Dr. Stephen L. Kirkpatrick, from Olympia, Wash., explains why Dr. Murphy’s occlusion article from the September issue of Surgical-Restorative Resource struck a nerve, on two counts.
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Dear Dr. Murphy:
I was glad to read your Sept. 7, 2011, DentistryIQ article "Simplifying Occlusion to Gain Patient Acceptance." It struck a nerve, on two counts.
First, the shorter and perhaps funnier one.
You should read Woody Allen’s short story "If the Impressionists Had Been Dentists," which is in his collection titled “Without Feathers.” You may be aware that much is known about Vincent Van Gogh through the letters he wrote to his brother, Theo, who was an art dealer in Paris. In the Woody Allen story, Vincent is a dentist. I haven't read the story in years, but I'll mention my favorite section. Vincent-the-dentist complains that his patient is so bourgeois. She actually wants to chew with her bridge, and he wants it to be a wild, flowing thing. (Also note the part where he says he works in a different medium each week. Some days he works only with floss.)
Second, I will try to put words to a long-held complaint of mine.
I recently named it Museum Syndrome. Despite my concise and clear notes in my lab Rx, the lab will make a crown that is better suited for going into a museum, rather than into my patient's mouth. This happens most often with a new lab, trying to impress me, I think.
Symptoms of Museum Syndrome include:
- Triangular ridges lovingly created, tall and dramatic, which I have to grind off. Even after I get them out of balancing interference, the patient will say: How come my tooth is so bumpy? As I grind off more, I ponder the question: I'm paying for this?
- Lower molars with tall lingual cusps. That's why the tooth broke/needed endo in the first place. You want to sell me another crown in five years? Or an implant or bridge when this tooth fails? The occlusion needs to be shallower, the farther distal you go. And keep the centric contacts on peaks and valleys, not on slopes. We're not planning to orthodontically move the tooth.
- Extreme ridge lap, hanging 3 mm down buccally and lingually. Didn't I circle the drawing of modified ridge lap, besides describing it as minimal ridge lap? It took me nearly an hour to grind back the excess zirconia on that one, and I should have sent it back.
- Upper incisors with any kind of marginal ridge. Yes, certain segments of humanity have those, but not everyone, and by the time a tooth needs a crown, those will be worn down. Maybe the tech is an anthropologist or a sociologist trying to make my patient's mouth more diverse.
- Hanging DF or DL cusps on an upper first molar. That's asking for trouble: let's wedge apart those lower molars. And break the new crown.
- Dark brown stains in grooves or Class V. I didn't ask for those. Maybe light stain (read my Rx). My patient didn't pay big bucks for a crown with a cavity.
- Lack of proximal contacts. That's a deal-breaker. Maybe other dentists don't complain to the lab about this, but I asked for proximal contacts. Notorious area: between the molars (distal of first or mesial of second.) I tell the lab I prefer to adjust prox contacts. If they try to make prox contacts "perfect" for all cases, they're light or open 25% of the time. My lab needs to scrape dies and let me fine-tune. With oral scanning, this may be harder to get right.
Now there's a name for it: Museum Syndrome. Hope your lab doesn't catch it.
Stephen L Kirkpatrick, DDS, PLLC
P.S. I caught your "act" once: an excellent presentation of Vident's Easyshade device.