Category Archives: Tips & Techniques

Sydney dentist tips and techniques

Ceramic restorations on Discoloured stumps around the gingival tissues

A tooth can discolour for a lot of reasons. If you ask a Sydney dentist about this, you will be advised that teeth could discolour due to age, food, beverage, medications, trauma, dental caries or exposure to highly staining compounds.

A tooth fitted with a porcelain fused to metal crown may stain after prolonged exposure to the metal. This results in an unsightly discoloured stump that often reflects and affects the gum tissue. Teeth with discoloured stumps are very unattractive. It gives the patient a smile that looks dirty, old and diseased, especially since the stained appearance reflects on the soft tissue or gums too.

It is a frustrating problem because even if you place the margins at a subgingival level, the problem still remains. When we encounter a problem like this in the clinic, we suggest a few things to the patient:

1. Internal bleaching. An initial remedy for the discoloured stump that has spread to the gingival tissues is to perform an internal bleaching procedure. This is most appropriate for root canal treated teeth, with effectiveness that is quite unreliable.

2. Opaque restoration. A more definite solution that we provide involves masking or covering the discoloured stump with an opaque restorative material or composite resin. Using Kolor +- Kerr Dental we overlay the darkened area to mask the unappealing area so that it does not reflect on the crowns and on the gum tissues.

This kind of remedy is applicable for root canal treated teeth, teeth receiving dental crowns, bridges and veneers. It may be performed on porcelain-fused-to-metal crowns, all-porcelain crowns or even zirconium crowns. The result you receive is a natural-looking teeth restoration, the appears good as new. The teeth will appear beautiful, healthy and clean.

Discoloured stumpsDiscoloured stumpsCeramic restorationsCeramic restorations

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Implant rehabilitation in the edentulous jaw: the “All-on-4” immediate function concept

When a patient loses all of their teeth, they are essentially relegated to living the life of a “dental cripple” and are compelled to see a Sydney dentist to find resolution. The teeth are very essential to any human being and when a tooth or all teeth are lost, chewing efficiency is lost, their level of comfort declines and often they appear to age prematurely. The teeth provide more than a bright smile on someone’s face. A complete set of dentition maintains the bite and keeps all the structures in harmony. When changes occur after teeth are lost, patients begin to seek the dentist.

Edentulism can be a result of poor oral hygiene and dental disease. Sometimes patients who have received previous restorations meet a failure in their cases and their teeth are deemed restorable and hopeless. A growing number of the population possess a terminal dentition and the ability to retreat is restricted due to the poor remaining tooth structure and support, combined with limitations from the financial burden of full mouth reconstruction. How and why a person is edentulous varies. When patients come into the clinic, their oral condition is assessed and the appropriate solution is planned and presented—all encompassing the health and financial capacity of the patient.

It is well recognized that an edentulous condition has a negative impact on your life:

  • You need your teeth to eat because otherwise you will be limited to a soft, unappealing diet.
  • You need your teeth to smile, to flash a confident set of pearly whites to people.
  • You need your teeth to maintain the integrity of your facial structure, otherwise your bite will collapse and along with it, the face will sag and make you look much older.
  • You need your teeth to maintain the health of the jaw. The temporomandibular joints (TMJ) rely on the teeth. When the bite collapses, the changes that occur can be very damaging to the joints.
  • “All-on-4” implants have become a leading choice in many teeth replacement cases. The text below explains it further and discusses the benefits you can enjoy.


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Class II: Wedge doesn’t do anything!

Dental caries or defects on the teeth may occur on different areas. Pit and fissure caries affect the occlusal table and decay of this nature is limited to just one surface, but when caries extend to the proximal areas, a different approach is required. When the sides are involved, a barrier or matrix band is utilised to keep saliva and blood away from the area and properly restore the proximal and contact points. Ideally, a matrix barrier should be enough. It is inserted in between the teeth, is held in place with the help of wedge and the restoration is given to the tooth without any problem.

Unfortunately, sometimes you will come across those frustrating cases when you stick a wedge into a matrix and the bloody gum still bleeds as you work. This can be quite frustrating because it makes it hopeless to restore the tooth. The blood and saliva will disrupt your work, so you will take longer. Either that or the restorative work you complete will be poor.

One way of adapting the matrix more intimately is the use of another wedge (two wedges) or another neat trick is to use Teflon tape (aka plumbers tape) to adapt the matrix to ensure a clean field to place your composite. Using a Teflon tape is unusual but it offers a few benefits:

  • Teflon tape will isolate the and provide visual enhancement for results achieved. With its help, the dentist is able to shape the composite up to the proximal third of the crown.
  • The Teflon tape is very flexible and thin. It is kind of the tissues and it inserts easily through the area between the gum and tooth. It provides better barrier and protection to the tooth and gums.
  • This offers proper manipulation of the composite material, so that you can avoid creating dark triangles in between the anterior teeth you are trying to restore.

  • WedgeWedge

    wedge

     

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What is Biomimetic Dentistry?

The days of invasive dentistry that involves having to remove vital parts of teeth or cut down teeth for crowns are drawing to a close with the latest in Biomimetic technology. Biomimetic Dentistry allows a Sydney dentist to conserve teeth by treating weakened teeth that may be fractured or decayed and protecting them from bacterial invasion by sealing them with an adhesive restoration.

Better than traditional methods, Biomimetic Dentistry does not require a dentist to destroy healthy tooth structure in order to build a new restoration. Using the latest in technology, we can bond and adhere teeth together and build missing components of teeth without destroying vital tissue. Modern Dentistry believes in conservativeness of treatments and so nowadays we seek to undertake as little prep or even no prep when it comes to applying veneers or offer onlay, partial crown Biomimetic solutions in preference to a traditional crown thus conserving teeth. This means that restorative treatments are achieved without compromising health.


Indirect Restorations


The advances in adhesives and bonding materials have improved dramatically over the last 40 years, in so much that dentists can restore many cases that would have required crowns with minimally invasive conservative restorations. Although relatively successful and producing increased likelihood for success, understand that carrying out conventional crowns can lead to non-vitality of teeth due to the aggressive preparation required. By utilising the philosophy behind Biomimetics, the preparation needed is often reduced, thus minimising the biological impact to the tooth. Additionally, when this route is opted, many times the preparations can be kept at a supragingival level, leading to the preservation of healthier tissues that allow easier impressions and simpler adhesion procedures.

The Biomimetic technology involves the use of innovative materials. These new materials mimic tooth dentin so well that it even fuses to the existing tooth, offering reliable stabilisation and strength to the restoration. Biomimetic means to copy or mimic nature. For any restorative or cosmetic job done, a patient should appreciate any effort to get their smiles back in the healthiest and most aesthetically appealing manner.

Bio MimeticImage Courtesy of  https://biomimeticdentistryce.com/what-is-biomimetic-dentistry/

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The centripital layered build-up of a posterior direct composite resin

No matter how brilliant the Sydney dentist is, did you know that all composite restorations face as much as 5% polymerized shrinkage?

This phenomenon lead to:

  • Internal debonding and the inevitable dislodgement of the restoration.
  • Marginal openings that causes leaks and re-infection or recurrence.
  • Cuspal flexure and microfractures which causes consequent permanent deformation due to the load subjected by the restorative material.
  • Postoperative sensitivity that may be the result of tissue exposure due to microleakage.
  • Marginal staining, also caused by microleakage.
  • In the clinic, I make use of nanofilled composites to remedy these noted discrepancies with hybrid composites. Nanofilled restorative materials have particles that are as minute as 0.02 microns. With this, restorations are more successful, with recorded shrinkage as low as 1.6%. More so, it allows the dentist to create better restorations.

    The article below does not only count the number of benefits one can enjoy with nanofilled composites. It also discusses the importance of proper manipulation and layering. This technique involves the incremental addition of restorative material into a cavity. Instead of packing a bulk of composite into the tooth, the filling is brought in, little by little, in a technique called “layering”. With the use of a nanofilled composite, you already improve success rates; when you perform the layering technique, you increase polymerization depths, improve aesthetic results and decrease polymerization stress.

    This follows a precise process:

    Step 1: Shade selection. To ensure aesthetic satisfaction, proper shade is selected.

    Step 2: Rubber dam placement. Proper isolation of tooth is performed to improve results.

    Step 3: Preparation. Tooth is drilled to remove diseased tissue and to prepare it to receive the filling material.

    Step 4: Etching. Application of the etchant prepares the tooth to receive the bonding material. Successful etching improves success.

    Step 5: Internal Adaptation. Making use of flowable composite that better penetrates the tissues.

    Step 6: Incremental Layering. Composite resin is added in small amounts.

    Step 7: Building the Proximal Contact. If the restoration involves the proximal areas, the proximal contacts should be restored harmoniously.

    Step 8: Building the Artificial Dentin. Dentin composite is placed in the right shade.

    Step 9: Building enamel layer. Enamel composite is then provided in the right shade.

    Step 10: Occlusal staining. Whether you like it or not, it is done to satisfy aesthetic appeal.

    Step 11: Finishing and Polishing. The tooth is moulded and polished to mimic the appearance of the natural tooth.

    Step 12: Rebonding. For an even more impressive finish, additional shine is provided.

    This process is explained in much detail in the paper attached on this post.


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USEFUL APPS FOR DENTISTS AND PATIENTS

The world as we knew it has changed. We are in the digital age and to better survive, one has to fully integrate the changes into their lives. The same could be said with dentists. These days, we have multiple technologies in our grasp, and one of the easiest for patients to understand is using a tablet like an iPad. Being able to demonstrate images on a tablet is just so much more high tech for a patient. This sets you apart from another Sydney dentist and helps educate your patients in a more effective manner.

Here are just some apps for dentists and patients:

DDS GP

DDS GP

DDS GP is an app for dental professionals that allow them to show dental conditions and treatments to their patients using an iPad. It is probably the most comprehensive of all the applications that I have seen.

  • You can TAP and DRAG items on the screen, to easily show severity of decay, periodontal disease, cracks, and numerous other conditions and procedures.
  • You can DRAW right on the screen with your finger and you can save your drawings for future use.
  • You can also ADD your own images or photos from your photo library, then draw on and save them.
  • Finally, you are allowed to SEND or PRINT custom treatment plans to your patients using this app.
  • Check here for details & download
  • Dental Navigator

    DENTAL NAVIGATOR

    Dental Navigator is an interactive application, which can be used by dentists to explain different methods of treatment to patients. If you have the new Apple iPad, you can use an HDMI adapter to project the whole application onto a large screen for better viewing.

    Check here for details & download.

    Dental Expert

    DENTAL EXPERT

    This application is an excellent app for patients as it explains the different treatments available in dentistry, and the best thing is it is FREE! Check here for details & download.

    Pediatric Dental Expert

    PEDIATRIC DENTAL EXPERT

    This application is a food guide that parents could use to be able to understand the proper dental care that their children need. It is FREE and it is easy to use, so you can download it today. Check here for details & download.

    Dentistry ProConsult

    Dentistry ProConsult

    Dentistry ProConsult is designed to provide dental students with a quick and easy way to review procedures they may have to perform in clinic. It is Free!

    Check here for details & download.

PORCELAIN VENEER PROVISIONALISATION

As a Sydney dentist, when I teach veneer provisional fabrication I teach a few different methods.

  • Direct buildup – a very small dot of etch is placed on the tooth in the mid-labial section and then bond is applied generously over the remaining preparation including the etched area and non- etched areas. This will allow sealing of the dentine so there is no sensitivity. Composite is then directly placed and sculpted into position to simulate the anatomy. This is best for a single or minimal amount of veneers. Please remember after removal of the provisional, a bur must be run over the etched area to remove any remaining composite that may be still bonded in the spot.
  • Bis-acryl provisionalisation conventional method. Using a putty key the temporary material is placed into the putty and placed over the prepared teeth. This is then removed and trimmed and cemented into position with temporary cement. This can be difficult due to the fact that these temporaries are thin and can break upon removal. It is recommended that a clear temporary resin cement like TempBond NE is used, as using an opaque cement can lead to very opaque looking veneer causing concern for the patient.

TempBond NE - sydney dentist

  • Shrink Wrap: Firstly the preparations are cleaned with chlorhexidine, and then a generous amount of desensitizer is used over the teeth, as this protocol does not involve cementation of the temporary veners. Using a putty key the temporary bis-acryl resin material (e.g. Protemp – 3M Espe, Luxatemp – DMG, Integrity- Denstply) is placed into the putty and placed over the prepared teeth, and as this polymerises the material undertoes shrinkage which “Shrink wraps” the temporary veneers onto the prepared teeth. Any excess is carefully removed best with multi-fluted carbide burs.

Shrink Wrap - sydney dentist

  • Spot Etch and Shrink Wrap: This is exactly the same technique as the shrink wrap but we add the spot- etch technique where avery small dot of etch is placed on the tooth in the mid-labial section and then bond is applied generously over the remaining preparation including the etched area and non- etched areas. The shrink-wrap technique then allows for the temporary material to bond to the etched area and the rest of the temporary is wrapped onto the teeth.

 spot-etch temporisation - sydney dentist

Each technique has advantages and disadvantages, however my favoured technique is the spot etch and shrink wrap technique as this ensures that the patient does not lose their temporary. Just remember that it can be more difficult to remove due to this being etched onto one specific area, so warn the patient, and also remember to go over the etched area with a bur upon removal of the temporaries to ensure that there is no remaining composite or adhesives stuck to the tooth. Once I have done this I like to use the Prepstart(air abrasion 27 micron Aluminium Oxide at 40 psi) to clean the tooth and prepare for adhesive processes.

prep start - Veneer - Sydney Dentist