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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.

What about small fractures? Or is there more to the story?

Enjoy the before and after!

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Patient could tell something didn’t feel right, it hurt initially, and a small piece broke off, but, then, the pain temporarily subsided. There was meaningful decay into the dentin in the area where the chipping occured. We removed the old amalgam, the caries (decay), and restored with a composite. Recurrent decay with associated fracture: #19 – DOB

He wore through the cusp tips from grinding. I did not extend the outline of the filling into the areas of erosion on those cusp tips, as the patient’s grinding was largely historic from having very large tonsils in his youth. He did not have his tonsils out until 18 or 19-years-old. The airway disturbance, akin to Obstructive Sleep Apnea, caused associated bruxism. If we did extend the outline of the filling into those areas, the tooth would be very weak and would require a crown and would be at high risk of fracture.

Leaking Sealant

Before and After of Leaking interface between filling and sealant.
Before and After of Leaking interface between filling and sealant.

In this case, we have a classic example of a leaking sealant. The interface between filling and sealant at the occluso-lingual groove of #3 has broken apart and been seeping with each day getting into the dentin beneath the filling and the tooth. The interface between the sealant and the filling breaks and starts leaking. I identified a small area of grayness at the marginal interface. These types of failures rarely show up on a radiograph, but, MUST be visually identified by the dentist. By the time it shows up on an x-ray, it would be very deep and very large. Luckily in this case we were able to identify it early and simply replace the failing restoration with a new clean composite that should last for many years to come.

People have asked me in the past, ‘Why do you only seal some teeth, but, not others?’ Only teeth in high risk patients and high risk teeth should be sealed. (Factors which determine caries risk are: whether the mother of the patient has caries, caries in the primary teeth, homecare – if they are brushing 2x per day, using a fluoridated toothpaste, and whether the individual tooth has deep grooves, and socioeconomic status.)

In-Office Whitening Special 10-Year Anniversary

YEAR OF JUBILEE Special: Professional Whitening In-office $200 off

The normal $510 for 1-hour In-office Whitening, we are running a quarterly special celebrating 10-years in practice, for $310. We ran this as a CYBERWEEK special last year, so I brought it back by popular demand as a way to say thank you to patients.

  1. Use the Pay Now.
    • Enter the information for the person paying for it, under First Name Last Name Billing Address, City, State, Zip Code, Country, Phone Number, and Email, all of these top fields should match the credit card billing information.
    • In the space for Invoice Number/ Chart Number, type “JUBILEE” Under the space for PO Number/ Patient Name, type the name of the person who will be receiving the in-office whitening.
    • In the space for Amount, enter $310.

This can be gifted for any special occasion to a family member or friend.

If a friend or family member comes in who is not yet a patient, as long as they have a home office where they have been seen within the past 12 months, they are eligible to do in-office whitening. If a person does not have a home office, but, wishes to redeem the whitening, we would strongly encourage them to get a cleaning, x-rays, and exam before moving forward with whitening. Otherwise, a person would need to sign a waiver that states that they understand that we cannot be held responsible for underlying caries, periodontal disease, or any other conditions, without a comprehensive exam. If a person who is redeeming the gift would rather use the money toward a cleaning, x-rays, and exam, then, the $310 will spend like cash and would cover a new patient visit (including cleaning, x-rays, and exam) assuming that the patient does not have periodontal disease. If the person using the gift certificate would rather have bleach trays made for at home bleaching and whitening, they can apply their credit to that, which would normally be $510, and it will completely satisfy the cost for whitening trays with 3 tubes of whitening gel. They will not owe $200, but instead will receive the same consideration, and the $310 gift will serve as complete payment.

If you have any questions about this promotion, call our office at 512-454-2744

This promotion is valid from 11/1/18 through 1/31/19.

Minimally Invasive Dentistry

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Patient presented with a small area of wear and chipping, and a microfracture on the incisal edge. In this case, a simple and conservative option is simply smoothing off the area with a very fine polishing disc. Because the reduction is less than 0.5mm, and the chipped tooth appears slightly longer, it makes a reductive approach the most minimal option.

The reduction was completed with no anesthetic and done with a very fine ortho disc, and polished with the blue Sof-Lex discs. The patient was very happy and the cost is very small, since this is a simple and inexpensive method to improve the look and feel of the incisal edges.

Case Study – Drink Beer Out of a Can instead of a Bottle

Drink beer out of a can instead of a bottle.

Click on the picture for the blown up view of today’s before and after for the chipped tooth.

before-and-after-front-chip

I heard an all-to-familiar story today. A patient was relaxing with his friends and was enjoying a beer. But, he made the fateful mistake of drinking it out of a bottle.

I have been practicing for 10-years and anterior chipped teeth are frequently caused by drinking beer out of a bottle. I have great advice… drink your beer out of a can.

Sincerely,

J. Russell McFarlane DDS

TAP-3 Appliance (Snoring, Sleep Apnea, TMJD)

Dr. McFarlane: “So, we came to deliver the TAP-3 appliance, today… to follow-up. We delivered it last week. And now, we’re following up to see, ‘How does it feel?’”

Patient: “It’s great.”

Dr. McFarlane: “OK. Now, tell me a little bit about what you were telling me earlier about sleep. How was your quality of sleep?”

Patient: “Well, before, you know my snoring would wake me up.”

Dr. McFarlane: “OK.”

Patient: “[With this appliance] I could tell the first night that I slept all the way through the night. And I actually woke up, earlier than the alarm. And it felt good! I didn’t feel really tired!”

Dr. McFarlane: “Alert?”

Patient: “Yes.”

Dr. McFarlane: “For the first time in…?”

Patient: “A long, long time – Several years.”

Dr. McFarlane: “And you were comparing that to falling asleep on the couch?”

Patient: “So, when I didn’t have it in… so, I wore it for about a week and then on the weekend I didn’t wear it and I woke myself up in the middle of the night. And I could tell the difference.”

Dr. McFarlane: “And the reality was, you were snoring possibly losing airway function.”

Patient: “Yes. This is so much better than having a tube running around on your face. Like a CPAP.”

Dr. McFarlane: “So, you’re describing a CPAP. What do you think the issue is with a CPAP when you describe that?”

Patient: “Well, I’ve never had one on. But, it just looks like it would be very cumbersome and when I turned over I might jar it loose.”

Dr. McFarlane: “We know the success rate on CPAPs is about 49% at 1-year. People can’t tolerate wearing it. But, you’re not the first person that when we look at the guard has said, ‘Man, that is changing my life.’ (That after wearing it for a few days,) you start going, ‘Man, I am not going back.’ And tell me, you said, ‘it was kind of like biofeedback for you.’ Talk to me about that.”

Patient: “Yes, the first night I wore it I could feel some tension in my jaw. And I’ve had some issues with TMJ. It made me really relax and not hold so much tension in the joint. So, after 3 or 4 days then I was not even really aware of it. It wasn’t like hurt, like deep pain. It was just sore, at first.”

Dr. McFarlane: “At first, you felt some soreness. You’ve been clenching you jaw shut, for who knows how long, to hold your jaw in a certain position when you sleep and that grinding has been associated for you with probably some snoring, (maybe sleep apnea events – we don’t know.) But, what we do know for sure is that your airway (when it’s open,) you can actually relax your jaw. And that’s holding your jaw forward.”

Patient: “And my teeth looked whiter. But, I know that’s not the cause.

Dr. McFarlane: “[Joke] Even whiter teeth – what are you going to do?”

Patient: “Yep. I’m happy.”