago

Terry 
The Pan you see from Ash is Major facial reconstruction of Maxillary and Mandibular osseous structures
You clearly note the Condyle implants rehab,
 lower arch surgical advancement
Maxillary reconstruction 
Teeth are then restored to correct disparity
One very brilliant face and oral reconstruction by a great team of Surgeons and Dentist.

These types of procedures are big $$   in today's numbers would be over 250K  Surgeon/OR/ Dentist and when we total the time invested
 = there is more revenue doing Class II composite restorations.

  • Impressive yes
  • Great service for the patient yes
  • Back breaking for the Restorative Dentist
  • Great satisfaction for a Dentist 
  • Minimal financial return
  • NM or CR/CO concepts are not the agenda - the patient is
  • Healing takes 4-6 m and the patient has to be maintained thru that phase
  • Recon takes time, gradual adj and they continue for a life time
  • Zirconia IS NOT the material of choice.
  •  have used cast gold onlays,3/4 and 7/8 or 1/2 Crowns and full crowns in the posteriors
  • Anteriors PFM with Golden gate low fusing ceramic material that can mill a bit better than conventional porcelain
  •  have used emax restorations in the past few years and all resin restorations,  
  • They just need constant monitoring and adjustments
  •   there are changes in jaw relation and treatment is always fluid
  • In same patients you take 4 sets of records and none is repeatable!! 
  •  find it a simpler and successful outcome when I let the patient mill the resin provisionals 
  •  have used heat processed occusal guards with group function type support and seen wear patterns change 
  • So it goes...


  • Arun






On Tue, Jun 4, 2013 at 7:43 PM, <terryfrey@relax2smile.com> wrote:
Ash and all ... I've never seen anything approaching this in my small rural practice in SE Indiana. What lead up to this?  This is WAY off my chart.
Thanks,
Terry

J Terry Frey, DDS
Advanced Dental Care
623 N State St/PO Box 1008
North Vernon, IN  47265
 
 
-------- Original Message --------
Subject: Re: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs
ago
From: Ashley Goodman <agoodman@agoodmandds.com>
Date: Tue, June 04, 2013 7:27 pm
To: arunnayyardmd@gmail.com
Cc: dr.stevehill@shaw.ca, smarkus147545@comcast.net, Ace
<acesthetics@googlegroups.com>




Here's one of those cases.  This patient looked up at me with tears in his eyes after we put him in the FM splint and said, "Thanks doc!  Now I can start eating solid food again."  He gave me a big hug and the nurse while he was still crying for joy.  Later on he told me that we gave him his life back.  Very, very rewarding case (And I'm not talking money here).
------- Ash ------------------------------------ Ashley Goodman, DDS 8736 Lake Murray Blvd.#108 San Diego, Ca 92119 Phone: 619-697-6677 Fax: 619-697-6632 Email: agoodman@agoodmandds.comWeb: www.agoodmandds.com------------------------------------On 6/4/2013 4:11 PM, arunnayyardmd@gmail.com wrote:
I was waiting for u to comment. Those of us who were practicing in the 1970s-90s when this surgery was hot have seen our share.
I agree with the vdo + calming and healing to no symptoms THEN restore IF needed
I will share more as this pt tx moves forward
She is v anti dental right now
Arun
Sent via BlackBerry from T-Mobile
From: Ashley Goodman <agoodman@agoodmandds.com>
Date: Tue, 04 Jun 2013 16:04:07 -0700
Subject: Re: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs ago

I've done these cases very successfully.  Prior to the FMR definitly place the patient in a full splint that doesn't have any occusal locks and do constant adjustments.  WAIT FOR HEALING! and the patient to be in a comfortable position.  Section the splint as you restore each area so as not to loose the jaw position.  CR and NM are pretty much useless with no condyles, TMJ, etc.  All the patient has is a fibrous joint that shrinks just like scare tissue and also adhesions.  Fun cases.
------- Ash ------------------------------------ Ashley Goodman, DDS 8736 Lake Murray Blvd.#108 San Diego, Ca 92119 Phone: 619-697-6677 Fax: 619-697-6632 Email: agoodman@agoodmandds.comWeb: www.agoodmandds.com------------------------------------
On 6/4/2013 11:22 AM, Steve Hill wrote:
IMHO....posterior compression is the potential issue here. This issue is bad enough when the articular disk is not in place...but no condyles?? If you put a deprogrammer in the anterior, what do you think the force vector of the masseter muscles will tend to do to the mandibular plane??
The TENS will actually place the masseters close to their physiological resting length. But no matter what what is done to determine the bite/mandibular position, please place a full occlusal coverage appliance....
 
Respectfully,
Steve
 
Sent: Monday, June 03, 2013 7:48 PM
Subject: Re: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs ago
 
Keep it simple – soft diet, deptrogrammer, rocabado pt referral. 
 
Steve Markus
The Centre for Dentistry at Haddon
209 White Horse Pike
Haddon Heights, NJ 08035
www.SmileSouthJersey.com
856 SMILE S J
 
Sent: Monday, June 03, 2013 9:26 PM
To: Ace
Subject: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs ago
 
Hi Friends
 
New referral   46yr old female, bilateral condylectomies 16 yrs ago.  Had endo 6m ago and restorative.... long appt.  Now she has pain in her muscles and is blaiming her Dentist caused it by keeping her mouth open a long time.
 
SO all the occlusodontists here..  how would you manage this patient.??
 
I will appreciate your guidance

Arun

--
 

Arun Nayyar DMD,MS. Atlanta, Georgia

 
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--
 

Arun Nayyar DMD,MS.  Atlanta, Georgia

Private practice limited to Prosthodontics -   Imagix Dental Group

Former Director of Fixed Prosthodontics -     MCG School of Dentistry

Principle Research Scientist ( Adjunct )       @  GaTech -GTRI

Clinical Director -     Center for Dental Technology @ GaTech - GTRI

 

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