To drill or not to drill..that is the question.

This morning I am encountering a very frequent quandary...tooth colored fillings that have small defects. The question is do I remove the fillings and replace them with nice new ones or are these fillings still functioning and perhaps I should leave them alone? In this case, X rays do not offer any help.
Although it may seem like a simple situation in which I should just re-do the filling..the problem is that anytime you drill into a tooth to replace a filling you might end up with a sensitive tooth afterwards and then I have a patient telling me that everything was just fine until I suggested this!!
Well in this case I decided that I should replace the fillings to prevent this from becoming a larger problem down the road....will report back on this next week.

Drill-etch-glue-fill-polish

I have been away lately due to a death in the family...and have been very busy setting up a blog for the family....
But now I am back and here we have one of my usual cases of bonding an eroded tooth.
In our first figure you can see that this was bonded many years ago but both the bonding and the tooth have eroded even more..

the first step is to drill away the old bonding and prep the tooth to accept a new bonded filling...so i drill away until I am down to clean fresh tooth structure...but that is not all...to get the filling to stick I have to first use a conditioner to etch the surface of the tooth..and that is what this next photo shows...if you look carefully you can see that the arrows are pointing to a frosty surface...that is etched enamel which has micro-porosities...

At this point I take the bonding agent...which is just a fancy term for glue and lightly apply it to our tooth surface....

Once this layer is hardened with my bonding light I then apply the filling material until it blends in with the rest of the tooth...
The filling can now be polished and we have a nice smooth surface ...

small, medium and large...dental work comes in sizes also!

It may seem boring, but bonding is what I do during most of the day...people not only want to feel good but they want to look good as well...and that includes their teeth!
Here is a woman who exhibited some gum recession which exposed the roots of her teeth. The roots were beginning to erode and we decided that we would restore the tooth back to its original form factor with some our newest bonding materials.

After administering local anesthetic, I prepared the teeth for bonding...due to the adhesive qualites of the bonding agent the amount of tooth reduction needed is minimal...sometimes I even do this without anesthetic!
And in very short order we have three teeth bonded and restored..

The teeth will not only look better but the bonding material will prevent further erosion of these teeth!!

Multiple choice...

Sometimes we get choices...take a look at these...
1. New decay on a tooth that never had work...needs a new filling.
2. Old silver filling(amalagam)breaking down..needs removal and restoration.
3. Old crown has the porcelain breaking down...new crown needed.
What do we do first? Well I am going to leave the crown replacement for another day...today we will focus on placing two new fillings.
Step 1..removal of old filling and excavate new decay....

Decay fully removed from both teeth now...

Here you can see the two teeth each with a matrix retainer applied...and then the finished fillings...



Have a happy thanksgiving...

Tooth du Jour!

Friday's are wonderful...only half day of patients and then the weekend!

But before we go...here is one to hold you over till Monday...
Here is one of my wonderful patients... complaining of pain in the lower right region...all I see that might be suspicious is a tooth with an old silver filling...but it looks solid and the x-ray doesn't really show a problem. I, or rather we, decide to replace it since it looks pretty lousy anyways...and just maybe her pain will subside.

Fig. 1 shows our tooth du jour with the intact silver filling...however when I removed the filling I saw that there was most certainly decay lurking underneath...fig. 2.

Much to my dismay, the decay was actually much deeper than I expected...see fig. 3, which shows that even after the initial excavation there was still more decay.
Finally....and I say that because I am now getting close to the nerve...I reach a point where although there is still some staining...it is not decay..just stained tooth structure...fig 4.
At this point the matrix retainer is already in place and I am able to bond in a beautiful tooth colored restoration.


So until Monday...

Bonding...cervical abrasion

Well today is Friday and we are all anxious for the weekend to start but we do have patients scheduled today!
Here is another very simple case in which a young woman with otherwise healthy teeth presented with an area of gum recession around an upper canine. The recession caused the patient to abrade and wear away some of the tooth structure at the gum line, often termed cervical abrasion.
Within just a few minutes we were able to bond (a fancy dental term for glue) an esthtetic tooth colored filling into the area. This will restore the tooth back to its original form and prevent further abrasion of the tooth!

See you next week...have a good weekend!

30 minute rescue

Hello fellow flossers...as promised...here is a very straight forward case from today.

Like many of us... this patient had put off doing dental work for a while and presented with a tooth that had a large filling fall out. The patient did not want a cap placed so instead we opted for a quick procedure...30 minutes... I was able to place a tooth colored composite filling. With today's newest generation bonding materials available, I felt this was a reasonable choice. Although this tooth really needs a cap this will probably hold up well for many years.