A quick tip against dehydration while doing direct bonding with composite resin in the anterior!

Often when we are performing direct bonding with composite resin in the anterior, we struggle, chasing the moving color target of an adjacent tooth that is slowly dehydrating and changing in value. A quick tip to counter this is to apply bonding agent to the surface you wish to match, often a contralateral tooth, at the beginning of the bonding procedure. It will tend to stay true and be a more reliable reference for color matching while you work. When you are finished, just polish it away!

Note how by applying bonding agent to both centrals, by the end of the procedure, both centrals look the same, while the laterals have changed significantly due to dehydration.

Try it out! It has worked consistently for me.

 THIN CEREC VENEERS

Introduction:

Monolithic Emax can take on a natural color gradient, warmth at the gingival, brighter middle third and translucent incisal third when the restoration is made transparently thin (0.3mm). Here are two examples of a feathered gingival-facial margin (no chamfer) with natural looking integration and an enamel bond. Case #1: The lingual half of a tooth had been sheered away due to undermining decay. A conservative crown was planned to restore the tooth. The preparation was designed to allow for 0.3 mm thick facial on the restoration (no chamfer on the facial margin) in order to allow the natural tooth color to show through and blend in with the surrounding dentition, and maintain the integrity of an all enamel bond. Note the transparency of the restoration upon try-in with water, and the seamless biologic integration upon completion

Case #2: The transparent crown prepared for tooth #10 with a supragingival margin, rivals the supragingival margin of the empress crown on tooth #7 prepared with a traditional thin chamfer.

Tooth #10 shown here with try-in paste.

The virtual "contact lens" effect of the thin HT Emax and the feather-margin preparation allow the meeting of porcelain and tooth to disappear after cementation.

Two weeks after cementation, now that the gums have recovered and the teeth are fully rehydrated, the actual color blend can be evaluated.

Due to the strength of the material and the enamel bond we have at the margin, we can expect this restoration to serve this patient for many, many years.

Just a few before and after CEREC cases demonstrating just how beautiful the possibilities of CEREC can be!

Restoring Fractured Front Teeth

Case Type: Class IV direct resin, #7 and #8

A young patient presented with fractured incisors after a hiking trip.   Direct bonding was selected as treatment of choice for its conservative nature.   Micro-etching was the only preparation done.   Teeth were etched, bonded, and layered with dentin and enamel shades of composite.   Teeth were contoured and polished to mimic the patient's natural dentition.

Pre-op fractured incisors

A mock-up was used to create a sil-tech lingual/incisal guide, and a B1 dentin from Four Seasons was used for the build-up of the incisal edge and dentinal lobes.

An opalecent composite from Omega Estilite was placed at the incisal and a B1 enamel from Filtech Supreme was placed as a final outer enamel layer.

Contouring was done with a fine diamond and flexidiscs, followed by Enamelize paste from Cosmodent.

After evaluating the post-op photos, I see that it will be nice to have the patient return to correct the width of #8 in order to make it more symmetrical with #9, fine-tune the polish, and have a follow-up with the patient.

Beyond Clinic Survival

In Dental School at The University of the Pacific, a few fellow classmates and I began a series of what we called "Clinic Survival Courses" where we would document our cases and share tips or techniques with one another from the things that we were learning  -- things that we had tried that went well, or things to avoid that went wrong -- things that we thought would be of value to eachother from our early beginnings in clinical dentistry.

As I started putting these Powerpoints together each month for my classmates and studying the upclose photography I had taken, I began to see the details of my work -- and I tipically found a lot of room for improvement. Consiquently, I started seeing my work with different, more critical eyes. Knowing that I would be presenting to my peers and answering questions on whatever the subject of the month would be, such as "tecniques to taking a better impression", or "how to predictably take an accurate centric relation bite record", I started studying the material from a different perspective.  It wasn't long before I felt myself and my understanding grow through this process. I soon saw my clinical ability greatly develop and improve at a faster rate than ever before -- and I loved how that felt! Since those"Clinic Survival days", Even now I am all the more hooked on, and convinced of, the educational value of photodocumenting the procedures I do in an effort to continually improve upon my current clinical ability.

I really hope that this blog becomes something of value for those who feel driven to persue excellence in their own clinical dentistry, and something of interest to all those who simply appreciate the philosophy behind that kind of quality. I do want to display my work, not because I think it is perfect -- its not, and that is the beauty of it! -- but rather because I feel there is great value in observing the clinical process though upclose photography where one can critique and learn from what went well, and more importantly from what went wrong. It is in our shortcomings, our weakness, or setbacks where the opportunity to grow is greatest. It is my intent that this record become in the end a portrait of great growth -- and at the same time, not only something interesting to look at -- but worthy "dentistry to talk about".