Measure Twice, Cut Once

I've done some dumb things over the years. I've even made an upper partial denture that didn't have room for teeth because the lower teeth had erupted into the upper space. I knew better, but I didn't do the simple things I should have done because I got in a hurry.

This image shows fractured porcelain on two lower molars. The second molar is actually a crown that is implant retained. The metal showing through is not the coping under the porcelain; it's the stock abutment showing through.

 

If you look at the opposing arch you would see an upper second molar that has supraerupted into the lower second molar space resulting in inadequate room for the tissue level implant, the abutment and the crown.

This is most likely because the case was done without any pre-treatment planning and both the surgeon and restorative dentist missed this important issue. Had the case been treatment planned using articulated diagnostic casts it would have been obvious that there was inadequate intermaxillary space.

Either intruding the upper molar orthodontically, or placing a restoration on the upper molar to bring it back into the plane of occlusion could have easily solved this issue. Even if the upper molar required a crown lengthening procedure prior to a new restoration, it wouldn't be necessary to do the lower dentistry over.

Sometimes remembering the simple things we learned in dental school is fundamental to our success.


The concept of Facially Generated Treatment Planning can greatly simplify treatment planning for wear patients. You can find more information about treatment planning, esthetics and occlusion within the Spear Digital Suite. Download the free resource:
The 8 Steps Checklist-Facially Generated Treatment Planning.