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

Female patient presents to the dental office for try-in of the Maryland bridge and the lower RPD (removable partial denture). The Maryland bridge did not seat at first so we adjusted it mesially and distally. Then the bridge’s wing did not contact the lingual surface of #23. The dental lab technician tried burnishing it with stone but it did not correct the problem. There was also a lot of metal showing on the incisal portion of #21 so we reduced that. A new 3 way impression was taken for the Maryland bridge and the bridge will be remade. The shade of the pontic was somewhat bright on the gingival aspect so a slightly grayer shade will be added to that portion.

The lower RPD was also tried in. The RPD did not sit on the ridge on the left side. The RPD also did not fit on the cast and will therefore be remade. A new impression of the lower arch was taken for the new RPD to be fabricated.

N.S., New York University College of Dentistry, Patient 1 – part 6

Female patient presents to the dental office for bonding of upper anterior teeth (#8 and #9) and prepping of #21 and #23 for a Maryland bridge. Prepped #21 and #23 with cingulum rests using an inverted cone bur. At first a chamfer bur was used but it was not sharp enough and did not have rests that were well defined. I thus determined that a sharp inverted cone bur would be better. I then took a 3 way impression of the lower arch for the Maryland bridge and the preps came out very well defined. I also took a bite registration using yellow PVS.

We examined the lower RPD with the lab tech to determine if we could easily reline or rebase the RPD for a better fit, as well as add teeth onto it in the areas of #28 and #29. Lab tech said it would be easier to just make a new RPD so we took alginate impressions of the upper and lower arch.

I started the bonding of #8 and #9 using 1 step etch and bond and A1 composite. The shade looked nice on the natural tooth structure. The contact area was somewhat thick so as I pulled floss through at the end some of the tooth bonding chipped and will be fixed during the next visit.

N.S., New York University College of Dentistry, Patient 1 – part 5

Female patient presents to the dental office for 3^rd tooth bleaching session and sculpting of upper and lower right anterior teeth. Patient was satisfied with previous bleaching sessions and reports no sensitivity. I performed a 3^rd bleaching treatment on the patient for two 12 minute sessions using Opalescence. The patient was very satisfied with the new tooth shade. Following this I performed sculpting on #6, 7, 26, and 27. Her crossbite was corrected and the patient was quite satisfied.

She brought in her lower RPD and we evaluated the fit and option of adding 2 new teeth on the lower right. RPD did not fit well and she had a lisp when she wore it. We decided we would look at it again at the next visit after we finish the bonding. We might try to reline the RPD and add new teeth in, or we might take an impression and make a new RPD.

For the next visit we are going to do bonding of #8, 9, 23, 24, and 25. Also, we are going to prep #21 and 23 for the Maryland bridge we are going to place there. We will be making preps that will be similar to RPD cingulum rests with slots.

N.S., New York University College of Dentistry, Patient 1 – part 4