Miami is an energetic, enormous city that is easy to travel to and from. The minute you touch down at one of the two closest airports, you’ll experience the distinctly Florida vibes featuring international influences and diverse people. Plus, a decent helping of ocean breezes!

Both Miami International and Ft. Lauderdale airport are good options depending on your preferences for travel and distance to the Key. They offer different experiences for those suited to bustle and others who prefer a slower, more relaxed atmosphere. Here’s our perspective on the best ways to visit the Pankey Institute with the least stress and most ease:

Airport Travel to the Pankey Institute

MIA

Miami International airport is an American Airlines hub, which makes it a great choice for those who rack up the AA miles. Otherwise, you should know it’s the fastest way to get to the Key. MIA is a 25 minute drive from Key Biscayne. You’ll be driving over the Rickenbacker Causeway seeing the Miami skyline and blue Biscayne Bay before you know it.

They have Uber, Lyft, taxis, and private car services readily available. It’s a big, busy airport, with a lot of international travel. Allow extra time for security and getting to and from your gate on the way out.

Bonus Tip: Baggage commonly has delays or long wait times at MIA. If you can travel with only your carry-on, you’ll save a lot of hassle.

FLL

Ft. Lauderdale is a Southwest airlines hub. It’s also a smaller airport with a slower pace. Security will be faster and it’s a much better option if you plan to check bags. Car services, Uber, and Lyft are available, as well as Super Shuttle. The downside is it’s an hour drive from Key Biscayne. Traffic can be a pain depending on the time of day.

We always recommend you arrive at least the night before your course in case there are any travel hiccups and to connect with faculty and other participants as we always plan some social time. It will also make traveling less hectic and give you a little more time to appreciate your drive through the bright lights and activity of Miami. If you can avoid rush hour, even better!

Early in my career, I became frustrated with splint therapy. In the clinical area it was working. In theory, it made sense to me that I should be able to take the appliance back through well-articulated CR casts and ultimately to my patient’s mouth.

Turned out, patients treated with splints were not beating down my door for definitive dentistry. Like Mick Jagger, I Couldn’t Get No Satisfaction. A decade later, I have experienced something magical happening and am singing a new Rolling Stones song in my head, Time is On My Side. (Yes it is!)

Time and Splint Therapy

Perhaps I was not waiting on my patients or more than likely they were waiting on me. I have hundreds of splints on unrestored patients that visit me a couple of times a year. They bring along the plastic to have it ultrasonically cleaned, sometimes tweaked, sometimes repaired.

There was a time when I believed the transition to treatment was a given once the appliance was well-adjusted on a patient willing to trust me with their investment in therapy. (I mean geez, that happens every time for the folks who taught me how to make one, right?) The presentation of the next phase was a conversation that probably sounded a whole lot like a sales pitch and generally fell flat on its face.

Time is on our side. I’ve grown to realize the virtue of patience and listening. Specifically, I listen for compliments, appreciation of the appliance, and sometimes simply a statement of dependency on the plastic. Sometimes this takes years. This is the time to ask, “Would you like to discuss dentistry that can make your teeth feel this way?” Sometimes they outright ask me.

Time is on our side. Appliance therapy is a seed. Our caring attention is a well-nurtured garden. Patients will bloom when they are ready.

My experience with splint therapy was like most dentist’s prior to developing the skills taught at Pankey. In fact, my appliance was not really therapy at all. Perhaps just a shot in the dark “helmet” that protected teeth against collisions with very little intention.

Throughout the years there have been many facets of my experience I value greatly in guiding patients to health using plastic:

Splint Therapy and Appliance Design

Appliance design is a provisional analog (that is, a practice replacement) for any changes we make to the teeth and ultimately the stomatognathic system. The splint is a great diagnostic tool that is capable of healing, but it’s also an iconic part of the behavioral interaction between the provider and the patient.

Aside from physically being an orthotic analog, the splint is a training tool, maybe even the greatest reversible “do-no-harm” in our profession. Case by case, each patient experiences changes and familiarizes themselves with my touch and caring.

Month by month and year by year dentists educate themselves and develop an understanding of bite relationships by using therapy. This happens case by case too, much like waxing cars and painting fences for Mr. Miyagi. As the experiences compile, sometimes our questions do as well. Sometimes we turn to our mentors for answers, much like the Karate Kid.

For the learning dentist, different parts come together when bringing splint therapy from the classroom to the operatory. There is the initial understanding of the “why” that can be conceptualized in theory, but not realized in practice until the “how” of the technical piece arrives through experiential understanding.

Each provider comes into their own by developing skills to have patients relate needs and eventually invite them confidently to enter appliance therapy.

There’s more to come in Part 2! What challenges have you faced in splint therapy techniques to ease patient discomfort? 

My patient wasn’t satisfied with the esthetics and feel of her previous restoration. Detailed planning enabled me to deliver a beautiful, functional result. Here is the conclusion of this case and placement of the new six unit anterior bridge:

Failed Restoration: Provisional

After the treatment planning was completed, I removed the patient’s existing anterior bridge and replaced it with a bisacryl provisional derived from the orthodontic wax-up. I sectioned it specifically to enable tooth movement while I restored the pontic sites. This meant sectioning between the maxillary central, the upper left lateral and central, and the upper right canine and lateral.

I then cemented the provisional with Rely-X luting cement. Doing so decreased displacement secondary to the orthodontic forces. Next, the patient went through orthodontic therapy over three months. Following this, she was ready for periodontal surgery. Crown lengthening was done on the upper right canine, in addition to placing connective tissue grafts in the pontic sites. This ensured ovate pontics could develop.

Failed Restoration: Equilibration & Placement

Equilibration was the natural next step. It was used to achieve the necessary anterior guidance with posterior disclusion, as well as freedom in the anterior and no centric occlusion slide to maximum intercuspal position.

I prepped off the orthodontic provisional and refined the preparation. For the margin design, I went with a shoulder and rounded internal line. This could accommodate the all-porcelain restorations.

We weren’t worried about the reduction of 1.5 mm because of the original tooth reduction, but we did go forward with placement of a third plane of reduction. This was necessary for final incisal edge placement in a AP dimension.

Venus from Hereaus was used to create the six unit provisional from upper right to upper left canine. This also allowed tissue development to occur in the pontic sites.

After taking final impressions three months later, the six unit bridge was made using E.max. I placed the patient’s direct composite veneers on the upper first molars and bicuspids. Shade matching to the anterior bridge was one advantage of this approach. Also, the patient could choose to move to porcelain at some point in the future.

My patient was finally happy with her smile. All in all, it took dedicated teamwork between myself, the ceramist, orthodontist, and periodontist to exceed her expectations.