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.

33 year old female presented for second stage implant surgery on tooth #10. Tooth #10 was lost due to an extraction by a previous dentist. It was mistakenly taken for a primary tooth. The implant was placed 6 months prior with no complications, and temporized with a Maryland bridge that was bonded to teeth #9 and #11 lingually.

Today the Maryland bridge was removed. Local anesthesia was given, and an envelope incision made. A healing abutment was placed and the occlusion adjusted to leave the abutment out of occlusion. A periapical xray was taken to demonstrate the proper seating of the healing abutment, and then it was torqued into place. The abutment was temporized using a duralay temporary and adjusted for proper occlusion. No sutures were needed. After proper healing of the tissue, a final impression for an implant crown will be taken.

N.D., New York University College of Dentistry

Today’s experiences encompassed the evaluation and editing of a complex treatment plan. The patient is a 57 year old female patient who is extremely phobic in the dental setting. Her past medical history includes smoking 1 pack per day, sinus problems, migraines, and dental phobia. Her chief complaint was that she wanted her top teeth fixed for her son’s wedding this upcoming summer.

The patient’s dental phobia is a major contributor in the execution of her dental care. Her dental phobia is so severe that she sent her husband to the first few visits to take care of the treatment planning instead of personally being there, and, due to past dental related trauma, when she is in the dental office she cries. She would like the treatment done all in one day and under IV sedation so that she can get it done as quickly and as painlessly as possible.

The patient would only like to focus on the upper arch at this time. She has #4-11, 13, and 14. She is missing #1-3, 12, 15, and 16. The patient has periodontal disease which could be classified as moderate to severe chronic generalized periodontitis, evidenced by photographs and radiographs. (Figure 1)

Figure 1. The moderate to severe chronic generalized periodontal disease is evident in this radiograph. Notice the low bone height on both the maxilla and the mandible.

Therefore, initial scaling and root planing of the upper arch is indicated. Although the patient also has the disease on the lower, the patient would only like to focus on the upper arch and the dentist would like to avoid any sensitivity on the lower arch. Because the patient is afraid of any possible pain from her dental work, endodontic therapy was suggested in all of the upper teeth to avoid the pain. On most of the teeth the endodontic therapy is not indicated for carious or disease related reasons, but primarily to avoid any post-operative pain.

After the periodontal and endodontic therapy is done, the planned restorations will be prepared and inserted. There will be crowns on #4, 5, 13, and 14 and there will be resin veneers on #6-11. The crowns will only be temporary since the patient would only like to come in for 1 visit. The temporaries will be placed under a condition that the patient will come back for final crown insertion within 6 months of this treatment. The veneers will be resin because the patient does not want to come back for another visit, which would be necessary if porcelain veneers were fabricated. The patient was informed that resin veneers are not as strong or long lasting as porcelain veneers.

In addition to the aesthetic work which will be done on the maxilla, there is also a concern of a red lesion on the hard palate. Since the patient smokes 1 pack per day, this puts her at a higher risk for oral cancer. The oral surgeon will examine and possibly biopsy the lesion during the visit. (Figure 2)

Figure 2.  The red lesion on the palate is of concern, especially since the patient is a smoker. An oral surgeon will examine and possibly biopsy the lesion.

All of this therapy will be done in one visit in order to comprehensively deal with the patient’s phobia of dentistry and pain. In addition, since the husband is the primary person involved in the treatment planning process, both the husband and the patient will sign the treatment plan, confirming that they both understand and agree to the treatment outlined.

Lateral, front, and occlusal views of the maxilla before treatment.

N.S., New York University College of Dentistry

Patient presented with a chief complaint of severe pain on the upper right. There was a root canal and crown done on #2 in the past, so before examination it was thought that perhaps this tooth would be the culprit. However, the patient was quite specific in pointing out that the pain was coming from the cervical region of #3. A periapical radiograph was taken and it showed that there was neither pathology nor caries.

It was determined that the pain was probably due to abrasion from abrasive tooth brushing habits. The area was slightly abraded with a high speed, acid etched, bonded, and composite was placed.

The patient was told that initially there may be more sensitivity but that in a few days the pain should go away. Should the pain not go away it may warrant further exploration and possibly necessitate endodontic therapy.

N.S., New York University College of Dentistry

Today’s session proved to be quite educational. Dr. Dorfman met with a newly graduated endodontist seeking career guidance. Dr. Dorfman frequently meets with young dentists and specialists to help them prepare for the transition to private practice. The meeting consisted of the endodontist showing some pre-operative and post-operative radiographs of her work to show her competency. In addition, she answered some questions regarding endodontic and emergency care and afterwards took a tour of the the office. Being included in this meeting provided me two different viewpoints. While one view may be more applicable to my current position as a graduating student, hopefully the other view will be applicable in a few years as I begin to build my own comprehensive practice.

N.S., New York University College of Dentistry

Today a female patient came in for insertion and cementation of veneers from #4-14. Previously the patient had veneers from #6-11, which she was satisfied with, but she wanted a full new set of upper veneers completed to make her smile beautiful. At the last visit the current veneers on #6-11 were removed and #4-14 were prepped and temped. At this visit the temporaries were removed by cutting them down the mid-facial aspect with a bur. Incipient decay was removed on teeth # 4, 12, 13, and 14. The veneers were tried in and shown to the patient before cementation, and the patient was quite satisfied with the shape, size, and color. The veneers were the cemented in with Nexus Base Clear, a very esthetic cement. Occlusion and esthetics were checked. She will return later for mandibular veneers.

Figure 1. The patient with veneers from #6-11. She was very happy with them but has a wide smile and would like the full smile to be veneered.

Figure 2. The teeth prepped for veneers. Minimal preparation is needed.

Figure 3. Some of the incipient lesions that were prepped to remove decay.

Figure 4. Occlusal view of the cemented veneers from #4-14

 Figure 5. Frontal views of the final veneers from #4-14.

N.S., New York University College of Dentistry