14 responses

  1. Michael Nugent
    April 3, 2015

    Awesome.

    Reply

  2. Ritesh
    April 3, 2015

    Great Job, Dr. Mike !
    I am new to your website and blog and find it incredibly inspirational to read such articles from you.
    I’ve been out of school for 9 years now and finally decided to stop working full time for a dead end corporate job, and started my practice 6 months ago from scratch.
    Although new and struggling, I have faith and keep pushing on against the odds, and it fills me with confidence to know that I think along the same lines as you, and if that be the case, I must win..eventually..but surely !
    Thanks again.

    Reply

    • The Dental Warrior
      April 3, 2015

      Hi Ritesh. Thanks for visiting my blog and taking time to post a comment! Good luck with your new practice!

      Reply

  3. Michael Benlevy
    April 3, 2015

    Mike: I have seen a lot of nice work from you in the past…which leaves me even more, puzzled and shocked over your treatment plan for this case!

    In spite of what you show with all your arrows: I can’t make out the retentive grooves beyond a bit of imagination ala “Emperor is Wearing Clothes”).

    And, why a cantilever, (in the CANINE area!!!).

    What “listening to the patient” convinced you to do it this way?

    Reply

    • The Dental Warrior
      April 3, 2015

      Hi Michael! The prep is very minimal / small, and the photo doesn’t show them very well. I’ll see if I can enhance the photo. But, the grooves are there, I promise! 🙂 The retainer actually had retention without cement, due to the prep.

      The abutment is her actual canine. Mom wanted minimal prep. Mom was a former dental assistant, BTW. I didn’t see any advantage in involving the premolar. The premolar was involved with the first MB, and it kept debonding (and later, the retainer BROKE). I spoke with my lab about the design of the bridge, which was entirely my idea, incidentally.

      The patient is 14 y.o. She did NOT want a “flipper.” She’s not a candidate for an implant, yet. This was deemed a compromise treatment from the “git-go,” and it was discussed as such with Mom. I told her I wasn’t sure how well it would work.

      It’s been 9 months since I placed the new MB. So far, so good! I’m betting this will work quite well for quite some time. And, that’s what we’re doing… buying time.

      Here are the best images I’ve got:

      Reply

    • The Dental Warrior
      July 16, 2018

      It’s now been four years. It has not de-bonded even once, yet. 😀

      Reply

    • The Dental Warrior
      March 26, 2025

      Patient was in last week for hygiene. She’s now 24 years old. So we’re at almost exactly 10 years of longevity. It still looks good and has not debonded even once.

      Still shocked at this case? 🙂

      Reply

  4. Ken
    April 8, 2015

    Great case Mike as usual. I’d like to ask you a somewhat related question with cases like these or with cases in general small or big, how do you handle premature fee questions? (And I guess for that matter questions about the cost in general?)

    Reply

    • The Dental Warrior
      April 8, 2015

      Hi Ken,

      I’m not sure I understand the question in the context of this case. If a patient asks for a fee for a big case “prematurely” (before I’ve formulated the treatment plan options), I simply tell them that I need to sit down and plan the case before I can answer it accurately.

      Reply

      • Ken
        April 20, 2015

        Sorry Mike, my question really doesn’t pertain to this case specifically but in the future I’d like to see you do a piece on properly handling fee discussions for larger cases.

        Reply

      • The Dental Warrior
        April 20, 2015

        Ah… OK. I’ll put that on the list. In the mean time, did you see this?

        Treatment Plan Presentation – Big vs. Small

        Reply

  5. ellebelle
    April 14, 2015

    Awesome job! I am betting on your cantilever. Maryland bridges don’t like to go around curves. They work well in a straight line but when flexure occurs in two different angles you get debonding (think vector physics). e.g. 23-24-25 works well if relatively straight. 22-23-24, not so much if teeth follow the natural curvature of most arches. It was very smart to have it just bonded on the one side and then cantilevering it.

    Great post and the Aspen Dental post was spot on…it is just sad. I don’t understand how people can be taken in by that stuff. Didn’t their parents every tell them that nothing is ever free?? Just like my “free CE course” this fall….all I had to do was join a 2K a year study club. LOL. Hope my free course is worth it, so far the study club has been very useful.

    Reply

    • The Dental Warrior
      April 15, 2015

      Thanks, Elle. Time will tell with the cantilevered MB. But, it just made sense to me. I’ve always liked Albert Einstein’s quote that applies to many things in life: “The definition of insanity is doing the same thing over and expecting a different result.”

      Reply

  6. Joe
    May 1, 2015

    Dentists absolutely need to listen to their patients. After all, our role is to help make them smile! If we neglect to listen to their needs, they’ll leave our office feeling stress, not happiness.

    Reply

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