These before and after pictures show the removal of two broken silver fillings, removal of tooth decay (dental caries) and placement of white dental bonding material.  Treatment time is usually about one hour.

Dental Bonding material replaces broken silver fillings.

This afternoon I continued the treatment of a patient’s #3 PFM crown. The crown came back from the lab with a Kaitlyn Loop on the lingual side of it for floss to keep a better hold of the crown. The crown was tried in, margins and contacts were checked, and occlusion was adjusted. The patient was satisfied with the esthetics and fit of the crown and signed a consent form for final cementation. The crown was cemented in with RelyX cement and the Kaitlyn Loop was removed.

The patient then complained of a chipped filling on the lower left. The patient is not currently in any pain. Tooth #19 was examined and the restoration was chipped on the buccal portion of the occlusal surface. A periapical and bitewing radiograph was taken of tooth #19. A periapical pathology was seen on the mesial root as well as a widening of the periodontal ligament on the distal root. Caries was found on the distal portion of the tooth. There is a possible fracture on the mesial root. The patient was given the information and treatment options and will return at the next visit to further explore the treatment options for this tooth.

N.S., New York University College of Dentistry

This Wednesday was a great learning experience for me.  I had the opportunity to watch the Doctor perform a DO dental caries excavation on tooth #20; however, the caries was very extensive, and there was a pulp/nerve exposure. He then performed a direct pulp cap and bonded over it with composite to complete the restoration, and informed the patient of the possibility of future root canal therapy on that tooth. So I will never forget what a direct, or indirect, pulp capping procedure entails, I did some research on the topic:

Vital pulp capping is a controversial procedure as many clinicians are uncertain of the long-term success when compared to the proven long-term success of root canal therapy.  Vital pulp capping basically entails dressing exposed pulp to maintain vitality.

For success, the tooth should be asymptomatic and have bleeding controlled. 

There are basically two techniques.  First the area is disinfected and then calcium hydroxide placed directly on the pulp.  Then the calcium hydroxide should be covered with RMGI or zinc oxide eugenol then dentin bonding agent and permanent restoration placed.  The second technique involves total acid etching the cavity preparation created with 32% phosphoric acid then dentin bonding agent and a few layers of primer followed by RMGI and a permanent restoration. 

M.C., New York University College of Dentistry, Observation

The result of the direct pulp cap mostly depends on ability of dentist and capping material to prevent microbial leakage. 

Indirect pulp capping is a procedure performed when a dentist comes close to the nerve/pulp when excavating caries, but there is no penetration or exposure.  This is done to stimulate reparative dentin formation and prevent the need for root canal therapy

A 48 year old male patient presented for restoration of tooth #29 DO with composite. Patient had an amalgam filling in the tooth and according to a PA, there was a recurrent decay present around and on the gingival floor under the temporary filling.

I went in with a 1556 bur and removed the amalgam filling to assess the amount of decay present under it. I also removed the temporary filling to assess the remaining amount of decay. Under the amalgam there were a few spots where decay process had begun. Also, on the distal wall, there was extensive decay. After having reevaluated the PA that we had available for #29 to see the depth of the distal axial wall decay, we also became suspicious of the mesial side of #29 where we saw a radiolucency that could have been potential decay. In order not to come back to #29 later in the treatment process, we decided to take another bitewing centered on the mesial of #29.

R.F., New York University College of Dentistry, Patient 2

My first patient today needed a bonding on tooth #2.

The patient presented with an occlusal sealant underlied by black staining and caries. The patient was anesthetized with carbocaine and the procedure was started. The cavity was excavated; and as I proceeded the cavity got deeper and deeper. The patient was informed that the decay is extensive and that there are also cavities on other teeth in the mouth as was seen in the x-ray. The patient however decided to wait for her insurance before she started her other restorations. 

The decay was excavated the bonding was completed. The bonding was redone due to a void on the distal of the restoration. Once the restoration was completed occlusion was checked and adjusted.

I have learned many things. There were a number of unexpected challenges; working in an unfamiliar operatory was a challenge for me despite having been on the clinic floor for over a year. Light curing, taking pictures, chair positioning, patient communication and hand pieces were all new to me and made the procedure much more challenging. I am used to finishing a bonding procedure in about 45 minutes, but it took me about 2.5 hours today and that was quite surprising. The tooth I was working on was the second molar and visibility, moisture control and drilling all became even harder and increased the amount of time it took me to complete the procedure.

H.A., New York University College of Dentistry, Patient 3