43 year old male a broken upper right tooth. The patient was initially seen two days prior as an emergency. Intraoral revealed tooth #3 was fractured lingually. Previously the patient had had root canal therapy on #3 and had a composite MOD restoration.

Nitrous oxide delivered – 1:3 (liter nitrous:liter oxygen) for 1 hr. Local anesthesia ½ carpule lido 2% Hcl Epi 1:100,000 locally. Lingual portion of tooth #3 extracted without complications.

 

The remainder of #3 was prepared for a crown and temporized. The patient will return for root canal re-treatment at the next visit.  Subsequent visits will include conservative crown lengthening, a cast gold post and core and fabrication of a crown. 

N.D., New York University College of Dentistry 

30 year old male from Israel presents for emergency visit. Chief complaint “I broke my bottom front tooth eating a bagel.” Intraoral exam revealed tooth #25 fractured above the gingival tissue.

Patient was told that esthetically bonding could be done until post & core and crown could be completed upon return to Israel. Tooth #25 was beveled, etched, bonded surfaces MIDLF with bonding shade A2. The tooth was shaped and occlusion adjusted. The patient was very happy with the esthetic results.

N.D., New York University College of Dentistry

Patient presented with multiple caries and restorations that needed treatment. When I arrived at the clinic, the dentist was just beginning to restore the patient’s heavily worn incisal/mesial edge of #9. His tooth was restored with a simple composite placed after etching (placing an etching gel for approximately 30 seconds, washing, and lightly air drying), priming, and bonding (priming and bonding with achieved with a single solution that was cured for about 20-30 seconds after placement). Composite chosen to match the patient’s tooth shade was A4.

After the composite restoration, the dentist proceeded to complete the TPS, evaluating each tooth and restoration for caries and defective restoration. Multiple defects were found in the patient’s dentition, but the patient decided to restore only the four of the defective restorations at this time. Furthermore, the patient was recommended to receive a bite guard in order to prevent supra-eruption (which Dr. Dorfman explained to the patient).

To address the proliferation of decay present throughout the patient’s dentition, the dentist discussed the effects of high sugar levels on the enamel, and the precautions that the patient could take in order to reduce detrimental effects of sugar on the teeth (ie. avoiding sugar, rinsing the mouth with water immediately after heavy sugar consumption). Next Visit: Patient has agreed to receive bonding treatment on the four teeth shown above as well as a bite guard.

H.C., Columbia University School of Dental Medicine

Today I observed a case where final porcelain crowns for teeth # 6-11 on a 53 year old female. First the patient was shown the crowns out of mouth, and she found them to be esthetically pleasing. The patient was given nitrous for several minutes and local anesthesia in the maxillary anterior region.

The temporaries were carefully removed, first by separating each temporary into individual units, and then sectioning each individual unit to allow the most comfortable way to remove the temporary. The final porcelain crowns were tried in, and the patient was given a mirror.

Initially the patient was satisfied with the appearance of the teeth when shown outside the mouth, however she wanted to make changes once the teeth were placed in her mouth. I learned that it is important to allow the patient to make the final decision on accepting the final product, and to be careful not to make up their mind for them. The patient made several requests to a lab technician that was available in office, including but not limited to a darker shade, shortening of the incisal edges, and squaring off the rounded incisal edges. The crowns were sent back to the lab for refinement and returned in one hour for final insertion.

N.D., New York University College of Dentistry

30 year old female presented to the dental office for an unscheduled appointment. Her chief complaint was a chipped porcelain tooth veneer on #8 that occurred from a glass hitting #8 while drinking a glass of white wine. The veneer was placed in this office 3 years prior.

Today the patient was given several options in resolving the chief complaint. The first option was that the veneer could be smoothed where the fracture left it sharp, and then either left as is, or bonded as a class 4 at a later time. The other option given was that the veneer could be replaced if the smoothing or the bonding did not give desirable results.

The patient chose at this time to smooth the sharp edges of the fractured veneer and then to come in for a later visit for a class 4 bonding. The veneer was smoothed with a football diamond bur. The patient was happy with results of smoothing the veneer.

N.D., New York University College of Dentistry

56 year old female presented for final insertion of a porcelain fused to metal bridge spanning teeth #4-13. Previously the teeth were prepared for crowns and temporized.

The temporary was removed and final try in of the bridge. The patient was very satisfied with the cosmetic results.