North Texas Dentistry Special Issue 2016 | Page 37

predictably diagnose and treat occlusal
disease in a minimally invasive manner.
O’Rourke explains, “The residency
program is based around experiential and
exponential learning that enables attendees to be involved in the restoration of
20-30 cases over a period of 12 months.
Our intimate learning environment (class
size averages 12 attendees) fosters oneon-one interaction between students and
instructors. Each doctor personally rejuvenates two full cases during the course and
presents each case as it progresses to the
other attendees in the program.”
The Center’s residency program is breathing new life into dentists and their
practices. The program is for dentists who
want to take a big step, slow down and
change the way they practice dentistry
day to day.”
Hal Stewart, DDS and Dan O’Rourke, CDT
(Co-founders of The Texas Center for
Occlusal Studies) have been practicing
minimally invasive full mouth rehabilitation for more than 15 years with great
success. Their partnership in this case
illustrates that when sound occlusal principles are applied, composite resins can
be used to treat even the most extreme
cases of wear.

Eric is a 69-year-old male who lives in
Scottsdale, AZ. Figure 1. He suffered
from severe attrition and erosion from the
effects of multiple diet soda consumption
daily for years. Figure 2. He visited
several dentists all over the country only
to find that his treatment options were
limited to full mouth crowns, also increasing his chance of needing endodontic
therapy, or full mouth extractions,
implants and overdentures. His desire
to save as much of his natural enamel led
him to Dr. Stewart.

After thorough examination, TMJ images
and diagnostic study models. Dr. Stewart
found Eric’s gingival tissues to be healthy
and stable. His TMJs were very stable and
asymptomatic as well. He had severe
erosion and attrition with a decreased
vertical dimension of occlusion. His
mouth was comfortable but Eric was very
self-conscious of his appearance and he
was aware that complete edentulism was
inevitable if no action were taken.

An optimal vertical dimension of occlusion was determined from intraoral jigs
and a centric relation bite was taken at
this vertical dimension. The models were
mounted on an AD2 Semi-adjustable
articulator and a complete diagnostic wax
up was completed by Dan O’Rourke, CDT.
Figures 3 & 4. Stints were made to allow
Dr. Stewart to duplicate the wax up to
within 8 microns of accuracy intraorally.

The treatment was completed in two
days. Day one was devoted to the
restoration of the lower arch. The patient
was sent home with an upper deprogrammer so the muscles of mastication
could rest overnight. The upper arch and
the occlusion was restored and established on day two.

The anterior teeth were restored with
Filtek Supreme (3M) and the posterior
teeth were restored with G-Aenial
Universal Flow (GC America). The lower
left resin bridge was reinforced with an
Ultradent fiber core post.

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All composites were bonded in with the
following protocol: Teeth cleaned with
Consepsis Scrub (Ultradent) then etched
with Ultra Etch (Ultradent) for 20 seconds.
The etch was rinsed thoroughly and the
teeth dried lightly then Peak Universal
Primer/Adhesive (Ultradent) was applied
and cured prior to composite placement.

At the time of the writing of this article,
Eric is stable, his chewing system is functioning efficiently and effectively and he is
comfortable and happy with his new bite
and his new smile. Figures 5 and 6.

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6011 Morriss Road
Flower Moun