by Dr. John Nosti
I’ve repeated “protect the patient” over and over again in this ceramic protection series because it is the most important step you can take to avoid fracture.
Of course, patient-oriented care is always the golden standard by which we should operate. If you take into account the larger, more detailed picture of a patient’s dental history, you can better treat them.
This guideline is the least pressing of the four that have followed, but it can still pose difficulties in the long run.
Cosmetic dentistry is rewarding for not only the significant financial benefits, but because it can build more emotionally satisfying relationships with patients. Implementing parafunctional protection guidelines will help you foster and strengthen them further.
Protect Patients Who Report with an Ever-Increasing Diastema
If you notice – and it would be difficult not to – that your patient has a diastema, that should raise a few warning bells. Make sure you question them to see if they have noticed that the space has increased.
This indicates that an appliance is worth consideration. You will also want to check for fremitus in the teeth. This should be treated prior and post operatively if you realize it is contributing to the problem.
If you don’t notice the issue before beginning treatment, it’s not as difficult to resolve as the fracture causes I have outlined previously. Most likely, the patient will report a space where the original diastema was. This will typically occur about one month post-cementation.
The fix is relatively simple. Closing the space can be done with a combination aligner/protective appliance.
Look for the final guideline in this series to learn how to limit the percentage of porcelain fracture in your dental office. These tips are a compilation of ceramic restoration knowledge that I have put together over 10 years of performing “cosmetic rehabilitations.”
Read the first three guidelines in Dr. Nosti’s ceramic porcelain fracture series. He discusses the best approach to occlusion for preventing fractures, why you must evaluate a patient’s past tendency to broken temporaries, protecting patients were anterior guidance is not achievable and dentistry in general.