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Our Blog section is created by Basinview Dental Centre for our patients to keep up-to-date on various events and promotion offerings. We hope you enjoy it and look forward to reading your comments!


A patient presented with discomfort on the lower left side due to pulpitis of tooth 3-5. The tooth had been previously restored with a very large and deep composite restoration. The depth of the decay and trauma associated with removing it caused an irreversibe inflammatory response in the tooth known as pulpitis. This tooth required immediate endodontic treatment to remove the inflammed pulp tissue and resolve the discomfort.

Traditionally, this treatment is completed using chemical irrigation of the canal system to ensure the organic tissue and bacteria have been removed from the system. Some chemicals can be dangerous and difficult to use. Also, there is little guarantee that the chemicals introduced into the space can completely reach the apex of the tooth without passing beyond the tooth into the periapical tissues.

At Basinview Dental Centre, Dr. Luke Haslam does not use chemical irrigation to complete root canal disinfection, but rather uses laser energy applied by the Waterlase iPlus. With this system, root canals are cleaned and shaped using traditional instrumentation (hand and rotary endodontic files; stainless steel and/ or nickel titanium). The irrigatant used is simply distilled water - zero complication if any water passes beyond the tooth apex. Once the canal has been shaped as desired, a special laser tip is inserted into the canal space. Once the canal is shaped properly, this tip can be placed into position to allow laser energy to disinfect the tooth apex. Laser energy is applied in a series of passes throughout the canal system until the desired disinfection is achieved - for some teeth, this may merely take 30 seconds!

There is no discomfort or chemical smell. The laser will remove organic debris and bacteria 1000um laterally from the main canal.  This means far greater penetration of disinfection than chemical systems into lateral canals, fins, isthmuses and apical deltas. These areas are a common cause of root canal failure - the chemical disinfection simply can not remove was it can not touch.

The root canal completed for this patient clearly shows a complex apical delta - there are at least 5 openings at the apex of this tooth. The laser disinfection allowed for these areas to be easily cleansed prior to obturation which allowed the gutta percha filling to flow into these areas. This will greatly improve the patient's chance of success with this treatment. 

The patient noted no post-operative discomfort and has been symptom free since the treatment was completed 4 months ago. The patient has scheduled to have a full coverage crown placed on this tooth to complete the treatment for this tooth.

This patient presented for an emergency assessment of a fractured laterla incisor. The tooth had been previously endodontically treated (i.e. root canal) and had a large composite resin filling that encompassed all tooth surfaces. Due to the extent of these restorations, the tooth was in a highly compromised state and predisposed to fracture. (Sorry, the pre-operative photo did not save properly).

Luckily for this patient, there was enough tooth structure and healthy supporting tissues remaining to allow for a new restoration. The large amount of coronal tooth structure missing meant osseous crown lengthening was required achieve a stable crown margin that would not interfere with the biologic width (i.e. irritate the supporting tissues and bone causing chronic inflammation and premature failure of the restoration). 

Crown lengthening was achieved using the Waterlase iPlus. The bone was moved apically 1-2mm as required and the soft tissues were recontoured. There was no need to delay placing the restoration 6-8 weeks as is normally required with traditional crown lengthening, because there is minimal risk of recession following this treatment with the Waterlase.

There is a video of this process at http://basinviewdental.com/dental-videos/



To increase retention, a Fiber Lux Parapost was placed into the root canal space of the tooth. This radiograph shows the post drill inserted into the canal as a reference to guage both the width and length of the canal space. The final post was placed 5mm from the root apex. 

Once the post and resin core complex were completed, the final Cerec crown was fabricated using EMax (lithium disilicate) material. The crown was sintered in a ceramic furnace and stained to match the adjacent teeth. Two layers of glaze and polish were completed to stabilize this color.






Here is the post-operative view at two weeks following treatment.Other than minor healing still visible along the buccal margin, it is difficult to tell which tooth was restored. The disto-buccal tilt of the tooth is a product of the patient's occlusion and could not be corrected without significant alteration of the opposing lateral and canine teeth. The patient was happy to simply dupliacte the appearance of his tooth prior to the fracture. He is now going to return to have the same treatment completed for the upper left canine which currently has a large composite filling, 4 stainless steel pins and has been endodontically treated. The patient has chosen to proactively restore this tooth before it fractues

Thanks to the Cerec chairside system, the Waterlase iPlus and our Programat CS sintering furnace, this treatment was completed for this patient in a single appointment. No temporary crowns were required and there was no post-operative healing period following the minor crown lengthening. With traditional methods of treatment, this case would have taken months to complete. Crown lengthening would require 4-6 weeks of healing at a minimum while the patient wore a temporary crown. Once healing was complete, the temporary would be removed and a final impression fabricated to be sent to a dental laboratory. The temporary would be replaced and the patient would return in another 2 weeks for crown try-in. If the esthetics or fit were not acceptable, the crown would be sent back to the laboratory for adjustments while the patient wore the temporary for an additional week. In total, this could have taken 9+ weeks to complete! 

At Basinview Dental Centre, Dr. Luke Haslam was able to complete this case in 2 hours! With these technolgies, we will not only see a reduction in treatment time, but also a reduction in treatment cost. In this case, the patient did not require referral to a periodontist to have the crown lengthening completed (as would be traditionally required). There was no commercial laboratory used to fabricate the restoration so there was no third party bill to pay. The patient was resposible for the treatment time and materials only which saved this patient close to $1000.00.

To learn more about our technology, please feel free to schedule a consultation with Dr, Luke Haslam at Basinview Dental Centre.




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 patient presented with a loose gold onlay. The restoration debonded due recurrent caries 
undermining the remaining distobuccal cusp of tooth 36. The slight mesioangular tilt of tooth 37 also created a root proximity and proximal contact issue that required recontouring of the adjacent restoration as well as moving the 36 distal margin apically to allow for proper hygiene of this area. The condition of the tooth was reviewed and the patient chose to proceed with a full coverage Cerec restoration (the patient wanted a tooth colored restoration rather than gold).

 














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).

http://www.ncbi.nlm.nih.gov/pubmed/22615717

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!

https://www.youtube.com/watch?v=cXlFVYwq_f4

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:

http://www.cda-adc.ca/_files/position_statements/totalJointReplacement.pdf

http://www.aaos.org/Research/guidelines/guide.asp
 

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.

https://www.facebook.com/BasinviewDentalCentre

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.