We’ve seen a lot of comprehensive dentistry through the years, and just about everything that could go right or wrong. This is what we know for sure – cutting corners and skipping steps almost always compromises the results. We have the full service team in place to support even the most complex problems. We have protocols and sequence lines for most types of cases and the experience from past cases to stay out of trouble. From severely worn dentition, to complex implant work, we have the knowledge and expertise to support you from treatment planning to final delivery.
The severe wear type cases present special challenges as well as opportunities for the doctor/technician team. A critical first step is just to properly diagnosis the cause of the wear. From occlusal interferences, to para-functional habits, to chemical erosion, the causes can be varied but should be an important part of the diagnostic process. On severe wear cases, a CR/MI discrepancy can actually be your best friend, as the back and up seating of the condyles will often result in a down and back repositioning of the lower anterior teeth creating much need restorative space. > More information on severely worn dentitions.
Our team of ceramists are all board certified with in-depth knowledge and experience in functional esthetics. All have been through multiple courses within Dawson, Kois, Spear, and/or Pankey programs. We work daily with facebow mounted casts, custom incisal guide tables, and incisal edge matrix records. Photographs on anterior cases (see our photo check list) and study casts of provisionals are essential to give you out best work. IPS e.max is our preferred ceramic material for most anterior cases. We utilize pre-shaded “fusion” high performance zirconia for our bridgework cases, which we design in-house. Checklists are also available for specific types of cases, and we are also happy to assist with the diagnostic wax-up phase whenever possible. Our Cosmetic Team features several master ceramists from around the world, including an AACD accredited ceramist, Shoji Suruga, CDT. Bay View customers enjoy the option of choosing their ceramist with our “Request Team Service” or they can ensure a guaranteed two-week turnaround with our “Cosmetic Express Service”.
Our implant team is familiar with virtually all implant systems and specialize in treatment planning implant cases. Our protocol begins with a full contour wax-up in order to establish proper abutment design and soft tissue contour. On most cases, we recommend patient specific CAD/CAM abutments where we completely control the design in-house. Our preference will usually be the titanium nitrate gold hue abutments from Atlantis. More comprehensive casework may involve additional diagnostic work and should be discussed on a per case basis.
Fixed/Detachable Restorations (Hybrid Restorations)
These are sometimes referred to as “hybrid” cases, since the design is somewhat between a fixed and removable. These cases are implant supported, screw retained, and thus removable, but by the doctor not the patient. They are typically used on the lower arch, ideally with 5 implants, placed in the anterior and premolar region, with the restoration cantilevered distally depending on the Anterior/Posterior (AP) spread of the implants.
Overdentures present special challenges but also special opportunities for the life changing effects they offer for patients. Most overdenture cases these days are with locator attachments and 2-4 implants. Sometimes a bar may also be indicated and we always recommend a metal base for strength. To improve doctor/lab communication, we use HD video cameras to facilitate the set-up and try-in process for tooth position. Our materials include BEGO Wyrosil alloy for strong lightweight frames, and the Ivocap injection system for a dense, precise fitting denture base. Teeth will be either IPS Phonaris from Ivoclar, or Ceraperal from Jensen.
By design our department is small, with all removable bridgework created under a microscope, just as we do for C&B. Combination cases are often the most challenging restorations in dentistry due to the wide range of knowledge and skills required as more teeth and a combination of procedures are involved in treatment. These are our specialty restorations and we welcome the opportunity to partner with you on such cases.