Schudy Lecture
Dr. Claude R. Stephens
The 1st annual lecture in honor of Drs. Tom Creekmore and Fred Schudy was given on Friday, September 19, 2003. It was presented during the joint meeting of the SWSO, GLAO & MSO in New Orleans.
Prior to the lecture a video presentation was made on the lives of Drs. Schudy and Creekmore. The presentation, which included many photographs, was both informative and moving. The Schudy and Creekmore families had representatives present and each family received a gift to commemorate this first annual lecture.
Dr. Vince Kokich was given the honor of providing the inaugural lecture. He was introduced by his former student and current SWSO member Dr. Devek Frech.
Dr. Kokich talked about the importance of close communication between doctors when several disciplines are required to ideally restore the dentition. He clarified the difference between a “multidisciplinary” versus “inter-disciplinary” approach. Dr. Kokich made the distinction that multidiscipline meant more than one doctor working on a case, whereas his description of an inter-discipline approach meant doctors working together on a case. In his lecture he gave us the following five guidelines for the inter-disciplinary approach to restoration.
1. The first guideline was “create the vision”. Basically this is where one starts with the end in mind and often that necessitates a diagnostic wax-up. He made the point that when he does a diagnostic wax-up he duplicates his wax-up in alginate, pours that in hard stone, and sends the duplicate model to the restorative dentist. He took us step-by-step through a wax-up of a case that involved an implant.
a. duplicate the entire casts
b. cut out one arch at a time
c. reposition only the teeth that will move
d. always leave one tooth unmoved for reference
e. once the arch is set up, then move to the other arch
f. select the proper size tooth for implant ( for this he uses plastic
denture teeth and attempts to get the ideal size, shape and color, to
include in the wax-up.)
g. duplicate the casts
h. create a surgical stint that the oral surgeon can use for guidance
in the placement of the implants
Dr. Kokich has pointed out that this information as well as all of his previous publications were put on a disc and sent to the AAO. Anyone who would like to access that information should call the librarian at 800-424-2841 x242. Ask for Celia and explain to her what you are looking for and she will be able to burn a copy for you.
2. The second guideline of the inter-disciplinary approach was to “establish the sequence of treatment”. By this he simply means to determine “who does what” and “when do they do it”. He pointed out that when he and his colleagues get together to look at a case, they decide what steps need to be taken and then they go back and sequence them. They specifically assign each step a number and the treatment is delivered in that specific order. Each doctor involved in the case receives a copy of this sequenced treatment plan, so everyone can know where the patient is in the progress of the treatment plan at any point in time.
3. The third guideline was to “determine the responsibility for periodontal treatment”. Dr. Kokich made the point that he specifically asks for a current periodontal charting from each general practitioner on every new adult patient that he gets. In fact he said he likes to have that on hand before the adult is seated, if possible. Dr. Kokich went on to give us a brief review of periodontal boney defects. He categorized four major boney defects:
a. The interproximal crater (a type of two-walled defect). He pointed
out that this type of defect can have rapid osseous destruction and we
need to be acutely aware of these.
b. One-walled defect (this type lends itself to correction via orthodontic
eruption of the tooth involved).
c. Two-walled defect
d. Three-walled defect
4. The fourth guideline for interdisciplinary treatment was to determine the optimal timing for extraction of hopeless teeth. He gave presented a case where teeth that ultimately needed to be extracted were used temporarily for anchorage during rehabilitation of the bite.
5. The last guideline was the critical necessity for “positioning the teeth to facilitate restoration”. He gave an example of a case that started out with maxillary central incisors that had relatively even incisal edges. However, there was a distinctive difference in the facial gingival height of the two. One tooth had supererupted significantly over the years because of incisal edge attrition. In this case he intruded the superupted tooth so that after orthodontic treatment the gingival contours were even. Obviously there was a dramatic height difference in the incisal edges post-orthodontics, which was addressed prosthetically. The result was a beautiful smile with ideal gingival and dental esthetics.
Dr. Kovich’s inaugural lecture was a very nice tribute to the memory of two great former SWSO members, Dr Tom Creekmore and Dr Fred Schudy