The patient presented with two fractured central incisors. The right central incisor was endodontically treated and covered with a failed PFM crown. Unfortunately, the tooth was no longer restorable and required extraction. The treatment options were reviewed including a discussion regarding the state of the remaining anterior teeth. The patient chose to proceed with a fixed bridge restoration to restore the entire anterior segment from canine to canine. The patient also chose to extract the left central incisor.
Here are the pre-operative images of the anterior segment:
The central incisors were extracted and the remaining anteriors were prepared as bridge abutments (i.e. teeth 13, 12, 22 and 23). A temporary bridge was fabricated using Luxatemp and cemented in place with TempBond NE. The temporary was contoured to include ovate pontics for teeth 11 and 21 (right and left central incisors) to give the teeth a natural emergence profile. Below are the preparation and temporary photos taken 4 weeks after inital treatment. Normally, a longer healing period would be used, but in this case the patient had limited time constraints.
For the definitve restoration, a zirconia framework was chosen for both its esthetic nature and strength. The patient's deep bite and heavy occlusion required that lingual reduction of the abutment teeth be maximized. The opposing teeth were also recontoured to improve contour, contact and esthetics. Below are the final photograhs taken immediately post cementation.
In the lingual view, you can see the monochromatic, opaque nature of the zirconia framework. It provides excellent blockout of the dark, underlying abutment teeth resulting in a more life-like and vital appearing restoration. Layered procelain was added to the facial surface of the bridge to give the smile its natural color, reflection and translucency.
Case 1:Vita Enamic, 2M2T shade
The patient presented with large pinned amaglam restoration on tooth 46 with failing margins and recurrent decay. A full coverage restoration was recommended and the patient decided to proceed with a Cerec crown restoration.
The decay was excavated from the tooth and the remaining tooth structure was prepared for the Cerec crown. Hemostasis was achieved in subgingival areas using the Waterlase iPlus.
An Enamic 2M2T block by Vita was chosen for this restoration - a very durable and resilient material. The Enamic is a hybrid ceramic material with a composite resin matrix designed to resist the propagation of cracks thus reducing the risk of fracture. The material is quickly milled by the Cerec MCXL milling unit (this particular case took only 4min) and is easily adjusted with finishing burs. A slight increase in proximal contact strength during the design phase was required to achieve the desired intraoral contact strength. The Enamic polished well using a series of soft points, goats hair brushes and a cotton wheel with high shine paste (the polishing time was 10-15min). The crown was bonded using Scotchbond Universal and Rely-X Ultimate (3M ESPE).
The monochromatic nature of the Enamic block creates a very opaque looking crown. To improve esthetics, a lighter shade in combination with intraoral, resin-based stains should be used.
Case 2: Ivoclar Empress A3 MultiCAD
The loose gold onlay was easily removed, the decay excavated and the remaining tooth structure prepared for a full coverage restoration. Shade A3 Empress MultiCAD by Ivoclar was used to match the unrestored first bicuspid and canine. The Empress CAD blocks are a leucite reinforced glass ceramic - the multiCAD blocks have an internal shade gradient with increasing translucency that creates a tough, highly esthetic crown (milling time was 6.5 min with the Cerec MCXL).
The crown was bonded using Scotchbond Universal and Rely-X Ultimate (3M ESPE). The Ceraglaze ceramic polishing system was used create a high shine (approximately 10 minutes). The esthetics of the Empress block is lost in the post operative images due to the overshadowing nature of the surrounding gold onlays. The true nature of this case will be visible following replacement of the failing 35 onlay.
Conventional periodontal therapy usually involves mechanical scaling and root planing to remove the hardened deposits and rough areas along root surfaces in attempt to allow natural healing. When this treatment is unsuccessful, periodontal surgery is often the next step, which is often very expensive, time consuming and met with post-operative pain. The surgery often results in recession that is not esthetically pleasing.
Laser periodontal therapy is an effective treatment alternative to conventional surgical therapy. In most cases, the treatment can be completed without reflecting a surgical flap of tissue dramatically reducing the risk of recession. The laser energy applied to the pockets and is very effective at removing the infected tissue, disinfecting the pockets and removing the micro-deposits of calculus and infected cementum that can not be removed by mechanical means. In many cases, the entire procedure can be completed with the use of topical anesthetic alone!
There are countless studies that demonstrate the effectiveness of laser periodontal therapies. This simple procedure has been proven to promote reattachment of tissue, bone growth and wound healing. These results can not be achieved by conventional therapies alone.
Keep posted for some treatment results that have been achieved through laser treatments completed by Dr. Luke Haslam and the Waterlase iPlus (ErCr:YSGG 2780nm RFTP).
Basinview Dental Centre is pleased to offer dental treatments using the Waterlase iPlus. With this technology, many cavities can be easily and quickly restored without the application of anesthesia. That means no more needle and no more numbness.
The laser simply applies light energy (photons) to the tooth with a fine mist of water and precisely removes the targeted tooth structure and decay. There is no heat and no vibration and therefore, no discomfort.
Over the coming weeks, we will highlight a variety of specific treatments that can be completed with the Waterlase. With each treatment, we will outline the procedure, the treatment goals, the duration of time required and the expected treatment outcome. We will also offer some basic laser physics so patients can better understand just exactly how the works and why it is so effective at promoting wound healing.
Here is a 30sec video clip of the laser in action. An old composite filling and underlying cavity is removed without any anesthesia. The filling was slightly below the gumline causing some minor bleeding at the margin of the preparation. The tissue is quickly dried with the laser, again without the use of anesthesia. Note the distinct popping sound the laser makes and how the handpiece never actually touches the tooth!
The Canadian Dental Association (CDA) in coordination with the American Dental Associtaion (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) have changed their protocol for antiobiotic prophylactic coverage for patients who have received total joint replacement. Patients who have received a total joint replacment (including pins and other retentive elements) are NO Longer Required to take prophylactic antbiotics prior to dental appointments.
An evidence-based review of literature has shown the risk of complications from taking a prophylactic antiobiotic is greater than the chance the antiobiotic coverage will prevent infection localized to the joint. The prophylactic use of antibiotics results in unnecessary use of antiobiotics increasing the risk for the production of antiobic-resistant strains of bacteria.
For more information, please refer to:
Basinview Dental Centre is on Facebook! On our page you will find daily and/ or weekly updated dental information about the practice, oral health tips, dental humor, treatment before and after photos and information about general dentistry.
For those of you who have already 'liked' us,
Thank you and enjoy the page!
Dr. Luke Haslam
Many of you may or may not already be aware of the recent changes made to the MSI dental coverage for children. As of May 30, 2013, children will be covered for basic dental services up to the end of the month of their 14th birthday. This is a significant improvement over the previous age of 10!
Coverage for children has remain unchanged; i.e. children up to 14 will be covered for examination, 2 bitewing radiographs and one preventitive service per year. Children with a history of cavities (and subsequent fillings) will be covered for fluoride treatments twice per year. Restorative services are covered as per usual. Emergency treatments are often covered when accompanied by an explanation of the emergency service provided by the dentist.
Any children covered by another insurance provider(s) must have all claims submitted to the primary insurance provider(s) before being submitted to MSI. Any remainer may then be submitted to MSI. They will cover the co-pay portion of any services which they would normally cover. Parents will be responsible for balances on non-insured treatments only.
There are some services that will not be covered by MSI such as Panorex radiographs, extractions for orthodontic purposes, space maintainers (unless the total household income is below the specified criteria), etc. Often, the services covered by MSI are insufficient to completely provide children with the appropriate level of preventative care they require.
Despite the system's shortcomings, this is a siginificant improvement! This will increase the access to care for children into the teen years.
If you have any questions or concerns, please feel free to contact us at Basinview Dental Centre and we will be happy to explain the details of this program further.
Dr. Luke Haslam
This patient presented with a tooth that had fractured at the gumline and was hoping to have the tooth restored. Unfortunately, due to the extent of the fracture and the underlying caries (Cavity) that was the source of the fracture, the tooth was nonrestorable and required extraction.
The coronal portion of the tooth had fractured to the level of crestal bone. The patient had minimal discomfort due to a previous endodontic treatment completed on the tooth. Catastrophic failure of a restoration/ tooth such as this is often easily prevented by properly restoring the tooth with an appropriate full coverage restoration (i.e. crown).
A full thickness flap was raised to access the remaining tooth structure followed by a minor osteotomy. The remaining fragments of root structure were extracted and the site was closed with 4-0 chromic sutures. Once the site has healed, the patient plans to replace the missing tooth (and other missing teeth) with a removable partial denture.
An abscess is a collection of pus that is produced following an inflammatory response. The cells that are activated as part of our immune response are so destructive that they not only destroy (or attempt to destroy) the source of the inflammation/ irritation, but they also destroy our own normal cells in the surrounding area. The collection of these cells and their destructive byproducts is 'pus' and is often contained in an epitheial lined sac known as an abscess, cyst or granuloma.
In this radiograph, tooth #26 has a large radiolucency extending around the roots (outlined in blue). The patient indicated the tooth was restored about 4 years ago with a very deep filling due to a very deep cavity. Over time, the insult of the deep cavity (and subsequent restoration) caused a chronic inflammatory response in the pulp of the tooth leading to eventual pulp necrosis. The necrotic pulp tissue is attacked by the immune system creating the abscess visible on the radiograph.
The patient had been experiencing intermittent periods of swelling and discomfort over the past 4 years, but did not seek dental treatment. The chronic condition resulted in advanced destruction of the tooth's supporting structures. The treatment options were reviewed and the patient decided to have the tooth extracted.
In the extracted views, the abscess is clearly visible and outlined in blue. As described above, it is a pus filled sac resulting from a chronic inflammatory insult. In this case, the condition is formally known as a "chronic periapical abscess". Delay in treatment of these conditions is not recommended and can be potentially life threatening. The close proximity of these infections to vital structures and vessels can allow the infection to spread freely throughout the body. There have been documented cases of dental lesions spreading through sinus vessels to the cavernous sinus of the brain resulting in death!
In this case, the patient presented with a missing tooth in the 25 position (upper left second bicuspid) and a fractured tooth in the 24 position (upper left first bicuspid). Unfortunately, due to the extensive decay, the 24 was no longer restorable and required extraction. A variety of treatment options were reviewed with the patient including replacment of the missing teeth with implant-supported corwns, a long-span fixed bridge or a removable partial denture. The patient weighed the pros and cons of each type of treatment and chose to replace the teeth with implant-supported crowns.
At this point, diagnostic models were made and the patient scheduled with the oral surgeon to have the 24 extracted and two implant fixtures placed in the same appointment. The extraction and placement of two Nobel Active implant fixtures were carried out without complication. The patient was assessed a few days after placement of the implant fixtures and reported no discomfort.
The implant-supported crowns were fabricated following 3 months of integration time. Custom Zirconia abutments and crowns were fabricated and over-layed with porcelain. The crowns were seated using a screw-retained method and torqued to 35Ncm. These crowns will provide the patient with years of trouble-free service and if properly cared for, they can last a lifetime.