CASE PRESENTATION: Treatment of Deep Caries of Tooth No. 9 in Adolescent

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Date: 09-22-2020 07:58:09 am

A 13-year-old girl presented to the practice for her recall visit. Upon examination, we detect­ed caries on the distal of tooth No. 9. A diag­nosis of deep caries was confirmed with x-rays. After discussion of treatment options with the patient’s parents, we chose a minimally invasive approach that included the use of a laser for tooth preparation. 

Tooth preparation was performed using the LiteTouch erbium laser (AMD Lasers). Because of the use of a laser, we were able to complete the tooth prep without any anesthesia. According to proper protocol, we used a total of 2.3 W and low energy combined with air and water. 
Because of the deep preparation required for the caries removal, we needed to provide pulpal protection. One layer of TheraCal LC resin-modified calcium silicate pulp protectant/liner (BISCO) was applied. Each layer was light-cured for 20 seconds. The calcium release* from TheraCal LC makes it stable and durable as a liner. 

Next, using the selective-etch technique, Futurabond U (VOCO) was applied per manufacturer instructions. The application of Futurabond U was followed by 2 increments of Admira Fusion (VOCO) shade A2. The restoration was finished and polished using Gazelle composite polishers (Microcopy). 
The patient and her parents were pleased with the outcome of the treatment. They were especially impressed with the use of the laser to prepare the tooth as well as the excellent esthetics.



GO-TO PRODUCT USED IN THIS CASE

THERACAL LC
TheraCal LC is a light-cured, resin-modified, calcium silicate filled liner designed for use in direct and indirect pulp capping and as a protective liner under composites, amalgams, cements, and other base materials. It can be used as an alternative to calcium hydroxide, glass ionomer, RMGI, IRM/ZOE, and other restorative materials. TheraCal LC performs as a barrier1,2 and protectant of the dental pulpal complex. TheraCal LC’s precise placement allows its use in all deep cavity preparations. The light-cured set permits immediate placement and condensation of the restorative material. Its proprietary formulation allows for a command set with a light-curing unit while maintaining ease of placement due to thixotropic properties. The proprietary hydrophilic resin formulation creates a stable and durable liner.

* BISCO has on file the calcium release data for TheraCal LC.
1. Sangwan P, Sangwan A, Duhan J, Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013;46(1):3-19

2. Savas S, Botsali MS, Kucukyilmaz E, Sari T. Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materials by using a VALO LED light curing unit at different curing distances. Dent Mater J. 2014;33(6):764-9.

CASE PRESENTATION: Direct Composite + Post for Endo-Treated Discolored Anterior

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Date: 09-22-2020 07:38:08 am

The technique presented here is one I developed as an alternative to a lab-fabricated veneer when correcting discoloration caused by pulpal necrosis on an anterior tooth. By placing a direct composite “veneer,” I am able to manage the shade directly (i.e., at chairside), thereby eliminating the complexity of matching an indirect restoration. This process allows me to create an optically biomimetic internal aspect. With an indirect veneer, we use a more superficial opaquer, thus creating a clinical crown that is optically different than adjacent virgin teeth.
Primarily to add strength, I further enhance esthetics by placing a nonmetallic post (FibreKor, Pentron) because a substantial amount of discolored dentin was excavated and replaced by composite. Because the post is not metal, it does not affect the final shade. 

History
An 18-year-old male patient, in routine care in my practice, was referred to me by an endodontist for evaluation and treatment. He presented with the chief complaint of darkening of his maxillary central incisor, tooth No. 9. He explained that after a traumatic skateboarding injury, he required a root canal, which subsequently resulted in this unwanted discoloration. 
We discussed both the indirect and direct restorative options, and the patient was happy to try the less invasive, direct approach. 

Treatment: First Visit
Palatal aspect: Without administering local anesthesia, I removed the hemosiderin-stained dentin from the palatal aspect. I cemented (GC FujiCEM2, GC America) a fiber post into place and removed the excess length. Next, I placed composite using a dentin shade (G-ænial Universal Flo, GC America) as a core into the post access opening. Because neighboring teeth desiccate during placement of the post, a second visit was scheduled to capture the true shade. 

Treatment: Second Visit
Facial aspect: To reveal the dentin-shade core, I prepped the facial aspect to enhance retention of the composite. In addition to sandblasting the existing composite core and the unprepped enamel (Microetcher, Zest Dental Solutions), I created intracoronal subgingival troughing. I placed veneering composites (G-ænial Sculpt, GC America) in increments that were each light-cured after placement—first, flowable (bleach white shade) to effectively mask the still-stained dentin remaining in the root; next, a layer of dentin opaque; and finally, a layer of enamel body. 
Final finishing and polishing created a lifelike and undetectable restoration. The patient was pleased.

CASE PRESENTATION: The Right Magnification for Any Procedure

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Date: 08-18-2020 08:50:49 am

Effortlessly match the appropriate magnification level and field size for each procedure using the OmniOptic loupe system from Orascoptic

Many years ago, while still in dental school, my mentor, Dr. Harold M. Shavell, told us, “No one should be allowed to graduate from dental school without a 35-mm camera and a set of loupes!” After all, you can’t do what you can’t see. The year was 1979. While the use of magnification in den­tistry has certainly grown over the years, it is still not considered a standard of care by all dentists. But since we work in a clinical discipline where the difference between success and failure can be measured in tenths of millimeters or less, it makes absolutely no sense to perform dental procedures without the aid of mag­nification. Furthermore, most of us perform a variety of procedures, and the more exacting or focused the treatment is, the more important it is to have greater magnification for optimal visual acuity.
Orascoptic’s OmniOptic system allows me to easily match the most appropriate magnification power and field size to each specific procedure. It is the first loupe system that combines a customized frame with a selection of telescopes of varying magnifications (2.5x, 3.5x, 4.5x, and 5.5x magnification power). 

The OmniOptic system allows us to conveniently change the magnification as a procedure dictates, rather than having an inventory of loupes with different magnifications where the entire loupe and frame need to be removed and replaced each time a change in the power is desired. The frame is customized to the:  
•    Interpupillary distance and optical center—this determines the location of the telescopes on the frame
•    Declination angle—this determines the angle/tilt of the telescopes
•    Eye prescription, with or without bifocals.
 
The telescopes are customized to the individual’s comfortable working distance chairside at an ergonomically comfortable position from the patient’s oral cavity.

Application-Specific Views
With a generous 4+ inches of field size, 2.5x magnification is perfect for hygiene procedures, oral cancer screenings, and many quadrant-focused procedures. The 3.5x or 4.5x magnifications are ideal for individual teeth to check and refine margins, to examine tissue prior to master impressions, or during cementation of porcelain veneers or crowns.
The 5.5x can enhance efficiency during endodontic procedures, such as locating the canal orifice prior to instrumentation. I also found it helpful for laser dentistry—to better visualize laser-tissue interaction during cutting procedures—and for surgical procedures, such as extractions or implant placement/restoration where pinpoint accuracy is critical.







GO-TO PRODUCT USED IN THIS CASE

OMNIOPTIC
Accommodating 4 magnification powers ranging from 2.5x to 5.5x, the OmniOptic is an ideal system for users looking to increase their magnification power over the course of their career. The unique design features a magnetic anchor built into the carrier lens of the frame, allowing clinicians to upgrade their magnification power without having to succumb to the process of ordering a new loupe.
 

HOT TOPIC: If You’re Not Using Gen-8 Adhesives, You Should Be!

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Date: 07-15-2020 08:04:26 am

 

10 Factors In Avoiding Damage to Dental Handpieces

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Date: 06-24-2020 08:32:26 am

Tired of Handpiece Breakage? Here Are 10 Helpful Tips...                            

10 Factors

In Avoiding Damage to
Dental Handpieces​

1 Never use chemicals of any sort unless specifically indicated	2 Never use soaps during cleaning unless indicated,and if soap is indicated, don’t use one containing chloride	3 Never use pre-soak or immerse in any liquid, including water, holding solutions, or liquid chemical sterilant-disinfectant	4 Never leave the low-speed attachment and motor attached to each other when reprocessing
5 Never leave a bur in the attachment during cleaning	6 Never have a bur/dummy bur in  the attachment during autoclaving unless specifically indicated in the instructions for reprocessing	7 Never autoclave motors and  attachments at higher reprocessing temperatures or different cycles than recommended by the manufacturer	8 Never use a dry heat sterilizer as the higher temperatures will degrade resins and plastics
	9 Never use a chemiclave	10 Never skip indicated lubrication