bridge repair

pt came in with a 6 units bridge on #2-6. Abutments were #2,4,6, all serviceable except for a open margin on #6F. Previous history of treated periodontal disease, moderate to severe recession, but undercontrol with excellent oral hygiene.

pt had seen other dentist who suggested to have the bridge replaced, or sectioned with implants done on the missing teeth area. pt was very reluctant. Ridge was very atrophic, and quite a lot of bone graft would be needed.

I felt it was a very minor open margin considering how long was the bridge, and offered an alternative. Removing the decay and explore how deep it was. Fortunately, there was not a lot of decay under the metal.

I

 I beveled the porcelain, etched root surface, etched porcelain with hydrofluoric acid ( ultradent) and silane applied. primer on tooth surface, bonding agent on both, composite ( opaque first to mask the metal and match the opacity of the PFM abutment), finished and polished.

This was immediately post-op, after retraction cord removal.

This was taken in 2010, 5 years later  I saw him during recall this year, and it still looks pretty good.

Just some ideas for alternative treatment. I think this was the most conservative option we had. Both of us were very happy about the results.

brown stains from fluorosis

We tried to use opalustre ( ultradent) but it did not remove the brown stains completely. I ended up using air-abrasion, no anesthesia, and just a very thin layer of translucent composite on the facial. Very happy with the results.

internal bleaching

Some teeth show discoloration after root canal treatment. Sometimes it is caused by necrotic pulp left in the chamber, which happened here with tooth #10. Few weeks of sodium perborate inside of pulp chamber, #10 is no longer gray and discolored.

I don't believe every single tooth should be crowned after root canal treatment. The process of stripping off the entire enamel layer, which is the strongest part of the tooth, does not seem to be minimally invasive to me. I agree that most of time, root canal treatment happens to a severely decayed or extensively restored tooth, which may fracture without a crown. There are few exceptions though. In this case, #10 has no other restorations, the root canal was probably done when patient was still very young, because the chamber was very large. If we prepare the tooth for full porcelain crown or PFM, we would remove the thick layer of enamel away, leaving a thin layer of dentin, and composite build-up on the inside. I don't see any other fracture or crack, at this time, I prefer to restore tooth with composite only. 

erosion

Saw this 20 years-"young" shy gentleman, always soft spoken and smiling. Quiet kid, very polite. I like him. Moderate to severe wear on his teeth considering his age. All first molars have flat cusps. #20 had a chipped DO composite. I scheduled him for #20-DO and #19-O.

All I did on #19 was to sandblast the exposed dentin. On MB cusp, there was food trapped, so I also used caries detector to see if there was any decay, since the dentin did not have the shiny appearance that it normally does. I was asked by someone in the office isn't this caused by wear, would it come off easily? I disagree strongly. I believe it is cause by erosion, since there is no contact on those pitted dentinal area. I also believe that if we do nothing, the erosion will continue, and the unsupported enamel will be worn down. teeth will erupt. Can't just tell this nice young man to wear nightguard and just wish him good luck on the remaining awaken hours! I think too often we prescribe nightguard and do nothing for the patient while their teeth deteriorate. We blame them for not wearing it because it is bulky, and awkward. Really, who likes to wear it? Can there be even a slight possibility of romance if you are wearing nightguard to bed?

false negative in x-rays

I am sharing some of my intra-oral pictures taken at chariside, and thoughts on it.

#12 did not show clear decay on bite-wing taken. Clinically I can see a "yellow" shadow coming through the distal marginal ridge. Scheduled patient to come in for filling, but she was told they could not find decay on x-ray. 6 months later I saw pt for cleaning again, and this time I took picture of it while restoring tooth.

x-rays can give false negative results, careful clinical examination in combination with x-ray is the key to correct diagnosis. I know we have all been told and taught at school this way, and heard of this so many times, but I still see this happening too frequently...

why I am blogging

I told my husband that I wanted to have a blog. He stared at me and asked what would I talk about. It is understandable since it is coming from me, a low, low, low tech person. Have never touched a computer until I met him. I guess I have come long way...

"Dentistry!" Of course, what else would I talk about? ok, maybe cooking, I am exploring it as my relaxation  technique. Somehow beautiful and tasty food gives me satisfaction in making.

so here I am, this will be space to share thoughts, pictures, up-and-downs of my daily life.