The two keys really in terms of deprogramming is don't let the back teeth touch and make sure that when you are dialing the leaves in you fully clear the contacts at the back. Don't get complacent think oh they're only touching one just get some more leaves in there to deprogram a little bit. If it isn't fine document it in your notes and you'll know for next time how you won't have to do the screening again so once you found out that it is then we need to start collecting maybe a little bit more information, he says. "i agree my experience as well i just want to say my mum was sorry for interrupting but really important to
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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!
