Dear Spear fellows,

I posted a question a few weeks ago about how to work with orthodontist to restore pathway wear. My case went like this: a patient had pathway wear on #8 and 9 which made the incisal edges thin and transparent. Pt didn't like the look and would like me to restore the incisal edges. I recognized pathway wear and said I needed some space with ortho therapy in order to restore them. Pt said she's been thinking about doing Invisalign to correct the lower anterior crowding, so she's referred to the local orthodontist.

I received good suggestions from the Spear fellows such as asking the orthodontist to send the pt back to you mid-treatment of ortho, so I told the local orthodontist, who previously said I could do the comp when ortho was finished. However I did not have a big picture of what the whole process was like, so I was not sure what to tell the orthodontist when he should send the case back to me and what needed be done upon finish of the ortho, so that the pt's parafunctional grinding wouldn't knock off or grind off my comp.

I asked the question here but did not receive feedback, so I set out looking for answer from other resources. I probably asked the wrong questions, 'any parameters the orthodontist should follow to send the case back to me and to finish the case? '. None of my resources gave me clear answers, so I looked into the ' wear ' section of the Spear Online today, starting from the newest video. I found this video titled ' using comp to treat pts with tooth wear " taught by Dr. Spear. He talked about a pt whose upper anteriors had crossover wear. To treat it, Dr. Spear said the orthodontist proclined the upper anteriors and intruded/retroclined the lower anteriors, to create space for him to place comp on the lingual incisal of the upper anteriors, then pt went back to the orthodontist who established anterior coupling to finish the ortho, then he adjusted the bite to create broad contact between upper and lower anteriors to finish the tx of the wear case. Dr. Spear said pt would continue the grinding behavior but it’s OK, you could add new comp to fix it.

Did that answer my question? :) There is no specific parameters for the orthodontist to follow. I'm thinking to do this: I will tell the orthodontist that when there is space created for me to restore the transparent incisal edge to proper thickness in my case, please send the pt back to me, I place the comp; then he establishes anterior coupling to finish the ortho tx; then send the pt back to me again for anterior occ equilibration. Postop instruction to the pt: pt will likely wear on the comp again, but there is the space ( hopefully pt wears ortho retainer faithfully to keep the proper position of the anteriors ) and new comp can be added.

Please let me know if the description of tx process is the correct. Any comments and suggestions are highly welcomed. Thanks!