Re: They dont fool around in Ontario

From: Dr. Steve (dr.steve._at_.m.a.n.c.u.s.o.d.d.s.com)
Date: 09/10/04 

Date: Fri, 10 Sep 2004 20:21:34 GMT

Pipe Dude,

Take an alginate ahead of time. Vacuum form 0.05" (very thin) template
acrylic over model. Prep the teeth on the model right through the template.
Cut the tooth (to be extracted) off the model. Make a recess in the ridge
to simulate the extraction socket. Paint separator on model. Bend a
Monodont component to fit the preps (usually have to remove more stone and
make the preps bigger at this stage--modify preps with the template in
place). Sticky wax the component into the preps. Take a denture tooth and
trim it until it fits over the component snugly. Remember RPD lab in
school? Add tooth colored acrylic (denture repair liquid with SNAP or TRIM
powder). Heat cure in a pressure pot. Smoothen and polish on lathe.
Disinfect Monodont and template overnight in your gluteraldehyde soak.

Chairside: Numb patient. Place template and cut preps through holes in
template. Now extract the tooth. Lay a gauze strip over the socket (use a
cotton roll under the lip to hold one end in place--your finger will work
for the other end). Try-in the Monodont. Often, you will have to cut more
tooth as we dentists tend to always be too conservative. Once you verify
fit,,,,,,,, place a fresh gauze strip and cotton roll. Etch, rinse, dry,
hurriseal, BA, cure. Then,,,,,, fill prep 3/4 full with flowable composite.
Place Monodont in position, verify esthetics, and cure. Add more flowable
composite to just cover component and cure. Top off with your favorite
composite (micro-fill, macro-fill, whatever). Trim excess composite, adjust
occlusion and polish. Pull out the gauze strip and hand the patient a
mirror. Even with a very deep bullet shaped pontic the gauze strip pulls
right out.

After you get used to it,,,,,,,,,, 30 minutes of lab time and 30 minutes at
the chair. No lab fee. Plan it on Monday, seat it on Tuesday (or Monday
afternoon if you have time to get the lab work done).

Stevie Wonder 

-- 
+=_-+=_-+=_-+=_-+=_-+=_-+=_-+=_-
Stephen Mancuso, D.D.S.
Troy, Michigan  USA
.dr.steve@man.cuso.d.d.s.com.
~~~~~~~~~~~~~~~~~~~
"StovePipe" <stovepipeTR@SHglobetrotter.net> wrote in message 
news:1gjwic3.1aachcp1kzi1xfN%stovepipeTR@SHglobetrotter.net...
> Dr Steve <nospam@home.net> wrote:
>
>> Oh, BTW: I got my SoloPontic/MonoDont back from KellerLabs today, and
>> > removed the upper left central in my patient's mouth and cemented it in
>> > this night.... Learned from that: one should NOT pack the alveolus with
>> > too much Gel-Foam. Hell to work around the blood pool and try to keep a
>> > dry field. I have pictures and will post them soon, for your critical
>> > eyes.
>>
>>
>> I cut a narrow strip of gauze, hold it over the socket, and bond away. 
>> The
>> gauze pulls right out after bonding.
>
> If I had but read your posting from a few weeks ago, explaining how you
> do this, and the one you posted earlier for Carabelli (I **think**) who
> had to remove an upper central (and which dilemma was solved by W_B's
> suggestion of an immediate flipper...). I would have been adequately
> prepared for the prep and cimentation of this case. As it was, that was
> a last-minute addition to fill in an evening app't cancelled with a few
> hours' notice, coupled with the patient having phoned and complaining
> that the temporary composite bridge that I had placed each side of the
> central had come loose. (This means TROUBLE down the line I can just
> FEEL it...). My secretary told me to go get the case at the post office
> (duties levied by Kaannaadaa for the KellerLabs case) before starting. I
> didn't have time to review those posts.
>
> I DID remember you used gause strips... I DIDN'T realize, untill I was
> SWEARING at the bleeding alveolus, and praying to the saint of immediate
> and magical clotting (Ste. Apollonia, patron of Dentistry), just exactly
> WHY the gauze is so important. I know NOW that it is to WICK away the
> blood that was merrily pooling around the papilla mesial to the exo
> site. I know NOW that one CAN place Gel Foam in the alveolus, but it
> must be no bigger than pea-sized (whereas I just accepted the whole
> piece given me and plugged it like an Am into the alveolus, reasoning
> that the pressure would aid in hemostasis...), and preferably in no way
> interfering with the 'root' portion of the MonoDont. But Gel-Foam
> expands.... a lot! It was flush with the gum-line.
>
> I know NOW that I will schedule an 'Immediate MonoDont'/Exo with at
> least 1/2 hr between the prep-of-adjacent-teeth-Exo and the
> Try-In/cimentation of said blessed MonoDont. The patient will have had
> their first post-op pain med, I'll re-anesthetize and place the gause
> strip after etching the preps. An initial hemostasis will hopefully have
> occured.
>
> I'll post those blessed photos, along with the original x-ray photo
> (just to refresh your memory), as soon as I locate the $%??&&* SmartCard
> USB reader to transfer them from the camera to the iBook.
>
> I'll repost this part along with appropriate commentary re: the photos
> and we'll all have a good laugh over it. Remember, it was my FIRST CASE,
> and I am not as endowed with foresight as I would like. The next one
> will be smoother, as I've learned a lot from this one.
>
> At the very least, it will give you an idea of what the store-bought
> version (SoloPontic from KellerLabs) is like. I had wanted to send it to
> the local lab so they could take notes for future, but there wasn't
> time. We HAD to proceed Wednesday night, as the tooth was broken, and
> had I re-scheduled, there would have probably been a lot of marginal
> inflammation around the fracture (more blood post exo...).... <Sigh...>
> TMS&ISTI
> SP
> -- 
> To reply: take out the TRASH...

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