Today’s patient came in to have new zirconium crowns placed on #8 and #9.  Here is a summary of the patient’s previous relevant visits:

First visit – #6,7,8,9,10,11 prepped based upon lab models

Second visit – zirconium crowns placed for #6-11 with Nexus base clear. Patient requested darker shade – changed to A2.5 and canines to A3.0 with lab on same day

Third visit - patient feels #8,9 are too thick palatally. Pt informed that space at mesio-gingival margin can be closed

Fourth visit – crowns on #8,9 removed, slightly reprepped and new temp placed

The patient had signed a consent form before cementation, stating that the patient is happy with the try in and understands the consequences of changing their mind once the crowns have been cemented. However Dr. Dorfman was went out of his way to accommodate her and agreed to place new crowns on #8,9.

Today the new zirconium crowns for #8,9 were placed so the patient could see the new look. However she was still unhappy after the try in. She felt that it was still a bit thick palatally and also didn’t like the convergence of the teeth mesio gingivally. At another office, the crowns would have to be sent back to the lab and the patient recalled. However Dr. Dorfman called up his lab tech who showed up in minutes. He noted the changes the patient wanted and advised it would take a few hours.

The impression was taken with Impregum polyether impression material, using both light and heavy body. An anterior tray was filled with the polyether regular body and the light body was placed around crown preps. The lab technician said it was a good idea to blow air over the light body to prevent bubbles from forming. Once air had been blown all over the light body, another layer of light body was injected. Then the anterior tray was placed. The lab tech took his impression back to the lab to make the necessary adjustments.

The adjusted crowns had outstanding contours in the mesio-gingival area. The patient did still feel a slight thickness palatally so this was adjusted down. The crowns were then cemented on with Nexus Base Clear.

This experience really showed me the importance of always giving the highest standard of care, regardless of the circumstances. The patient clearly signed the waiver and knew once the crowns were cemented in, it would be difficult to make any changes. However, it’s clear from all my visits so far that Dr. Dorfman takes tremendous pride in the work he delivers to his patients. It is this reputation that he has build, which draws patients from all over the world to his office.

R.A., Columbia University School of Dental Medicine

Our New York City dental practice has considered the whole body relationship of dental disease for 24 years. We obtain periodontal cultures of patients with advanced gum disease, based upon the early work of Dr. Max Listgarten. The recent discovery of diabetes in a patient based initially on periodontal (gum) diagnosis is a case in point. The Center for Special Dentistry (www.NYCdentist.com) is proud to work with Dr. Keith Berkowitz at the Center for Balanced Health (www.CenterForBalancedHealth.com) in mid-town NYC. The fasting glucose tolerance test they performed to diagnose the patient’s diabetes will contribute to the overall health of this 42 year young woman. This should be considered the standard of care in dentistry particularly with the present Administration’s push to expand healthcare for all. It will improve health, save lives and is cost-effective. For microbiology results from Temple University’s Oral Microbiologic Testing Lab visit:
http://www.nycdentist.com/?fuseaction=atlas.displayImage&im_id=2249&at_id=243&at_parent_id=242

Read the Wall Street Journal article.

Reply:

Please re-read my comments:  I said our dental practice screened the patient for diabetes but worked with Dr. Keith Berkowitz (M.D.) at The Center for Balanced Health for diagnosis and treatment.  Dentists should not diagnose and treat diabetes but they can be invaluable in screening patients.

Separately, most physicians do not have any understanding of dentistry nor how it relates to systemic health.  It should be part of medical school.  Just 15 minutes ago we had to reschedule a patient who underwent AV Nodal Reentrant Tachycardia (AVNRT) in March at a prominent Long Island heart hospital but was not given instructions to premedicate for dental procedures for the first six months post-op.

This afternoon I viewed a patient who was in for an implant placement on #9. The 25 year old female had the tooth extracted over 10 years ago because the tooth would not erupt and was not able to be orthodontically erupted. Prior to the implant surgery a bacterial culture was taken because of a few severe localized pockets on select molars and premolars, which may be indicative of post-juvenile periodontitis. (See Image #1) The bacterial culture was taken by placing paper points into the facial and lingual sites of each deep pocket location for a few seconds, and then placed into the culture solution. The culture will be sent to an oral microbiology lab for testing and further treatment will be decided on then.

The patient received profound anesthesia prior to the implant placement. The size and location of the edentulous area indicated the use of a 3.5mm x 12mm implant in the area of #9. (See Image #2 and #3) Radiographs were taken to verify the placement and seating of the implant and healing abutment and sutures were placed to reapproximate the tissues for successful healing. The patient has been wearing a flipper for approximately 8 years and therefore the seating of the flipper post-surgery was confirmed and no adjustments were necessary.

N.S., New York University College of Dentistry

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.

My dentist is awesome! I’m a Broadway actor and my smile is my living. Dr. D bleached my teeth, then used “bonding material” to close several gaps and change the shape of my smile. Now I look like a Hollywood star. Thanks Dr. D!
-Anonymous