Friday 7th June
14 WORDS, rehabilitation versus reconstruction
14 years are already passed since the first time the 3STEP was proposed. Nowadays the indications are exponentially increased. The force of a 3STEP is the capacity to do a test drive on patients before restoring them, all done in composite and in ADDITIVE manner. Thanks to these two characteristic the 3STEP is not a technique, but it becomes an essential protocol for any clinician who what to treat a patients, stabilising the occlusion and improving the function. In this presentation 14 key words will be illustrated to show how the 3STEP could become essential part in a dental practice.
Understand that the 3STEP is more than a simple technique. It is protocol and a guide to know better each patient before starting with final restorations.
Often the diagnosis is lacking in case of restoring worn down incisal edges. In the author’s opinion, clinicians should identify the mechanics of the wear before starting the reconstruction. If the original (the enamel) broke down can a REPAIR perform better? In case of Erosion, yes, but in case of functional problems NO. In this presentation, a case of severe wear treated with a 3STEP with 10 year follow-up will be used to warn clinicians about the problems related to a lack of initial correct diagnosis.
Identify the different errors during the reconstruction of a dentition of a patient who was not correctly diagnosed and rehabilitated.
Centered mandibles, how and why?
The 3STEP has a strict protocol about the initial position of the mandible before starting the rehabilitation. The mandible should be in a muscular therapeutic position of comfort. The different ways to record this position will be explained, with a review of the 5 points essential in planning a rehabilitation.
Review the 5 points:
How to articulate the models?
How much give to the maxillary arch?
How much to increase the VDO?
How to distribute the posterior space?
Which type of white bite?
Revisited Planas, deep bite, ageing, and unilateral function
In this part of the course, Dr. Vailati will share her way of analysis patients, defined the desert island’s protocol.
In a complex panorama about function, analysing a patient may become very complex and expensive. Can a functional diagnosis be done also in a simplified, but still efficient manner, to be really used everyday? This is the aim of Dr. Vailati’s work. In this project, Dr. Pedro Planas’ ideas are perfect, adding value to particular topic such as physiologic ageing and tooth wear.
In modern time, esthetic has gained more space in the treatment plan than function. However, planning a full-mouth rehabilitation only based on esthetic requests could be very risky. The risk of worsening deep bite (and compromising patient’s function), while rejuvenating the patient’s smile is very common. Three different phases in treatment planning can be identified, based on the different parameters considered important by each clinician during the therapy. Dentists are in phase 1 of their professional life when they consider that the most important function of the mouth is smiling. This attitude is very dangerous, since it increases the risks of restoration failure.
A simplified approach to achieve a rehabilitation, which doesn’t only look esthetic, but also functions well is derived from the clinical observations of Dr. Pedro Planas. His ideas have been fully integrated in the work of Dr. Vailati to improve the comfort of the patient and the longevity of the restorations.
Thanks to his work, dentists can learn how to analyse the movements of the mouth and determine if they are physiologic or pathological.
The development of the condyles, mandible and maxilla will be considered and information on how a dentition should age will be given.
Learn about the movements of the jaw
Learn Planas’ laws on the development of the mouth
Learn the potential risks of a deep bite
Define how a dentition should age.
Decide to design the smile using an intelligent esthetic
Saturday 8th June
Motion and G test, vertical and horizontal function
When restoring patients, clinician hope that they will adapt to the new function in a manner which will guarantee the longevity of the restorations. In case of worn down dentition, however, patient present with a chaotic way of chewing and parafuncitonal habits. A classic way of checking occlusion may not be sufficient. Dr. Vailati has implement in her office the use of a simple chewing gum (the G test). With a not anesthetised patient, sitted upright on the dental chair, clinician can better identify potential interferences during function, before starting the rehabilitation. The mouth does not open and close in a static manner. Dynamic movements are the hardest to identify and patient’s collaboration is essential. With a simple gum, patients will be classified as horizontal, vertical or horiverti. Thanks to the gum, noises during chewing of restorations banging to each other could be perceived and eliminated.Occlusal adjustments will be done analysing the real muscular function of each patient to achieve at the end their comfort. Patients should not adapt to the restorations, because often this set the restorations to failure.
Learn how to do a G test.
Classify the way of chewing of the patients.
Increase of VDO complications
The increase of VDO represents often a challenge for many clinicians, not only because it is necessary to treat several teeth at the same time, but also because there is a generalized fear for the potential clinical complications. In this part of the course, the increase of VDO will be explained into details to comfort clinicians that it is possible and often very well accepted. However, attention will be paid to the different situations where this approach should be used more carefully, to evaluate if this increase will be LONG lasting in all the patients.
Evaluate the clinical conditions where the VDO increase could be problematic, because not stable.
Treatment plan of the participants’ cases
This session is the most interesting and variable one, since it is made by the participants. Dr. Vailati will look at 15 clinical pictures of each case brought by the clinicians, and diagnosis and treatment plan will be done together with the rest of the group. Generally, dentists learn that the data collection is not always perfect and fundamental information are missing. This is very important learning experience.
Help clinicians in collecting the correct data before starting any treatment.
Give an idea of the clinical parameters to look, when meeting a patient on the first consultation.
|- Milano -|
|Dal 07/06/2019 Al 08/06/2019 ||
After receiving her medical degree from the University of Bari (Italy) in 1996, Dr. Francesca Vailati left Europe to pursue her dental education in the United States.
In 2000 she received her dental degree from the University of Pennsylvania (USA) and in 2003 earned a certificate in Prosthodontics along with a M.S.D. degree from the University of Connecticut (USA).
Upon her return to Europe in 2003 she joined the department of Fixed Prosthodontics headed by Prof. Urs Belser at the University of Geneva (Switzerland), where she holds the post of senior lecturer.
Dr. Vailati maintains a part-time private practice in Geneva, dedicated to aesthetic restorative dentistry and prosthodontics.
She has contributed several articles in the field of restorative dentistry and implantology and lectures internationally on a variety of topics related to dental wear and ADDITIVE dentistry.