Follow-Up on the Old Man

My oldest patient on came back for another routine check the other day, and our #21 is still holding strong! His restoration was showcased in a CEREC Digest article that I wrote early this year, and it is still one of my favorite. Here’s a photo I took this week.

Eight-month follow up of the #21 ceramic restoration.

There’s something mesmerizing about the subtle details in emulating the defects and imperfections on his other teeth. Or the fact that this whole thing was stained on a piece of monolithic ceramic, so everything is a beautiful little lie. Just to recap the original treatment process:

Initial photo back in February.
The design process in CEREC.
One week post delivery.

One of the issues that I contended with for this patient was the design of his occlusion. His short abutment plus deep bite is already doubly fun, for sure, but the fact that he’s 92 made it unclear whether his teeth attrition is due to paranormal function or simply a consequence of time.

Oh ferrule, where art thou?

So in the end we went for a safe contact strength at maximum intercuspation, and pretty much just eye-balled the palatal slope needed for protrusive movement. I ended up adjusting a slight amount for the dynamic movements during delivery, though it was perhaps more for myself than the patient.

Light occlusal contact strength during MIP.

In retrospect, virtual articulator may have helped in this situation. It would’ve allowed me to adjust even less (or none) intraorally because all the protrusive interference would’ve been eliminated in the software. Of course, if we really wanted to go all out, the SICAT digital facebow could’ve given us the full picture. But then all that for a single-tooth restoration… Maybe that’s why digital facebows are a hard sell at the moment.

One of our treatments utilizing SICAT jaw tracing with CT integration.