In order to properly inform the patient i need to be able to tell them that a this might happen meaning i need to take more off the tooth and b if your bike changes it could end up looking a bit like this. It is desirable to restore that tooth but there's a higher risk for this last tooth in the arch syndrome. So they're in a level of informed consent here is amazing so how did you actually manage it? You've been wise and you've done your screening uh upper head and you've informed the patient and you've gone through trouble of you know mounted casts and to actually create these beautiful visuals is amazing.
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Episode notes
Have you ever prepared the last molar for a crown? And just when you check the occlusal reduction, the patient bites down and as if by magic, the reduction has all DISAPPEARED?! It is the phenomenon that we call ‘The Last Tooth in the Arch Syndrome’
This episode with Dr. Mahmoud Ibrahim will give you more confidence in recognizing, screening, and managing such complications in practice. But like I say in the main episode, optimistically, this phenomenon will never happen to you AGAIN if you follow these protocols for screening.
Protrusive Dental Pearl: Watch out for the patient with quite flat teeth as they are more susceptible to the last tooth in the arch syndrome / bite change. They do not have good posterior coupling/stability and therefore more likely to ‘forget’ their bite as the cuspal inclines do not guide the mandible back in to maximum intercuspation.
Highlights of this episode:
2:41 Protrusive Dental Pearl
6:09 Introduction to Dr. Mahmoud Ibrahim
9:34 What is Centric relation?
10:45 Last tooth in the arch syndrome
13:14 Risk assessment for Last Tooth in the Arch Syndrome
15:52 Screening patient’s CRCP and the degree of slide
17:33 Leaf Gauge protocol for screening CRCP
30:23 Communication with High-risk patients
34:35 Case Discussion
44:36 Management of space loss after preparation
46:24 Dr. Mahmoud’s top tips to prevent the ‘Last Tooth in the Arch Syndrome
58:47 Occlusion Basics and Beyond
Dr. Mahmoud Ibrahim and I are currently working on a huge project called OBAB, Occlusion Basics and Beyond – it will be the best occlusion resource in the Milky Way…and that’s our mission! We want to finally demystify Occlusion and make it Tangible AF!
