A 21 year old female presented as a first time patient to the dental office. Her chief complaint was she was unhappy with smile, specifically the position of teeth #6, 10 and 27. Both upper and lower arches were severely crowded. Another dentist had suggested braces as the only treatment but the patient absolutely refused it as a treatment option. It was explained that orthodontics was the best treatment option, but not the only one.

For teeth #6 and 10, alternative treatment options to address the patient’s chief complaint were crowns, veneers or cosmetic bondings. All benefits and risks were explained. The patient’s finances limited her options to cosmetic bonding. Due to the labial flare of #6 and 10, sculpting (reshaping) the teeth would require removal of a significant amount of tooth structure. This would lead to nerve exposure so root canal therapy was strongly planned.

On the lower arch tooth #27 was completely lingually displaced from the arch. There was no room for this tooth in the arch, so the only reasonable non-orthodontic treatment option was extraction of #27. On the day of the extraction the patient was anesthetized with 3.6cc of lidocaine, and the extraction was completed by an Oral Surgeon without complication. A simple chromic suture was placed to allow soft tissue approximation and healing by primary intention. The 1 week re-evaluation showed the area of #27 had epithelialized over the wound and healed properly. Treatment of the remaining minor crowding in the mandibular arch was not desired by the patient.

At the next visit, prophylactic root canal therapy on # 6 and 10 was completed by the endodontist. Tooth #6 was anesthetized with 1.7 cc Septocaine and isolated with rubber damn. Access was obtained, and the single canal found was instrumented to 25mm, obturated with gutta percha and cement, and temporized. Tooth #10 was anesthetized with 1.7 cc Septocaine and isolated with rubber damn. Access was obtained, and the single canal found was instrumented to 22mm, obturated with gutta percha and cement, and temporized.

During the following visit, bonding and sculpting of #6 and 10 began. Tooth #6 was completed by an NYU senior dental student, and tooth #10 was completed by a Columbia University senior dental student. No anesthesia was necessary, as the teeth were root canal treated. The temporary fillings on the lingual of #6 and 10 from endodontic access was removed and replaced with a permanent composite filling. The lingual surfaces were roughened with a bur to allow for better retention. Next, the labial surface of the teeth were etched, bonded and MIDLF surfaces were built incrementally with Herculite bonding shade A1. The facial surfaces of the teeth were sculpted, bringing the teeth back into the arch. The occlusion was adjusted as needed. The patient was satisfied with the cosmetic results.

During a followup visit the patient requested a few cosmetic adjustments. The facial surface of #10 was etched, bonded and built up with Herculite bonding shade A4 followed by a external layer of XL2 bonding cover shade. The final contours were sculpted and the occlusion was adjusted. The patient was satisfied with cosmetic results.

After acclimating to the cosmetic bonding on #10, the patient scheduled another visit for cosmetic bleaching of the surrounding teeth. The teeth were isolated with a liquid dam to protect the gingival tissue. Two rounds of bleaching at 10 minute intervals on both upper and lower arches were completed. Patient informed that some white spots are normal and will resolve with time as the color of the teeth settles. Patient was satisfied with the color. Tooth #6 facial composite bonding was adjusted to improve color and give uniformity to the facial surface. Tooth #6 was reduced 1mm facially, etched, bonded and 1mm increments of XL2 composite were added on the facial; Bonding was sculpted and the occlusion adjusted. Patient was satisfied with cosmetic result.

The patient was encouraged to return for any other dental work needed, regarding the cosmetic bonding done, or any future treatment. She was advised to avoid hard foods on teeth #6 and #10. In the future if financially possible, she was encouraged to have porcelain crowns placed on #6 and #10. She was very happy with the final outcome and less timid about smiling and showing off her new teeth. Overall the treatment was delivered in a satisfactory and timely manner.

N.D., New York University College of Dentistry

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

Thank you to all the wonderful professionals in your dental office that are making the smile of my dreams a reality!

Happy New Year!

C.R.

Wishing you and your family a blessed holiday season. You have been one of the best doctors I have ever met. It is always such a pleasure coming for my appointments and sharing a laugh with you.
Love, L.L.

The patient had porcelain tooth veneers and noticed craze lines or small cracks on her two maxillary canines. The patient was previously informed that she should wear a bite plate in order to prevent fracture of the veneers (since she was a grinder) but the patient declined. Alginate impressions and photos were taken. The veneers on the maxillary canines were carefully removed and the teeth were cleaned. Impressions were taken and sent to the lab to fabricate new veneers for this case. The patient was concerned about how the temporaries would look and if they would be the right shade. Temporaries were made with Luxatemp directly added to the facial surface of the canines. The patient was satisfied with the shade and shape of the temporaries. Her new veneers will be completed and inserted in 5 days.
N.S., New York University College of Dentistry

Thank you so much. Your dentistry has made me the happiest person alive! My smile was worth the trip from Europe!
Lots of Hugs and Kisses, J.B.

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