JON LUDWIG, DMD
Our Featured Monodont Case is from the office of Dr. Jon Ludwig, with offices in Orange and West Haven, Connecticut.

BIO INFO
Jonathan Ludwig, DMD is a graduate of Temple University School of Dentistry. He maintains a private practice in Orange, CT with an emphasis on comprehensive and esthetic restorative care. He also has a degree in Chemistry from Lehigh University, from which his interest in adhesive dentistry began. His other fields of interest include minimally invasive dentistry and laser dentistry, for which he recently received his Level I Waterlase certification. He is a member of the AGD, AACD, ADA, and ABFD. He can be reached at ludwigdmd@yahoo.com or at www.shorelinedentistry.com.

MONODONT ADVANTAGES AND CONSIDERATIONS
I first learned of the Mondont as a viable single tooth replacement option after reading a thread on Dentaltown’s website, www.dentaltown.com. There I was lucky enough to be able to bounce questions about the procedure off of one of the creators, Dr. Mars Lans. Mars and I began talking about a very nice gentleman in my practice that was an ideal candidate for this type of procedure. He then referred me to a lab in Friedens, Pennsylvania run by a fantastic technician named Rick Knecht (www.rgkdental.com). Rick had some experience with Monodont fabrication in the past and was able to further direct me in how to accomplish an esthetic and functional result using this technology.

I had a patient come in to our office about 1.5 years ago for comprehensive examination. His chief concern was replacement of a flipper which he had been wearing for the last 10 years to replace missing tooth #8. Although this flipper had been constructed well, my patient desired a fixed appliance and something that matched his surrounding teeth a bit better. After reviewing a full-mouth series of radiographs and working up a treatment plan, we began to talk about options for replacement of the flipper. He had a small discolored ML composite restoration on #9 and #7 was a virgin tooth, free of restorations and decay. Both teeth were stable periodontally. We began to discuss more traditional options at first, including an implant and crown for #8. He was shown the Caesy DVD presentation on implants, and I fielded questions regarding the procedure. Although the procedure sounded like a good one to him, his two main hang-ups were the surgery involved, and the cost of the treatment. He considered this a possible option for the future, but at this time, the implant was not the right procedure for him. An RPD was out of the question, as he desired a replacement tooth which was not removable. And after explaining the need and extent of “reshaping” of the adjacent teeth for a permanent bridge, my patient rejected this treatment option due to the invasive nature of the procedure.

We then began to talk about a newer procedure that I had no experience with as of yet, but had seen many successful cases completed on Dentaltown. The monodont seemed like a treatment tailored toward his exact criteria….minimally invasive, fixed, kept the option open for eventual implant, and in his case….cost effective (I did this one for him at very little cost, as it was my first case). My patient was very excited. After the treatment plan was accepted, I was able to take a quick PVS triple-tray impression and record the shade of the surrounding dentition. I snapped some digital photos and sent everything out to Rick for fabrication of the case.

Rick had done a few cases like this before. We talked on the phone a bit about this one regarding materials, pontic design, prep design, etc. The great thing about the Monodont procedure is it changes lives in a very short amount of time. Also, in between appointments, there is absolutely no temporization necessary. The first appointment was as simple as an impression, shade, and photo. No prepping necessary at the onset. Rick was then able to fabricate the monodont from the materials I sent him. He created a prep guide and seating stent to aid in the delivery process.

About 3 weeks later, I saw my patient for delivery of his new restoration. I opted for anesthetic, as I anticipated extending the preparations just into dentin. The delivery day consisted of preparation of the rest seats for the wings of the appliance (guided by Rick’s Siltec putty matrix), and simply bonding it into place. I replaced the old composite on #9 as part of the procedure, this was incorporated into part of the prep design. The procedure was fast and conservative, and thanks to Rick’s excellent artistic ability, was characterized to match his surrounding dentition very nicely. Needless to say, my patient was thrilled with the result, not only from the better esthetics, but also because he was finally rid of his flipper. The appliance has been in place for about 1 year now, and I’ve seen him a total of three times since placement. It’s holding up very nicely, and he’s been kind enough to refer the rest of his family and some friends in to see me for dental care.

I have since completed a handful of monodont cases. I’ve done one 2-unit lower anterior case, which included the Perio Tie-Bow intracoronal splints that East-Flex developed. I’ve done a few posterior cases where the occlusal load was light. I feel the monodont is a very versatile treatment option for single tooth replacement (or in some cases, 2 teeth replacement), but care must be taken regarding case selection (just as in any case). I’ve been happy to have the opportunity to offer this type of treatment to my patients, and the one’s that have gone through treatment feel very lucky. All of the cases that I have done have worked out well and have been very rewarding.

Jon Ludwig, DMD

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