Direct Resin-Fiber Pontics for Missing Laterals

Introduction to the case

I had a patient yesterday that came in for recall, CC that her flipper was broken. She has congenitally missing laterals #7/10 and originally came to my office for repair of an older flipper, which we did, and after it broke again we made her a new one. That one lasted about 2 year before it also broke.

She had planned on just having the flipper repaired again, but after discussing her options, she was sick of wearing it and always having it break, so we elected to do a bonded bridge.

This is my first direct attempt at this, but I’d seen a few case reports on the technique, along with all the great posts on here, so I had a pretty good idea of how I wanted to approach this.

I apologize for the poor photos, I’m using a 10 year old point and shoot camera and since this was unplanned we didn’t have a lot of time for perfect shots. I’d love some feedback on shade, contour, etc., as compared to what I see by some of the docs on here this look like chiclets.

Started by taking an alginate and doing a quick wax-up over lunch. Pt approved and we got to work. Began by bonding Fiber-Splint ML by Polydentia for added strength and to act as a framework to build off. I don’t love the stuff and the fiber-glass tends to come apart after you cut it and soak in BA, but it’s all we have. Used a putty mold from the wax-up to establish the incisal edge. Composite used was Filtek SU A3D (dentin) and A2E (enamel). Polished w/ brownie and rubber cup.

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Using Occlusal Stamping Technique with The Greater Curve

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Introduction to the case

Examined one of my original Sonicfills. It was a 2 years old large MO composite on #31. Margins were excellent except for a small hard pit void on an occlusal margin. I don’t blame that on the SonicFill material, I can be guilty of such a thing with any composite material. This is conjecture, but I believe the downward forceful pressure of the stamp technique will reduce the occurrence of marginal defects.

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Palatal Shelf Technique on #8 MIFL

Introduction to the case

Pipe to the face chipped the MIFL composite on #8. The most predictable way to do these for me is to use the “palatal shelf” technique with the shelf being made of a super thin layer of enamel shade composite, then a dentin shade composite to replace all the dentin, and then the last .5 mm being enamel shade again.

To create the palatal shelf, a matrix is needed and there are 3 methods to get it:

  1. Do a preop waxup and create a putty on the model (most ideal)
  2. Do an intraoral mockup very quickly and then create the putty in the mouth
  3. Finally, what I usually do just for the sake of time is I’ll make the putty with no mockup and then use a bur to create the “negative impression” to where the tooth should be (BRB technique). This is obviously easier when there’s not a lot of tooth missing.

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6 Minimally Conservative-Preparation Porcelain Veneers

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Introduction to the case

Patient received 6 porcelain veneers with minimal or conservative teeth preparation. The prep process was conservative to minimize removal of tooth structure. The images show tooth discoloration caused by old composite bondings. Following treatment, the teeth are whiter and less crowded.

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Lengthening Anterior Teeth With Composite

Terry Shaw

General Dentist

Perth-Ando​ver, N.B, Ca​nada

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Introduction to the case

69 year old gentleman came in for consult on bonding. Recent crown on right canine had broken off and he was balancing it in place. Lots of wear on remaining anterior teeth. He came back 2 weeks later for an elective root canal so I could place a prefab metal post and bond his crown in place. He was back a month later when I bonded his 5 remaining anterior teeth.

Some one placed a case asking for help with lengthening anterior teeth and I discovered these pictures buried in my computer so thought I’d post them to maybe help answer some questions about the problem.

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Anterior Composite Buildup Using Bioclear Matrices

Introduction to the case

This is my 2nd Bioclear case, just looking for feedback again from all you bondadontists. This one is more Doc Terry style.

91 y.o. male, didn’t like how worn his teeth were.

Filtek SU and Beautifil flow+ again.

It’s a lot of composite, but at age 91 I may have time on my side. You can’t tell from the pictures but the “crowns” are very thick, which I hope will compensate for the lack of posterior occlusion.

Still figuring out the technique. Big thanks to Doc Terry for making it seem possible, in the past I would have told him he needed RCT/post/crowns or a denture. This seems like a good compromise.

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Immediate Implant with Cement Retained Provisional Crown

Introduction to the case

Pt. presented w/ #8 w/ severely resorbed root (from ortho extrusion) and symptomatic. Pt. has very low smile line which works in our favor. Tx. planned for extraction, immediate placement and provisional. 4.3X13mm Nobel replace select groovy implant placed and temped using nobel screw down temp abutment. Picked up the white cylinder w/ luxatemp and tooth taken out of occlusion and all movements. Immediately temping this case with the temporary abutment and cement retained provisional crown worked nicely.

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