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Phased Restorations - Follow-up Questions and Answers

Posted by Doug Brown on Thu, Apr 21, 2016 @ 11:04 AM

In March 2016, Dr. Rick Rogers, President-Dental Association Company Maryland State Dental Association, presented: 
Providing Optimal Dentistry For Patients With Limited Finances”

This presentation was enthusiastically received and prompted a number of follow-up questions.

This article provides the questions and Dr. Roger's answers.

Platinum members who missed this webinar can view it in the
BiteFX Members' Area under Webinar Recordings

Non-Platinum members can call us to purchase viewing access.


Questions cover:

Q1: (Dr. Don Reid) Do you sometimes reduce facials/linguals at time of seating the posterior clear tray?

A1: (Dr. Rogers) The rule is the lab cannot reduce the tooth structure. I can chairside if needed. The only reason to reduce facial surfaces would be in cases requiring significant esthetic changes early so the lab is to wax over the entire buccal surface of selected teeth. If needed; the dentist can reduce during the procedure to allow more composite thickness to better control esthetics.

Q2: (Dr. Don Reid) Is that an issue if you don't touch the occlusal [surfaces?]?

A2: (Dr. Rogers) No. This buccal cosmetic change can be done regardless of the need for occlusal modification.

Q3: (Dr. Don Reid) How reliable are the indexes routinely?

A3: (Dr. Rogers) Very reliable as long as the lab and the doctor follow the rules of protecting the 'stops' and waxing the case up in the correct order and fabricating the indexes properly.

Q4: (Dr. Danilo Strumendo) When using orthodontics to put teeth back to where they used to be and create space for restorative material is the ortho done CR or MIP/ habit bite ? Correct me if I'm wrong but Invisalign is done in habit bite ?

A1: (Dr. Rogers) The case I showed was a situation where CR = is in the case of many collapsed vertical deep bite cases. As mentioned in the presentation; I don't get too concerned on AP ( anterior-posterior) CR/CR discrepancies with the patient lacking in signs or symptoms of occlusal disharmony. The patients that present with a lateral shift from CR to MIP should be treated with an acute awareness to this condition and every effort should be made to eliminate the 'slide' when making occlusal changes. Patients with either discrepancy, with low restorative needs and signs/symptoms indicate they are well adapted and in my opinion should be left alone. My standard of care, for my orthodontist who treats these adult patients, is to finish the case with CR/CO in harmony.
The response thus far has been about philosophy. The question focuses on Invisalign and its ability to correct CR/CO discrepancies. While Invisalign has been making efforts to utilize bite registrations for CR recordings for alignment; I still think cases with significant discrepancies, especially lateral shifts, should be treated with traditional orthodontics. In my hands, the exception to this rule is when the 'shift' can be corrected/minimized with pre-orthodontic equilibration. I have successfully treated many patients that first required limited equilibration to eliminate the 'shift', followed by a new bite recording in MIP, followed by Invisalign alignment for limited tooth movement.

Q5: (Dr. Danilo Strumendo) Is memosil a bite registration material ? Dr. Rogers said it was a clear putty - on the Heraus kulZer website they only have it as a bite material.

A2: (Dr. Rogers) Memosil 2 is a clear material that can be used for many applications including what was shown in my presentation. Adequate thickness of the material used for an 'index' allows for curing light penetration along with rigidity for an accurate transfer of the occlusal wax up to the mouth. 


Again, if you missed the presentation:


Tags: Dental Technique

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