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

Most dentists would look at the pano, and say, "Darn, that's who bought my erector set at mom's yard sale."  Never thinking about joint function (because you cannot think about what you do not know).  Personally, I would put that case down the Interstate to John Droter.
 
Steve Markus
The Centre for Dentistry at Haddon
209 White Horse Pike
Haddon Heights, NJ 08035
www.SmileSouthJersey.com
856 SMILE S J
 
Sent: Wednesday, June 05, 2013 11:52 PM
Subject: Re: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs ago
 
The PT portion of Tx/recovery was through direction of the medical/OMFS team that anchored this particular case for which I did the reconstructive dentistry which was just one aspect of the case. 

As I recall there were 2 or 3 medical/OMFS surgeons, Speech T, Physical T, Respiratory T, psychologist, plastic surgeon, neurologist, and myself the dentist.  Full case planning with each treater scheduled loosely.  These cases are full team projects and continue.  They are assumed lifetime patients.

Can you imagine one of these walking in to the average family dental office?  Probably give that dentist a chance to use that defib that's been just sitting in the office... for the dentist.  ;-)

Can't wait for Arun to update his case progress.  There's always much to learn from others doing these types of 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.com  Web:  www.agoodmandds.com  ------------------------------------
On 6/5/2013 7:29 PM, Steve Markus wrote:
Rocabado â€" formulated PT regimens for joint derangements.  I’ve been working with Amelia Nelson for over 30 years, and she’s a genius, trained by Dr. Rocabado back in the seventies.
 
Steve Markus
The Centre for Dentistry at Haddon
209 White Horse Pike
Haddon Heights, NJ 08035
www.SmileSouthJersey.com
856 SMILE S J
 
Sent: Wednesday, June 05, 2013 12:45 AM
Subject: Re: [ACEsthetics] New patient with bilateral TMJ surgery 16 yrs ago
 
First off as Arun pointed out, every case is unique.  Basically, you're flying by the seat of your pants and relying on a great deal of experience.  Don't get wrapped up in a specific Tx plan.  Things change as each case progresses.

For the splint, I do a wax bite with an educated guess for "centric" and vertical (Vertical more important at this stage) to where the patient feels comfortable (sloppy definition).  Decide which arch is more stable and that is the one that gets the splint with no occlusal locks (Flat plane).  I use a thermo plastic so that it will snap onto the arch at the centric/vertical of the wax mush bite.

I'm only looking for vertical first so I will add or remove acrylic as the patient feels better or has a problem.  The only occlusal contacts are at the cusp tips, at this point, sliding on the splint.  This goes on for roughly 2-6 mos. or longer.

Understand that these cases don't really "heal".  The fibrous articulations keep changing and you will still be doing some adjustments after restoration.  The pan that I showed was a near completed case.  I haven't had time to scan the preliminary pan (Which wasn't digital) for you yet.

A "comfortable" position is when the occlusion hasn't changed as fast as before and seems to be stable for about at least 2 mos. and the patient tells you that they feel comfortable (That's about as good an indicator as you're going to have).

You have no bone attachments for many of the muscles, and/or they've been repositioned on unstable or fixated bone and the bone and fibrous tissue is still changing in position, flexure, shape, etc..  There are no fixed landmarks for you to relate to as everything is in constant change and articulating in places that don't on a normal patient and those keep changing.  Picture trying to nail Jello to a wall.

PFM with removal buttons with everything cemented temporarily so that changes can be made to the bite, vertical, etc. (Time is case dependent.  The more surgical repositioning, the longer for "stability") by sending back to the lab.  Keep it close to flat plane and never more than 20 degree cuspal inclines.  If you bonded Emax, etc., you will really regret using that type of material when you're making changes.  You can also use lab processed acrylic, but it may not last the duration.

To reiterate what Arun said, these cases take time and require many changes along the way.  Don't rush and do expect to make changes as you go.

I'm not a good typist and it's getting late and one of my sons just flew in from SF area so I'm off for tonight mainly.  Let me know if there's anything I can help with as I find time (We also have a solar company besides dentistry).
-------    Ash    ------------------------------------  Ashley Goodman, DDS  8736 Lake Murray Blvd.#108  San Diego, Ca 92119  Phone:  619-697-6677  Fax:  619-697-6632  Email: agoodman@agoodmandds.com  Web:  www.agoodmandds.com  ------------------------------------
On 6/4/2013 7:26 PM, safariandmd@aim.com wrote:
Ash,
 
I have a few questions.
 
-How do you take the bite for the full splint?
-how do you adjust the case? In other words what type of contacts are you looking for?
-how do you know the patient has healed?
-what do you mean by a comfortable position?
-why  would NM be useless in these cases?
-not sure if the pano you showed was your case but if it was why PFM everything?


Shahin Safarian DMD, MBA, LVIF | Irresistible Smiles
Carmel Valley/Del Mar 858.755.8993 | Chula Vista/Eastlake 619.656.6785
WEBSITE | FACEBOOK | LINKEDIN | YOUTUBE | THEBATTLEGUARD



-----Original Message-----
From: Ashley Goodman mailto:agoodman@agoodmandds.com
To: dr.stevehill mailto:dr.stevehill@shaw.ca
Cc: smarkus147545 mailto:smarkus147545@comcast.net; arunnayyardmd mailto:arunnayyardmd@gmail.com; Ace mailto:ACEsthetics@googlegroups.com
Sent: Tue, Jun 4, 2013 04:04 PM
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.com  Web:  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 â€" 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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Unknown ● Thursday, June 6, 2013

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