Table Of ContentMichael D. Wise
t-=ailure in the Restored Dentition:
MJnagement and Treatment
Technical Appendix by Anthony Laurie
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Few people in Britain have made a greater contribution
to postgraduate education in dentistry than Michael
Wise. This book is a distillation of his teaching in
Restorative Dentistry and how he sets about treating
patients. The author's appeal to the general practi
tioner is obvious since, although he is regarded as a
specialist in his field, he is still a dedicated general
practitioner and quickly relates to their problems. To
say that his book is comprehensive would be an un
derstatement; the reader will find a well from which to
draw information and guidance for a long time ahead.
The author's approach is always to assess problems
in depth before any form of treatment is started. This
philosophy, as he rightly says, can save much grief and
argument later.
Treatment planning plays a major role in this book.
If you get the diagnosis and treatment plan correct then
you are half way to securing a satisfied patient.
However, the best treatment plans in the world are
no good unless they can be executed and the cooper
ation between dentist and technician is vital where
complex restorative dentistry is involved. Thus, the
technical side of dentistry is also given prominence
and the author is fortunate in having an in-house tech
nician, Anthony Laurie, to call on. Between them they
have unravelled the mysteries of occlusion and made
it understandable for the practitioner.
The soft tissue factor remains the Achilles heel of
dentistry and it hardly needs repeating that the perio
dontium is the key to successful restorative dentistry.
In the meticulous treatment planning sections, the
author guides the practitioner through the difficult
maze in an easily understood and practical way.
Michael Wise has gained our respect in the restora
tive field through his national and international post
graduate teaching and his book will re-inforce this
judgement.
Michael D. Wise
Failure in the Restored Dentition:
Management and Treatment
Failure in the Restored Dentition:
Management and Treatment
Michael D. Wise
B.D.S. (U. Lond.), F.D.S., R.C.S. (Eng.), M.S.D. (Indiana)
Private Practice in Restorative Dentistry, London W 1
Honorary Research Fellow: Institute of Dental Surgery, London WC 1
Technical Appendix by Anthony Laurie
Dental Technician in Practice with Michael Wise
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Quintessence Publishing Co. Ltd.
London, Berlin, Chicago, and Tokyo
First published 1995 by
Quintessence Publ1sh1ng Company Ltd
London, UK
© 1995 by Michael D. Wise
British Library Cataloguing in Publication Data
Wise, Michael D
Failure ,n the Restored Dentition:
Management and Treatment
I Title
617.643
ISBN 1-85097-033-5
All Rights Reserved
This book or any part there of must not be
reproduced by any means or In any form without
the written permission of the publisher.
Lithographed by Toppan Printing Co. (S) Pte Ltd., Singapore
Typesetting by Bosch Druck, Landshut, Germany
Printed and bound by Cortella industria poligrafica spa, Verona, Italy
Dedication
This book is dedicated to my wife, Priscilla, and my
sons Justin, David and Jonathan for their love, friend
ship and unselfish support.
It is also dedicated to the memory of my dear father
whose unconditional love was a constant inspiration.
He followed the progress of this work, but unfortunately
did not live to see its completion.
PREFACE
The combined effects of increased longevity, more dontics, osseointegration and full and partial denture
effective preventive methods for controlling dental dis prostheses, will only be considered so far as they relate
ease, and a greater dental awareness, have led to an to the specifics of diagnosis, treatment planning and
aging population who are neither edentulous nor totally treatment pertaining to this text. The details of these
dentate and free from restorations. There are many techniques can be derived from the standard text
whose remaining teeth have been restored, often con books. Partial coverage restorations are not described
stituting integral parts of complex, extensive and ex even though they would frequently be the restorations
pensive dental rehabilitations. The management of of choice. Details can be obtained from standard
failures occurring in these dentitions is often difficult. crown and bridge texts. Similarly, details of composite
The practitioner must be able to examine, diagnose resin and amalgam restorations can be obtained from
and develop a plan of treatment and then either provide the appropriate texts. It is certainly not my aim to
the necessary care or know when and to whom to refer produce a standard text book on every aspect of
the patient. A professional caring service is best ren restorative dentistry - this would be unrealistic and
dered in a well organised and secure environment. unnecessary. My primary objective is to present to the
Good practice management, therefore, is absolutely reader an overall approach towards the management
essential. of failure in the restored dentition, with emphasis on:
I have spent the past 22 years as a part-time post patients with extensive restorations; areas that are
graduate teacher and part-time in a practice devoted most frequently asked about; areas that I have found
to the treatment of restorative problems. Much time has to be inadequately covered in other texts. I trust there
been spent treating patients who have failed, exten fore that the reader will understand why, at first sight,
sively restored dentitions. Management has been this text may appear unbalanced, with more emphasis
based upon careful examination, diagnosis and treat on some sections than others. Once the reader has
ment planning, so that treatment could proceed in a grasped the essentials, it becomes possible to seek
controlled and predictable manner. Regardless of further knowledge from the appropriate sources. Treat
each particular detail, such control and predictability ment is based upon an analysis of the literature, but
can be achieved only if there is a realistic appraisal of: inevitably decisions are made which cannot be entirely
the patient's disease susceptibility; the individual den substantiated by published findings. Future publica
tist's ability; the social and practice environment and tions will lead to modifications of the recommendation.
the financial and occasionally legal implications of the Records of failures in retreated patients have been
treatment. It would be very easy to create unmanage kept since 1973 so that the efficacy of treatment could
able problems for these patients and to incur serious be assessed.
financial problems for both patient and dentist. It could be argued that, as with other restorative
The management of patients with failed restorations texts, each section should be written by a specialist. I
often requires the integration of many of the dental felt, however, that this could compromise the desig
disciplines. Although there are many specialist texts nated theme, which is to view the management from
available, it is difficult to integrate each of their contents the perspective of the person who has overall respon
into the coordinated and practical management of sibility for diagnosis, treatment planning, coordination,
these patients. Further, it is difficult for the practitioner and maintainance, that is, the restorative dentist.
to know what to read and what to take from each text,
The text will be divided into five sections:
without thoughts and treatment becoming "pigeon
holed" and un-coordinated. Part 1 - Patient and practice management.
The aim of this book is to present a management Part 2 - Techniques, materials and instrumentation.
rationale, together with details of some of the treatment Part 3 - Temporomandibular disorders and
and laboratory stages, illustrated by specific cases problems of psychogenic origin.
photographed during treatment in a practice environ Part 4 - Treatment planning options.
ment. The techniques related to periodontics, endo- Part 5 - Technical Appendix.
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