Oral Health Group

A Missing Tooth

April 1, 2010
by Sophie Labelle, CDA

In dentistry, the best asset to a dental operatory is a dental assistant who makes organization a priority. A dental assistant’s first approach to treatment planning is to predetermine and pre-prepare what has to be accomplished.

I begin by verifying the chart, complete treatment plan, study models and establish an action plan that is going to help the dentist reach the treatment objectives. By doing this, I am always thinking two steps ahead of the dentist allowing a smooth integration of the dentist’s plan and the assistant’s plan.


A Missing tooth: Diagnostic wax-up

Let’s begin by replacing a missing tooth with a fixed bridge. The evaluation of the study models and of the diagnostic wax up is an easy and logical place to begin. It provides us with a tool for the start of a complete treatment plan. (Fig. 1)

The wax up will allow us to consider the different aspects of the dentition and will facilitate planning modifications. In the opening where the pontic is going to be placed, an adequate amount of space is required. A perfect balance of the adjacent teeth is necessary and can be achieved by grinding the appropriate tooth on the model creating an instant orthodontics effect. (Fig. 2 and 3)

The assistant needs to establish on the model the ideal gingival level. This step will make the dentist’s job much easier. It is an extremely important step because a inclined tooth always need modification. Gingival modifications can be achieved by using a diode laser, electrosurge or scalpel. Corrections to the occlusal plane can be accomplished by the addition of composite resin. By proper planning, a dental assistant can correct these aspects outside of the treatment room. (Fig. 4)

When the adjacent teeth and the upper teeth fit perfectly. I will then sculpt a tooth pontic by respecting the area and the dimension of the dentition (Fig. 5, 6 and 7)

Advantages of a well planned temporary:

1. Allows the patient to get used to and live with his tooth. A well made temporary is the key to an esthetic restoration! It provides the lab with a blueprint for tooth length, width, thickness, and occlusion. Once the patient has approved the temporary, the lab using silicone templates replicates it in porcelain.

2. Reestablish the occlusal plane

3. Saves time during the appointment.

A well planned temporary will allow us to have a result with no surprises. We will have a happy patient with excellent esthetics, phonetics and a proper occlusion.

Time taken and products used:

– 20 minutes

– Composite resin to rebuild teeth

– Plaster study models

– Silicone matrix to fabricate temporaries

Occlusal adjustment exercise

Occlusion is the key to an esthetic case. How many times are we presented with cases where porcelain is broken, pain and occlusal traumatism resulting of an improper occlusal adjustment.

Dr. Peter Dawson has long advocated the concept of “Complete Dentistry” integrating dental and periodontal health with TMJ and muscular balance.

Occlusion is an essential part of this principle and every esthetic case should be treated in a complete way.

What I am about to show you is a proper occlusal adjustment in an easy manner that will make simplify your and your dentist’s work and most importantly benefit the patient. This adjustment is an easy task for the assistant but only three out of five patients will succeed in accomplishing this task from the first time. The idea is for the patient to understand and visualize how it is going to work.

In every successful esthetic restoration, the goal is to arrive to a natural, harmonious and healthy result. Unfortunately, certain cases can turn into nightmares resulting in pain due to improper occlusion.

These problems could be avoided by eliminating the possible interferences with masticatory movements. It is up to the assistant to make sure that these interferences are checked before the final appointment.

The interference occlusal adjustement exercise is comprised of four steps that are easy to understand for the patient.

Position 1 is to keep the upper and lower teeth in a complete closed bite position. If the patient is unable to do so, an easy trick is to ask the patient to swallow and this will put him automatically in complete closed bite position. We then ask the patient to produce lateral and forward movement to check if the central occlusion is perfect. (Fig. 8)

Position 2 allows us to check right lateral occlusion. Teeth #6 and #27 should be in contact (Fig. 9) to allow proper occlusion. Position 3 allows us to check left lateral occlusion. Teeth #11 and #22 should be in contact (Fig. 10) to allow proper occlusion. Position 4 allows us to check forward movement of the upper # 8, #9 and lower # 24, #25 central incisors that must touch in this position. (Fig. 11)

This simple exercise will allow the dentist to properly adjust the veneers or crowns after the final cementation thus producing successful complete dental esthetic cases.

These simple tools are not complicated to use on a daily manner, all one has to do is make them an automatic choice and results will come by themselves. One has always to remember that small steps in esthetic restorations save sometimes time, money and aggravation for the dentist and the patient. OH

Sophie Labelle became a certified dental assist ant in 1994. She works with Dr Elliot Mechanic in Montreal as his main assistant.

Oral Health welcomes this original article.