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August 2018

Advances In Prosthodontics TM

New Findings & Best Practices for Cosmetic & Restorative Dentistry

Do You Have a Patient With



INSIDE THIS ISSUE Severe Periodontal Disease?

Before
CASE SUMMARY:
Do You Have a Patient
With This Situation?
(see photos on right)
Complete Details
for this Oral
Rehabilitation…

Background
After
pages 1 - 2

Treatment Sequence
pages 2 - 3

Challenges
page 3

Final Result
page 3

COMPLEX CASES: Here’s the story of a patient who was referred from
Dr. Petrini & Dr. Schmidt’s another dental professional...
Training & Skills Make These
If you have a patient with several missing, broken or worn teeth—
Treatments More Successful or a condition affecting their teeth such as periodontal disease—
page 4 they may be a candidate for oral rehabilitation with the assistance of
© Sams Media Group, LLC
an advanced Prosthodontist.
Read more on the next page…

Do you want another opinion on a complex case? Or to meet and share ideas?

There are many ways we can help each other by working together on complex cases and by sharing
knowledge and experience.

With your reputation for quality dental care, and our experience with restorative treatments, we can work
together on advanced cases and both benefit! 


If you’d like meet to discuss a difficult procedure, or talk on the phone about how we can help each other,
please call or email our office with specific days and times when you are available to talk or meet.

Drs. Petrini & Schmidt ! The Complex Case Specialists™ ! (206) 242-6660 ! john@petriniprosthodontics.com 1
FROM THE PROSTHO FILES

CASE SUMMARY: Implant-Free Therapy Still Being Done Well


by John J. Petrini, Jr., DDS, MS, FACP, Board Certified Prosthodontist

Patient “Linda” was referred to our office for comprehensive care, and she presented
with the following background:
• Radiographic examination revealed decay
around #29 existing crown, and #28
cervical.
• Deep probings around the remaining
maxillary teeth indicative of Moderate to
Severe Chronic Periodontitis, with
significant tooth mobilities.
• In her lower arch her lower central
incisors had significant bone loss and
deep pocketing.
• She had a Class II occlusion with a Division II over bite.

Linda was very unhappy with her current smile, chewing ability, and overall dental health.
Because of the class II occlusion, her lower anteriors had erupted significantly making for
an accentuated Curve of Spee. This made it challenging for her to eat as the teeth would
hit the tissues palatal to the maxillary incisors. She wanted to have a beautiful smile and
be able to eat whatever she wanted again pain free.

As a Prosthodontist, I have experience planning complicated


Before
multi-stage treatments that coordinate with the general dentist 

& other specialists. For many of our patients, especially 

where severe periodontal disease exists in combination with
challenging occlusions, one of the easiest ways to establish 

great esthetics and re-establish ideal occlusion is with 

removable prosthetics.

The treatment sequence for Linda included:


• We recommended the removal of all of her remaining
upper teeth and the insertion of a maxillary complete
immediate denture. This denture was to be relined as
needed with Tissue conditioner for a period of 9 months
to allow total healing before making the definitive denture.

Continued on next page... Final result on next page...

Do you have a patient in Linda’s situation? Or another complex case?


If you have a question about a case and want another opinion, give our office a call. Or, if there’s
a case that you want to work together on, please fill out and send in the enclosed referral form.

We will take great care of your patient and keep you informed. Dental professionals refer to us as 

The Complex Case Specialists™ because we perform complex cases every day.

Drs. Petrini & Schmidt ! The Complex Case Specialists™ ! (206) 242-6660 ! john@petriniprosthodontics.com 2
FROM THE PROSTHO FILES

Continued from previous page… Linda’s treatment sequence:


• On the lower arch, the remaining lower anterior teeth 23-26 were to be removed as well as a surveyed crown on #29 and a
class V composite on #28. Subsequent to extractions, root planning and scaling was initiated and then a periodontal
maintenance program was established at every 3 months.
• The extractions and delivery of her interim upper denture and lower temporary RPD were done simultaneously.
• During the extraction and removable phase, the gums and tissues heal but also the patient allows themselves to evaluate their
interim prosthetics. Around the 4-month mark we had Linda back in to assess her comfort level with removable prosthetics.
Linda was very satisfied and desired to proceed with the definitive set at the 9-month mark. However, for other patients, the
4-month mark has proven an opportune time to discuss dental implant options in greater detail if they desire a fixed
prosthetic.

You can tell from Linda’s smile that she was extremely happy with her results. She had a beautiful smile, and was able to eat literally
anything that she wanted. She told us that, “I have gotten so many compliments at work.” This of course made her very happy.

Note that the anterior tooth arrangement wasn’t perfect or idealized. There were purposefully slight irregularities in the
arrangement of the maxillary anterior teeth to give a more natural look. Our in-house laboratory makes it possible to change teeth
arrangement in real time, even right in the operatory, and then transfer that to our lab with 100% fidelity.

What made this case extremely challenging was the occlusal corrections, which can be quite dramatic. 

This case took special consideration to take into account Linda’s current VDO, and her
tolerance for changes to this VDO. Additionally delivering a maxillary denture that would
allow a patient to eat “whatever I want” takes extra attention to controlling stabilizing forces
correctly in the denture, especially in a class II patient where patients tend to posture
forward to chew their food and thus destabilize the denture.

After Removable
prosthodontics is still
valid and is a dying art.
When it is done well,
you can expect your
patients to be extremely
satisfied as has been
illustrated with this case. 

I chose to specialize in
prosthodontics because
I love helping support
dental colleagues to
achieve higher levels of
care for patients facing a
difficult diagnosis.
I refer patients back to their general dentist for routine care, unless advised otherwise by the referring office, depending on the
patient and treatment. If you have comments or questions about how I treated Linda from this example, please email me at:
john@petriniprosthodontics.com

How can a Certified Prosthodontist assist you and your dental team?
We specialize in the treatment of complex cases, usually involving several procedures over months of 

care. The next time you see a challenging case, please feel free to call us and we can discuss treatment
planning or help you with any part of the treatment. Our goal is to be a resource for your office by helping
manage difficult and time-consuming procedures, restoring the function and esthetics that each patient
desires, then referring them back to your office for their ongoing care.

Drs. Petrini & Schmidt ! The Complex Case Specialists™ ! (206) 242-6660 ! john@petriniprosthodontics.com 3
The Complex Case Specialists TM

ABOUT OUR SPECIALTY PRACTICE

Drs. Petrini & Schmidt have prosthodontic training and private


practice experience that make treatments of complex cases more
successful, including the following examples:
• Patients with severely worn/damaged teeth, missing all teeth, or 

with ill-fitting dentures can receive a full arch of natural-looking
teeth to restore function & esthetics.
• Patients with congenital defects, a chronic condition, or
traumatic injury can receive oral prostheses, which may be a
combination of dental implants, crowns, bridges, or veneers.
Dr. John J. Petrini, Jr. Dr. William F. Schmidt
• Patients with difficult anterior cases in the esthetic zone can 

receive single or multiple dental implants to replace missing teeth, 

or veneers or crowns to improve the appearance of their smile.

In addition, the office of Drs. Petrini & Schmidt is equipped with an on-site dental laboratory,
which helps with individual customization, precision, and higher satisfaction for patients.

Personal Message To Fellow Dental Practitioners:


“As the referring dentist, you know your patient’s mouth and have key insight into your patient’s needs. 

We want to work with you to provide your patients with the best possible treatment outcomes. We will treat
your patient in a manner that reflects well on you and strengthen your relationship with your patient. We are
here to make you look good! When your patient’s care is completed, they are referred back to your office 

for their ongoing dental care. We are grateful for your colleagueship and trust with your patients!”

Why other dental professionals work with a Prosthodontist


Prosthodontists are specialists in implant, esthetic, and reconstructive dentistry.

1. You have a patient requiring complex treatment outside of your typical practice. 


Examples include patients with vertical dimension discrepancies, severely resorbed ridges, 

inadequate interarch space, TMJ, severe bruxism, traumatic tooth loss, or congenital abnormalities.

2. You have a patient with complex needs that may drain your time.


If your patient may require treatment from several specialists, Prosthodontists can help because 

they are trained to appropriately stage and manage complex treatment plans.

3. You have a demanding patient who wants perfect esthetics.



Examples include patients with a high smile line or needing a single tooth replacement in the 

esthetic zone. A Prosthodontist is trained in selecting the best solutions for high-demand patients.

4. You have a question and want to discuss a case with a colleague to ease your mind.


A Prosthodontist can be an excellent resource for you to ask questions because they are trained in 

many types of complicated treatments. For example, you may want to consult or refer to a Prosthodontist 

for complex implant-supported restorations. A Prosthodontist can work with you or complete the treatment 

for you to achieve the best in both function and esthetics.

Drs. Petrini & Schmidt ! The Complex Case Specialists™ ! (206) 242-6660 ! john@petriniprosthodontics.com 4