Whip Mix Corporation WHITEPAPER!

The Importance of
Records In Diagnostics
& Treatment Planning
By: Richard J. Pitz, D.M.D

About the Author

Richard Pitz studied at Hofstra University,
University of Kansas, Lehigh University, the
United States Army, and New York National
Guard prior to receiving his Doctor of Dental
Medicine (DMD) from the University of
Pennsylvania in 1967. Dr. Pitz continued his
education with an internship in oral surgery
with Metropolitan Hospital, advanced studies
at New York University, and a residency in
anesthesia with Mt. Sinai Hospital in New
York. He had his own dental practice that
provided on site laboratory services including
fabrication of crowns, bridges, and porcelain
restoration. He developed the protocol for the
use of the first injectable anesthetic
(Ketamine) with Dr. William Greenfield. He
also currently holds three dental patents
relating to endodontics, and is currently
working to introduce two new products to
dentistry. He is currently a member of the
Board of Directors, the State of New York
Dental Society, the New York State Dental
Society Wellness Committee on Alcoholic
and Substance Abuse, the New York Athletic
Club, and Treasurer of the New York County
Dental Society.
“When you don’t know where you are going, any road will
take you there.” We are constantly being told how “records”
are the most important thing we can do in dentistry. Accurate
records, not only those written in the chart, but those taken in
the course of a diagnosis and a treatment plan is what is
needed and “demanded”. Happy patients produce new
patients. Happy dentists are those dentists who see a
problem, know what is necessary BEFORE they pick up a
handpiece. You never do treatment planning with a handpiece
in your hand.
Dentistry deals with the “Bio-Mechanical” aspect of the oral
complex. This mechanical movement must be diagnosed as
normal, abnormal and pathologic. Normal tooth structure,
good occlusion, no missing teeth, Class I orthodontic, normal
movement and facial symmetry are just some of the
parameters we try to duplicate, when treating patients who
are deficient in some or all of the standards. For any simple or
complex dental case, we must have records not only of the
soft and hard tissues, but how they respond to the
mechanical aspect of the dental complex.

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If you say “Adjustable Articulators,” to most dentists, their response will be either “What is that,” “I don’t
use them,” or “I don’t need them.” When the world’s best clinicians lecture on the need for accurate
bites, facebow transfers and adjustable articulators are discussed, why is it that this valuable information
is not seen as important to many dentists? Full mouth rehabilitation cases demand accurate bites,
facebow transfers, and adjustable articulators in all cases.

Believe it or not, a single tooth restored with full coverage can be more problematic is many cases.
What looks easy may not be, and when a balanced occlusion becomes unbalanced and is ignored, it
sets off a string of events—all bad. How often does this happen? More often than one might
realize. Chronic occlusal trauma from an unbalanced occlusion causes bone loss, tissue inflammation,
pain that could eventually be severe, tooth loss and possibly TMJ problems. When one tooth moves
other teeth move as well.

While this doesn’t happen over night, in some cases within a week we wind up with a loose tooth. An
attempt to adjust the occlusion in the mouth does not work because the tooth moves out of the way and
the articulating paper does not leave a mark. No matter how good things “look” with a mouth mirror and
visual inspection, study models, a facebow, accurate bites, and a good mounting on an adjustable
articulator will give you more information that can be reviewd over and over without having the patient in
the chair.

“I have a great lab technician,” is what you hear. Triple trays, quadrant impressions and quadrant bites
may suffice—I say may; but once you learn to use the accurate bite, facebow and adjustable articulator
on a regular basis, it will be a time saver, give you better results and give you total control as to what
goes into the patients mouth. The cost for the equipment spread over time is worth the effort.

Why do we all require accurate bite and facebow transfer and properly mounted casts on an adjustable
articulator in the first place? Well, for one, if we have to back out of a treatment plan we can go back to
exactly where we were before the case was started. We can duplicate this set up many times in exactly
the same position which will allow for multiple approaches in all cases, particularly the difficult
ones. These records will allow any one who needs to view them as the definitive records. While it is true
we now have computer generated files, a human has to enter in the information. If you give poor
information you get poor results. In the end, it is the human decisions that determine the success or
failure of the result.

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Every case I made was mounted on either a Whip Mix or Denar articulator. Of course we need to
have closed margins and good esthetics. Individual teeth do not act alone, they work in harmony.
Good mounted study models on the correct articulator—not a “door hinge,” will allow for good
diagnosis and treatment. We do not discount good x-rays or photos, these too coincide with the total
diagnosis and treatment. We are now seeing the implant version of “I don’t use an adjustable
articulator,” by the failure to use cat scans and implant guides. One bad choice compounded by
other bad choices creates bad results. “Now Mrs. Jones, please tell the jury what happened with
your treatment in Dr. Smiths office.” Pay attention, it could happen to you.

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permission of the copyright holder. For permission, contact jhughes@whipmix.com