Transcript Debbie_C_-_PGOcclusion

Refractory CMD Case
5 years of treatment, 3
years of “Hell”,
5 months of Torment;
4 days to basic comfort!!
Presentation 5/21
Glued On Splint, Hygiene??
Cemented Splint Fractured
Splint Ends First Molar
R
Lower Anterior with Splint Off
What is the Intent of Treatment?
Extra Length,
Molars in
Occlusion,
Would the resultant
Vector distalize the
Mandible?
Not Very Comfortable,
Old Mandibular Splint
Where is
She
Rubbing?
Incisal Ramp
Is it
built
out
a bit far?
1st Mark, Splint Rocks!
What
Is the
Effect of
A Rocking
Splint?
What do you call this splint?
What is
the
Basic
Design?
Is this a
Tanner
Splint?
NO!!!
Can we use it?
If so, what is next step?
If so, what is next step?
Reline
And
Resurface
PGA
1st Adjustment
2nd Adjustment
3rd Adjustment - “Freedom”
3 day PO, Splint Great,
Chewing with Teeth Bad
1st Adjustment, Feels Good
4th Day PO, “Cadillac” of Splints
First Smile in Months
4th day PO, 1st Adjustment
Still Cannot Eat or Leave Splint Out
What is Next Check?
What is Next Check?
2+ Fremulous #8
Now What??
 Allow
her to feel motion
 Allow her to choose the affected
tooth
 Ask permission to reshape a
tooth
 Which one?
 #25, lower right incisor!!!
Is it the Bevel on #25, or
the length?
Unposed photo’s, 4 days apart
What is the real Effect??
Occlusal Impact

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This early result could be achieved with an
anterior jig or prop, Lucia or NTI.
The important aspect of the PGA is the
muscle and joint stability.
We are also on a diagnostic path that is
leading toward a stable conclusion.
Any anterior dis-occluding device must be
replaced with a stable occlusal design.
PGA simulates a stable occlusal design and is
in the progression to a final restoration.