Paul Gyogal who's joined this podcast now and then thinking oh my god I just discovered this thing called last tooth to the urge syndrome mrs smith is like totally pissed off at me what the hell do I do now. If you've already had the condyle seat and as long as when you put your whatever is you put on your bond your your composite you haven't reestablished a new centric relation contact point so you haven't put it in high he would wait and see if that patient develops or adapts to the existing new occlusion before doing another screening. Once they come back afteryou know a few weeks do the screening again chances are you'll find that their
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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!
