Last Tooth In the Arch Syndrome – 2nd Molar Conundrums – PDP130

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.




https://youtu.be/gs1r5mlefHU
Check out this full episode on YouTube



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.



Need to Read it? Check out the Full Episode Transcript below!



Highlights of this episode:



2:41 Protrusive Dental Pearl6:09 Introduction to Dr. Mahmoud Ibrahim9:34 What is Centric relation?10:45 Last tooth in the arch syndrome13:14 Risk assessment for Last Tooth in the Arch Syndrome15:52 Screening patient's CRCP and the degree of slide17:33 Leaf Gauge protocol for screening CRCP30:23 Communication with High-risk patients34:35 Case Discussion44:36 Management of space loss after preparation46:24 Dr. Mahmoud's top tips to prevent the 'Last Tooth in the Arch Syndrome58:47 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!



Join the waiting list HERE!



If you loved this episode, you will like If You are Not In Centric Relation, You Will Die







Click below for full episode transcript:



Opening Snippet: Because it sounds horrible, but if it's happened with all the sequelae of you losing space and bite changing, that is a big deal. I mean, this patient that might be looking at ortho might be looking at a rehab, who's paying for that? Chances are you. So for two minutes screen that you can do. And once you get good at it, it's, it's really, really quick. Just to buy yourself that peace of mind and being able to inform the patient and gain proper consent when you're restoring the terminal tooth or maybe the one in front. That two minutes is worth it in my opinion.



Jaz's Introduction:Have you ever prepared the second molar or the last molar of the patient's mouth for a crown? And when you've checked the occlusal reduction, you get the patient to bite together. And it's as if you NEVER DID ANY OCCLUSAL REDUCTION. You think what the hell is going on? I swear I just sunk a two millimeter bur into this tooth. And now it's like there's hardly any space there.



What's going on? Has that ever happened to you? Has that problem bitten you? Have you had that dreaded phone call from the lab saying, 'We need a bit more space here, Doc.' If you experienced this, you probably searched it and spoke to prosthodontics and got some information about LAST TOOTH IN THE ARCH SYNDROME where that space magically disappears. What's behind that? Why is that happened? Why, if you're not careful, it could happen to you could happen to anyone I know some great dentists. And it's happened to them. So no one is immune to this. However, the topics that me and Mahmoud Ibraham, my guest today will make sure that you will a be able to screen when this issue might happen. Have a conversation with your patient ahead of time and sometimes consider a change of treatment plan because you know that as soon as you prep the second molar, you're likely to lose space and to have that knowledge and screening for assessment is just absolutely fundamental.



And of course,