Tuesday, October 2, 2012

The Patient That Cannot Be Fixed

Sorry about last week. I didn't forget; I just am stressed beyond my ability to handle. See, I gave a lecture on Saturday, but this one was different. I gave my regular lecture in the morning and my first hands-on course in the afternoon. Oh my gosh. Doing a hands-on course is SO MUCH WORK.

When I do a filling, I go into a room and it is all there. I never have to think about how much stuff I really use. I don't have a sponsor, so I have had to beg, borrow and steal products to have on the lab bench for people. I am not getting paid very much to do to this because I just wanted the opportunity. If I spend money on products to give away, I really would make nothing. And making nothing is not an option because it is so much work (did I say this already?).

Triodent donated the models. But the models just have an MO and an MOD on them and I think everyone can do that. I wanted to take the class up a notch by putting in an MOL cusp replacement, an access filling and an MODF build-up. All this for them to think out of the box when it comes to restoring with composite.

There is just one small problem: the models don't come prepped this way. I prepped the teeth on all 17 models individually after work. I have been putting in 12-hour days, cussing under my breath saying, "I bet Frank Spear doesn't have to do this." I know, I know: I am no Frank Spear.

Along with the models, I had to get the resin donated. The bonding agent donated was donated. Twenty Contact Pros were donated. I got tofflemire matrices from WaterPik. I got bands and V3 rings from Triodent. But what about placement instruments or explorers or finishing discs or glazing products? Ughhhh. What a royal pain in the neck.

All participants have to bring their own handpieces (high- and low-speed), composite trays and finishing burs. Does that mean they are going to bring a tofflemire? I don't know. There are 17 participants, but I only have 10 tofflemires in my office.

Four days before the course, the university started sending me paperwork to sign. Oh, and I had to watch a HIPPA video and get certified. What? I have been scheduled to do this lecture for a year and you are sending me paperwork 4 days before the course that I am already stressing about?

And I am trying to run a practice. And I am training for a marathon. And I have a family that wants a piece of me, too. Anyway. That is just a little glimpse in my life. I know I made this bed. But I thought being a lecturer would be cool.

Today's topic (no, that wasn't it) is the patient that can’t be fixed. I have this retired man who has been a patient for a long time. He is an absolutely great guy. We all love him and he loves us.

He has a broken bridge. The abutments are 6 and 7 and the cantilever pontic is 5. I don't think he had 4. Both abutments had RCT and post and cores. The core broke on 7 but he broke the post in half on 6. I sent him to the periodontist to discuss doing some implants to replace this bridge. He said, "No way. They are too expensive. I am on a fixed income and I can't do it." We talked him into doing an implant on 4 and agreed that I would try to salvage the bridge.

I sent him to an endodontist to take the broken post out of the tooth; he said it couldn't be done. I put 3 minum pins in 6 and did a reverse build-up on both 6 and 7. It looked great and we just recemented the bridge. We finished up the implant and things were looking pretty good for about 6 months. Then, it broke off again with both abutments in the bridge.

Hmm. We decided there was not much we could do except try again. Two more reverse build-ups and recement the bridge. Again, things looked good… for about 4 months. By then, he was tired of spending money and I was tired of looking like a crappy dentist.

I told our patient that if he got the post out and we did a reverse post and core, this would be the last time he would pay for this. I was essentially guaranteeing the work. He agreed.

I then sent him to another endodontist to see if he would take the broken post out of 6. No problem. We did the work. I relieved the occlusion the best I could and he was thrilled. I was so proud of myself for fixing him and making him happy again.

Four months. This lasted four months before he broke the post again. I was now convinced this couldn't be fixed.

When the bridge was out, I took an impression for a Valplast partial. I then did some more minum pins and reverse build-ups and temporarily cemented the bridge so it would come off and not break the build-ups.

He was in the next day. We cemented the bridge with stronger temp cement and he was back in 2 weeks. At this point, the partial was made. We took 6 and 7 down to the gum line and put in his new free Valplast partial.

He was happy, but I don't know how he could be It must be tough for a 70-year-old man to get used to a removable partial. But this made me think. Sometimes some teeth, with the present technology, can't be fixed. I thought I could have tried a cast post and core, but other than that, there was nothing else to try. I think he still would have broken the cast post and core and, come to think about it, I think he might have broken the implant too.

So, you know what? I think we did the best we could. The thing is going to flex when he moves on over with his jaw muscles not breaking anything. I am just frustrated that I had to do this five times to realize it wasn't going to work. I want to think that what we do works. I know it does, but once, maybe just one time it won’t work. But you just never know when that patient is going to walk in.

Have a great week. I am probably out for tomorrow because I will be so stressed out. See you next time.



Lilya said...

That sounds like a tough case, but I am sure the patient appreciated that you gave it a shot, most dentists would just go straight to the partial.


Anonymous said...

Ferrule Effect.


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