Immediate Bridge Using Natural Tooth And Ribbond

The patient has had a lower anterior tooth that had gradually lost all the attachment around it as a result of localized periodontal disease. This left the tooth mobile and hopeless and it was starting to become uncomfortable chewing with it.

Before and Afters Of Immediate Bridge using Natural Tooth
Before and Afters Of Immediate Bridge using Natural Tooth

Once we determined that the tooth was hopeless, we set out to make the mouth healthier by removing the tooth. Then, we used the removed tooth to make a bridge between the teeth that will act as an immediate bridge. To make this possible, we anesthetized the area and extracted the tooth. Because it was already mobile and had very little attachment remaining, there was not very significant bleeding. We then, sectioned the tooth to get it out of the unhealthy pocket so that the periodontal tissues below it can heal. Then, we backfilled the root canal space internally in the tooth with bonding agent and flowable composite. We made a channel in the two adjacent teeth and the extracted tooth, then, using unfilled bonding agent on the Ribbond, and normal (etch, Scotchbond Universal) bonding agent on the teeth, placed a thin layer of composite and bonded 2 strips of ribbond into the channel to reinforce the teeth being intracoronally splinted together. We then, placed additional composite over the top, and I added a small amount of flowable composite from the facial interproximally to finish. Then, I touched up the occlusion with an ortho disc and smoothed off the edges of the composite in the channel with a flame diamond.

Fractured Tooth Emergency Repair with Same Day Crown

Patient presented with a fractured off tooth, which we were able to repair in-office same day with an all ceramic crown.

Fractured Tooth Repaired with All Ceramic Crown
Fractured Tooth Repaired with All Ceramic Crown

We used the laser to lower the gums, so there is some slight coloration in the gums (right now temporarily) from the use of the laser. That mild discoloration at the gumline will be gone in 1-4 days.

We used 1 cartridge of 4% Articaine given via infiltration locally on the tooth. This did not require a full Inferior Alveolar Nerve Block. The tooth was carefully prepped and the gums lowered to allow an adequate ferrule for retention.

The ‘A1’ shade Obsidian Block was characterized with some cream coloration to help match the natural teeth which have mild light horizontal striations. We were able to seat this crown, same day and this tooth is taken care of and the patient does not have to walk around with a very nearly exposed pulp chamber. The patient had not felt any serious pain on this tooth, and so we are not expecting to need a root canal for this tooth.

Hope you like it,

JRM

Before and After In-Office Whitening

Enjoy the before and after:

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On this case we completed today, we moved a patient from a A4/C4 to a B3. In-office whitening uses a process where we retract the lips and isolate the gum tissues using a soft light cured resin. The process takes about 1 hour. We do 3 applications of 38% H2O2 bleach gel to the teeth. Each session of the three applications is kept on the teeth for 15-minutes. Then, between each set we clean the teeth off and reapply fresh whitening gel.

Retraction in place
Retraction in place

To get a sense on the shade guide organized by hue, chroma, and value from lightest to darkest. Here is what it means to move from C4 to B3.

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So, the before and after on this case was really an awesome improvement.

Hope you like it,

RM

Responsible Esthetics: No Prep Veneers with Lumineers

I recently sat in a Hands-On course with Dr. Peter Harnois. We spent several hours discussing veneers. The primary topic was a discussion of prep design, tooth preparation in order to get the tooth ready to receive a veneer. Specifically, Dr. Harnois discussed Lumineers, which use strong lithium disilicate, and can be as thin as 0.5mm. The bonding of veneers with a resin cement is central to the combined strength as this prevents displacement and prevents flexure of the veneer.

Denmat is the dental lab that is responsible for the Lumineers and minimal prep and/or no-prep veneer options. I was compelled by the results that Dr. Harnois showed off. Here is a virtually no prep case that I completed with a single veneer for a lateral for a patient this past week. Click for FULL SIZE VIEW

Veneer Before and After
Virtually no prep veneer. Dusted off the sharp edges with a Sof-Lex disc before sending to lab.