September 29, 2011 at 9:58 pm by Ian Kerr
Filed under Clinical Cases
This case of two direct composite inlays shows how much we as dentists can differ in our views from our patients. By calling the work I did here direct composite inlays I am differentiating them from “simple white fillings” that they are often thought of by our patients. This distinction may seem petty and pedantic but actually I think it is an important one. When some asks me can I do a “simple filling” I think they are aligning their thoughts with very quick amalgam fillings that may have been plugged into the tooth under less than ideal conditions in a very quick appointment; the only perceived difference is that this one will be white as opposed to metal. In reality a direct composite restoration bears very little in common with the amalgam filling that it is seen to replace: it has totally different handling properties, requires completely different conditions, needs a sequenced series of steps to bond it in place and needs polishing stages to complete the task. The process is much more akin to the one used to bond modern laboratory made cast restorations which is why I prefer to call them direct inlays as opposed to indirect inlays, which would be made in the laboratory and cemented in place at a subsequent visit.
Some of my colleagues argue that it is not worth going to the level of finish and detail shown in these restorations because it takes longer and the teeth are not on show. I believe that every stage in the process is an essential one and a high level of attention is needed through out. It would seem a shame to put all the effort in to the all the stages except the final one, which is the one that makes them look nice!
I acknowledge that taking this much time and attention to direct restorations comes at a price for the final product but when ever I see a poorly placed and finished restoration in a patients mouth I always think that cost is a much higher one.
Cavities cut.Red dots show contact with opposing teeth
Initial finish. Bite checked to see that red dots are the same as before.
Final Finished Restorations
If you would like to know more about how we can help you fix your teeth please do not hesitate to call the surgery on 01580 752202 and we will be happy to help.
September 22, 2011 at 8:27 pm by Ian Kerr
Filed under General
This is another of those “no drilling”cases where a diminutive and very loose upper lateral was replace with an immediate bridge. We chose this option after extensive discussions regarding the use of implant retained crowns (IRCs). The IRC option would have been complicated by the wide space left by the lateral incisor, which would have required soft tissue remodeling and veneers on the adjacent teeth. Long term these options still exist but for now the patient just wanted the tooth out and result that gives her good aesthetics and function. The FRC bridge does this easily and at considerably less cost than the IRC option. This is case is a timely reminder that “one shoe does not fit all” and we need to be able to offer all treatment options to suit our patient’s needs.
If you would like to know how any of the techniques discussed in this post could help you then please call 01580 752202 and we will be happy to arrange a visit for you.
September 22, 2011 at 8:13 pm by Ian Kerr
Filed under Clinical Cases
This is an unashamed endo geek post- I completed this case today on what was a very tricky retreat, using MTA as the main apical filler for three of the four canal- all shortened with open apices and in the case of the palatal canal an apical third perforation. At the time of writing the tooth is symptom free and has been built up in to the bite to allow some orthodontic work to be carried out (sadly the tooth is in a 20 year old and one of three badly damaged molars. The MTA offers a great solution to canals such as these allows for excellent healing. Both and the patient are aware that this is not a tooth for life but if we can keep in place through their 20s whilst the orthodontic and restorative work elsewhere can be completed then its replacement can be much more predictable.
September 6, 2011 at 10:06 pm by Ian Kerr
Filed under Clinical Cases
This post is all about endodontics – my area of interest within dentistry. The examples show we can use pre-endodontic build ups to restore very damaged teeth. The importance of the pre-endodontic build up is that it allows us to isolate the tooth fully from the rest of the mouth whilst we complete the root filling. Without the build up and isolation we do not stand a chance of success in the long term. If often takes a whole session of treatment to remove all of the decay from the tooth and build it up. This visit is best seen as an investigation visit to assess the viability of the tooth as a long term option. If I cannot build it up and isolate then I cannot place a root canal filling and extraction is a better treatment option. If this is the case then it is much better to find this out at the first, investigation, visit rather than a few months later after further expensive work has been carried out.
Case 1
Very large cavity in molar
Same tooth with pre endo build up
Finished root filling SAF used in Palatal canal
Case 2
Root filling in premolar with infection beyond it
Re root treatment and FRC core
Finished FRC restoration in premolar
Case 3
Root filling in broken upper premolar
Broken premolar before treatment
Pre endodontic build up to enhance isolation with rubber dam
Re treatment of root filling in premolar (using SAF)
Core prepared for cast restoration
Cast restoration fitted awaiting whitening of adjacent teeth
This sort of work often takes three or more visits, each of at least an hour. The time and costs to restore the tooth need to be balanced against other treatment options but it is generally accepted that if we can restore a tooth with a good degree of predictability then we should as this leaves all other options available in the future but delays the loss of the tooth for as long as possible.
As ever if you would like to know if we can help you with your dental concerns then please do not hesitate to call the surgery on 01580 752202 and we will be happy to arrange a consultation for you.