Dentaltown April 2018 - 68
office
visit
gave them a smile they never had. Even doing an occlusal
restoration on a 5-year-old-during that time I get to be the
biggest goofball on the planet to entertain them. When the
practice of dentistry is like that, who wants to give that up?
What's the average day like at
your practice(s)? How does it compare
to when you first started practicing?
I' say it looks very similar from the outside. I think
there are people who think all I do is cosmetic dentistry
and full-mouth reconstructions. I may do a lot more of
those now than when I started in practice, but my average
day is still filled with general dentistry: new patient exams,
restorations and single-tooth dentistry. (Thankfully, having
great "average days" makes the big-case days that much better.)
As a fellow of the Academy of Comprehensive Esthetics,
Dr. John Nosti has dealt with some incredibly complex cases.
Here, he discusses some of his most challenging ...
The most challenging cases are patients who
are "destroyers." These are people who are going
to continue to break things, and all you can hope
for is to slow it down and try to manage them. I've
heard some of the great educators in our field talk
about these patients, and a few years ago I finally met
someone who truly fit this category.
Fig. 1
This patient was rehabbed several times
before by a few doctors. He presented to me
having lost teeth since his last rehab. He had
broken restorations and implants placed in
extremely poor positions. One or two implants
seemed unable to be restored, because of their
positions (Figs. 1 and 2). I had an honest
conversation with the patient regarding the fact
that implants should be removed and replaced,
which was something he wasn't willing to do. I
informed him that I believed that he was going to be
someone who, over time, would continue to break
restorations. That conversation was key!
One of the most difficult aspects of his rehab
was that on his maxillary left side, he had a natural
68
APRIL 2018 // dentaltown.com
dentition opposing mandibular implants. On his
maxillary right side, he had implants opposing a
natural dentition. His anterior teeth had root canals
with post and cores present.
We are currently replacing two teeth that
fractured with implants, and hopefully that will be
the last dentistry
to be replaced.
Fig. 2
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Table of Contents for the Digital Edition of Dentaltown April 2018
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