{"id":496,"date":"2012-04-09T12:03:44","date_gmt":"2012-04-09T17:03:44","guid":{"rendered":"http:\/\/allisonwatts.com\/blog\/?p=496"},"modified":"2020-12-23T11:31:14","modified_gmt":"2020-12-23T17:31:14","slug":"starting-full-mouth-rehabilitation-with-excellent-provisionals","status":"publish","type":"post","link":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/","title":{"rendered":"Starting Treatment with Excellent Provisionals"},"content":{"rendered":"

\"\"<\/a><\/h1>\n

Starting Treatment With Excellent Provisionals
\n\t<\/span><\/span><\/span><\/h1>\n

by Allison Watts, DDS<\/span>
\n\t<\/span><\/span><\/em><\/h1>\n


\n\t<\/span><\/span><\/p>\n

At this point, we have mounted models and they are equilibrated and we have a wax-up of the ideal esthetics and occlusion (what we believe is ideal any way!) and now it’s time to test it.<\/strong> We will use provisionals and or composite for this.<\/em> I use provisionals if I know the teeth will be restored and if the case will be moving at a reasonable pace.<\/span><\/span><\/p>\n

When we have come up with the solutions\/treatment plan, I will sequence it in a way that makes sense and figure up the time so we can give them fees. If they ask or if it seems appropriate, I will give them a ball park early in the process.   We then have a consultation<\/a><\/b> to go over the plan, timing, fees, show them the wax-up and go over the consent for treatment and sedation (if we are using it).  <\/span><\/span><\/p>\n

We will give them sedation instructions and the medicine ahead of time and often ask them to prepay to reserve the time and so neither we nor they have to deal with it at the appointment. We don’t accept money from people on medication unless they filled a check out ahead of time, their spouse brings it, or the exact arrangements discussed on the phone are being followed.<\/em> Patient is ready to go with treatment and we’ve talked about what to expect at the next visit!<\/span><\/span><\/p>\n

If we know ahead of time that ortho, perio, endo, oral surgery, or clean up dentistry needs to be done, we have already done it. Occasionally, a tooth will need endo, functional crown lengthening, or extraction after we start treatment, and that will be dealt with if necessary. I prefer to have any specialist treatment done before we start or while the patient is in provisionals when possible so we don’t damage the long-term restorations.<\/em><\/span><\/span><\/p>\n

Here we go!   Although it’s not the same for each patient, general guidelines and sequence can be discussed here.<\/span><\/span><\/strong><\/em><\/p>\n

Provisionalize and final impress whatever segments make sense:<\/span><\/span><\/strong><\/p>\n

Upper anterior or lower anteriors are a typical place I start. I will sometimes provisionalize the upper anteriors first and then lower anteriors, taking final impressions on the lower anteriors at this appointment. <\/span><\/span><\/p>\n

If there are major changes, I will not impress this day. I will have the patient wear the provisionals for 3-6 months to test occlusion. The deciding factors on which one I choose are:<\/span><\/span><\/p>\n

a.  <\/span>If there is a functional or esthetic reason to start with a particular arch or section<\/span><\/span><\/p>\n

b.  <\/span>If the patient strongly prefers one or the other<\/span><\/span><\/p>\n

c.  <\/span>How fast they are going to move forward <\/span><\/span><\/p>\n

Most of my patients and I prefer to have the uppers temporized first.<\/strong> I like it because then they can wear the upper provisionals for a few months before we order the permanents while we are moving forward with the lowers. This gives us time to know if the esthetics and occlusion are going to work.  <\/span><\/span><\/p>\n

If you are opening the vertical, depending on which arch is being used<\/strong> to open the vertical, you need to prep and temporize a full arch or build it up with composite, then prep and temporize the other arch and\/or build it up with composite. <\/span><\/span><\/p>\n

You may choose not to final impress any segments to allow the patient to truly have a trial period with their new provisionals (generally 3-6 months).<\/span><\/span><\/em><\/p>\n

No matter how I provisionalize the case, I generally final impress and finish the case in this order:<\/span><\/span><\/strong><\/p>\n

1.  <\/span>Impress lower anteriors<\/span><\/span><\/p>\n

2.  <\/span>Deliver lower anteriors, impress upper anteriors<\/span><\/span><\/p>\n

3.  <\/span>Deliver upper anteriors, impress lower posteriors<\/span><\/span><\/p>\n

4.  <\/span>Deliver lower posteriors, impress upper posteriors.<\/span><\/span><\/p>\n

5.  <\/span>Deliver upper posteriors, impress nightguard<\/span><\/span><\/p>\n

6.  <\/span>Deliver nightguard, final equilibration<\/span><\/span><\/p>\n

7.  <\/span>Final photos and celebration<\/span><\/span><\/p>\n

Lab communication is critical. Photography used throughout to document and communicate with lab, specialists and patient is very valuable.<\/span><\/span><\/p>\n

One of my motivations for writing these articles and helping other dentists clinically is my own challenges with these large cases.<\/strong> I didn’t take a single course or even a series of courses that I felt walked me through it step by step. I’ll never forget my first full mouth rehab. I had attended a lot of courses and felt I was ready to do full mouth case, but had never done one. <\/span><\/span><\/em><\/p>\n

I had to figure it out as I went. I was even attending Frank Spear’s courses in between appointments to feel like I knew how to do the next step! It was so stressful. The patient lived in my hometown, wanted and needed his teeth restored. I did everything correct leading up to acceptance and then he accepted! <\/span><\/span><\/em><\/p>\n

I initially used a matrix of his current teeth to provisionalize and the provisionals were too thin. I had not had a proper waxup done and the patient was scheduled so I thought, “I’ll just go ahead and prep and temporize and then I’ll have the the wax-up done and reprovisionalize." That’s what I did (mistake #1).<\/em> <\/span><\/span><\/p>\n

I had to find a new lab that knew how to do a full mouth wax-up and chose DaVinci. They provided a beautiful wax-up, but I had not provided them with any details about the goals of treatment, or parameters of the teeth, the vertical, the occlusion, etc. I just asked if they did full-mouth wax-ups (mistake #2).  <\/em><\/span><\/span><\/p>\n

I re-provisionalized everything and took impressions to have final restorations made for the entire upper arch (mistake #3)<\/em>. <\/span><\/span><\/p>\n

For me personally, I would not do this today—I prefer to have 6-8 final restorations made at a time because I feel I have better control that way.<\/strong><\/span><\/span> You’ll see what happened in a minute<\/strong>. <\/span><\/span><\/em><\/p>\n

The patient moved from Texas to California (for two years to go to massage therapy school) after we took upper impressions. We had restorations for the whole upper arch made in B1 and tried them in a couple of months later. He decided he didn’t like them—they were too yellow. Even after an approval appointment and him okaying the color, he changed his mind. Of course B1 is too yellow now, he lives in California! He says he wants white<\/b>… he wants people to know he spent a lot of money on his teeth (the exact opposite of what I want people to say!) <\/span><\/span><\/p>\n

Mistake #4<\/strong><\/em> is not having a signed form or some very clear understanding about whose responsibility it is if we have to remake the restorations after approval! I wanted him to be happy and since the color was going much whiter, the restorations had to be remade. I paid for it—the full arch! <\/span><\/span><\/p>\n

The rest of the case went pretty well, though all-in-all it was stressful. I learned a lot by figuring it out as I went through it. This is truly how I learned step-by-step how to do full-mouth cases… trial and error.<\/em><\/span><\/span><\/p>\n

One of the blessings (sometimes curses) I have is my personality style. Over the years, I have been willing to jump into something and figure it out as I go rather than being afraid of making mistakes. In some ways, this has cost me a lot of stomach and heart lining and in some ways this has served me well. <\/span><\/span><\/p>\n

Figuring out this process was brutal, so I hope to make it easier for others so they don’t have to go through what I did to figure it out! <\/strong>There may be someone out there teaching this process step-by-step, but not that I’m aware of.  I hope that this is clear and helpful for you.   I am not as accustomed to writing as I am to communicating these principles and ideas over the phone and in person.<\/span><\/span><\/p>\n

As I put this together, I realized I cannot put all the details in and that it will be helpful to continue to break this down into more detail next week. Let me know if you have any specific comments or questions or if there’s something you want to hear about.  <\/span><\/span>You can leave a comment or question below, connect with me on my Facebook Page<\/b><\/a> <\/span><\/span>or send an email to insights [at] transformationalpractices.com.<\/a><\/strong>
\n\t<\/span><\/span><\/p>\n

I will be more than happy to assist in any way that I can!<\/span><\/span><\/p>\n

Here's to clinical confidence!!
\n\t<\/span><\/span><\/p>\n

 <\/p>\n

\"\"<\/a><\/p>\n

           <\/span><\/span><\/p>\n

       <\/span><\/span><\/p>\n

 <\/p>\n

 <\/p>\n

 
\n\t<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Starting Treatment With Excellent Provisionals by Allison Watts, DDS At this point, we have mounted models and they are equilibrated and we have a wax-up of the ideal esthetics and occlusion (what we believe is ideal any way!) and now it’s time to test it. We will use provisionals and or composite for this. I use provisionals […]<\/p>\n","protected":false},"author":1,"featured_media":505,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_cloudinary_featured_overwrite":false,"footnotes":""},"categories":[310,22,25,23,24,27],"tags":[146,12,19,144,140,179,115,145,116,63,56,149,147,191,185],"yoast_head":"\nStarting Treatment with Excellent Provisionals<\/title>\n<meta name=\"description\" content=\"Starting provisional treatment with excellent provisionals impacts the success of a full mouth rehabilitation. I learned this through trial and error.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Allison Watts\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/\",\"url\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/\",\"name\":\"Starting Treatment with Excellent Provisionals\",\"isPartOf\":{\"@id\":\"https:\/\/allisonwatts.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608744672\/Allison_Watts_Provisional_Excellence_xnigae\/Allison_Watts_Provisional_Excellence_xnigae.png?_i=AA\",\"datePublished\":\"2012-04-09T17:03:44+00:00\",\"dateModified\":\"2020-12-23T17:31:14+00:00\",\"author\":{\"@id\":\"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a\"},\"description\":\"Starting provisional treatment with excellent provisionals impacts the success of a full mouth rehabilitation. I learned this through trial and error.\",\"breadcrumb\":{\"@id\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#primaryimage\",\"url\":\"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608744672\/Allison_Watts_Provisional_Excellence_xnigae\/Allison_Watts_Provisional_Excellence_xnigae.png?_i=AA\",\"contentUrl\":\"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608744672\/Allison_Watts_Provisional_Excellence_xnigae\/Allison_Watts_Provisional_Excellence_xnigae.png?_i=AA\",\"width\":231,\"height\":152},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/allisonwatts.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Starting Treatment with Excellent Provisionals\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/allisonwatts.com\/#website\",\"url\":\"https:\/\/allisonwatts.com\/\",\"name\":\"Helping You Live Your Brightest Life From The Inside Out\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/allisonwatts.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a\",\"name\":\"Allison Watts\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/allisonwatts.com\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g\",\"caption\":\"Allison Watts\"},\"sameAs\":[\"http:\/\/allisonwatts.com\"],\"url\":\"https:\/\/allisonwatts.com\/author\/admin\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Starting Treatment with Excellent Provisionals","description":"Starting provisional treatment with excellent provisionals impacts the success of a full mouth rehabilitation. I learned this through trial and error.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/","twitter_misc":{"Written by":"Allison Watts","Est. reading time":"8 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/","url":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/","name":"Starting Treatment with Excellent Provisionals","isPartOf":{"@id":"https:\/\/allisonwatts.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#primaryimage"},"image":{"@id":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#primaryimage"},"thumbnailUrl":"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608744672\/Allison_Watts_Provisional_Excellence_xnigae\/Allison_Watts_Provisional_Excellence_xnigae.png?_i=AA","datePublished":"2012-04-09T17:03:44+00:00","dateModified":"2020-12-23T17:31:14+00:00","author":{"@id":"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a"},"description":"Starting provisional treatment with excellent provisionals impacts the success of a full mouth rehabilitation. I learned this through trial and error.","breadcrumb":{"@id":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#primaryimage","url":"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608744672\/Allison_Watts_Provisional_Excellence_xnigae\/Allison_Watts_Provisional_Excellence_xnigae.png?_i=AA","contentUrl":"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608744672\/Allison_Watts_Provisional_Excellence_xnigae\/Allison_Watts_Provisional_Excellence_xnigae.png?_i=AA","width":231,"height":152},{"@type":"BreadcrumbList","@id":"https:\/\/allisonwatts.com\/starting-full-mouth-rehabilitation-with-excellent-provisionals\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/allisonwatts.com\/"},{"@type":"ListItem","position":2,"name":"Starting Treatment with Excellent Provisionals"}]},{"@type":"WebSite","@id":"https:\/\/allisonwatts.com\/#website","url":"https:\/\/allisonwatts.com\/","name":"Helping You Live Your Brightest Life From The Inside Out","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/allisonwatts.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a","name":"Allison Watts","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/allisonwatts.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g","caption":"Allison Watts"},"sameAs":["http:\/\/allisonwatts.com"],"url":"https:\/\/allisonwatts.com\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/posts\/496"}],"collection":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/comments?post=496"}],"version-history":[{"count":0,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/posts\/496\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/media\/505"}],"wp:attachment":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/media?parent=496"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/categories?post=496"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/tags?post=496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

Walking through the process <\/strong><\/em>–  a new patient called<\/b> <\/a>in and after talking to them on the phone, invited them to come in for a new patient experience. <\/b><\/a>Through the new patient process we talked to them about what they want for their dental health and helped them look out into the future 10-15 years. We took a couple of appointments to collect data and collaborate with the patient in their diagnosis and treatment plan<\/b><\/a>, showing them what is in their mouth, talking about what will happen if they do nothing and talking to them about possibilities and solutions. <\/span><\/span><\/p>\n