On Monday, I did some crown lengthening surgery on #6 because the distal margin of the crown prep extended to within 1mm of the alveolar ridge. Acutally, I did everything except remove the bone (which, normally I would do, but the doctor was in a hurry to get all the students done so she did it herself). Today, I had her in for a post-op, and the tissue looks like it's healing well. However, the papillas on the M and D of #6 are gone, as well as, the papilla on the M of #7. It looks terrible. I don't think the gingiva is going to fill in the spaces. The frustrating part is that I noticed that the papillas were lower on Monday, but the doctor indicated that they would heal nicely. Well, oops, I guess not. I'm hoping that we get some rebound over the next few weeks. Else, I'm going to have to alter the emergence profile of the crown on 6 and the veneer on 7. Plus, this patient worries about everything. This is just one more thing she's going to turn into a mini crisis.
I wish I had taken pictures today to show you all.
Oh, and to make matters worse, she says "Dr. Javadi, my temporary on #10 is wiggly." So, I give it a jiggle, and sure enough it's fairly loose. I pull it off and she says, "Oh my! Is my tooth broke?" Yup. It's broke right at the height of the gingiva. So, it's noon, and I've got 45 minutes until the docs pull out the whips to get us to finish up. I spend the next 15 minutes getting a new tray set up (our sterilization system is being overhauled and backlash is horrendous) before I can get going. I used a gates glidden #2 and #3 to get 5 to 7 mm of gutta percha out of the canal. Place a post in the space. Make a temp out integrity using a putty matrix, and then adjust the lingual until there is no contact in centric or protrusive. It's 1:30 now, and the doctors have all disappeared. Ten minutes earlier though, they were asking me how much longer I'd be. As if to say, "Hey, what's taking you so long?" I felt like saying "Hey, glove up doc and give me a hand, then we can both go to lunch." Ah, well. At least I got her in a temp and out the door with a smile on her face. I hope nothing else goes wrong with this case. We are doing empress crowns and veneers from #6 to #11, plus a lot of other work. The bill is already approaching $20,000. I want everything else to go as planned, and I want her to have the great looking smile she's fantasizing about.
I wish I had taken pictures today to show you all.
Oh, and to make matters worse, she says "Dr. Javadi, my temporary on #10 is wiggly." So, I give it a jiggle, and sure enough it's fairly loose. I pull it off and she says, "Oh my! Is my tooth broke?" Yup. It's broke right at the height of the gingiva. So, it's noon, and I've got 45 minutes until the docs pull out the whips to get us to finish up. I spend the next 15 minutes getting a new tray set up (our sterilization system is being overhauled and backlash is horrendous) before I can get going. I used a gates glidden #2 and #3 to get 5 to 7 mm of gutta percha out of the canal. Place a post in the space. Make a temp out integrity using a putty matrix, and then adjust the lingual until there is no contact in centric or protrusive. It's 1:30 now, and the doctors have all disappeared. Ten minutes earlier though, they were asking me how much longer I'd be. As if to say, "Hey, what's taking you so long?" I felt like saying "Hey, glove up doc and give me a hand, then we can both go to lunch." Ah, well. At least I got her in a temp and out the door with a smile on her face. I hope nothing else goes wrong with this case. We are doing empress crowns and veneers from #6 to #11, plus a lot of other work. The bill is already approaching $20,000. I want everything else to go as planned, and I want her to have the great looking smile she's fantasizing about.