Endo Retreatment with CBCT Showing Transported Canal with a Perforation

Craig Berry

Endodontist, Diplomate



Introduction to the case

Fun retreatment. Patient had RCT on 9, which was retreated by another endodontist 5 years ago. Patient developed pain and swelling in the area. CBCT revealed a transported canal with a perforation. I was able to locate the canal and hopefully save the tooth!


Composite Full Mouth Rehab Using Activa Bioactive Restorative

Introduction to the case

This is one of my most MacGyver cases to date. This patient has extensive damage from wear and erosion and was ready to restore his mouth before it gets any worse. He is now a faithful nightguard wearer but nonetheless, those masseters made me really nervous.

I like to test drive big cases in composite before committing to porcelain because if they’re going to be breaking stuff, it sure helps to figure out why and correct it before proceeding to finals. You can certainly do it with just a bisacryl overlay but it tends to pop off and you can’t really leave it on as a buildup. Doing the mockup in a real composite allows you to break the teeth up individually for flossing and allow them to wear it longer. It also serves as a buildup by filling in deficient areas of tooth.

In this case, I generated a template from a waxup and used it to injection mold the intraoral mockup. The contacts were broken by inserting mylar strips interproximally.

I chose to use Activa here for a variety of reasons. It is injectable, it’s dual cure, it doesn’t have to have a bonding agent, and it is very resistant to wear and chipping. The bioactive aspect is icing on the cake making it far less likely to have secondary decay.


16yo Non-Compliant Ortho Patient with Large Anterior Carious Lesions

Jonathan Held

General Dentist

Sioux Falls, SD


Introduction to the case

16 year old female presented with full ortho maxilla and Mandible. Patient had been in ortho for 2 years. Patient had very poor oral hygiene and presented with generalized decay in posterior and anterior, as well as deep carious lesions around ortho brackets. I called referring orthodontist to discuss case and patient’s hygiene regimen. Orthodontist stated that patient’s ortho treatment plan would last at minimum another year if we continued treatment. We made the decision to discontinue orthodontic treatment to address deep decay and improve oral hygiene. A few posterior teeth with deeper decay were addressed first and then we addressed anterior teeth following prophylaxis and a few weeks of healing. Full extent of decay was visualized following removal of brackets. Treatment plan included restoring anterior teeth with composite restorations with future need for full coverage crowns once patient’s homecare improves. Patient was seen in one visit to remove maxillary anterior decay and restore with Filtec Supreme Ultra composite. Greater curve bands were used for all restorations. Pictures show pre-treatment and post treatment, with a 2 week follow-up.


Creating a Color Blend for Class V’s


Introduction to the case

Creating a color blend for Class V’s can be frustrating. Give this technique a try. As an added bonus you will realize a stronger bonded restoration.

Using SureFil SDR flow as the first layer over the entire surface of the prep creates a low stress strong bond to dentin. The SureFil also creates a semi translucent layer which is covered by the Filtek Supreme Ultra “Body” layer. The result is a blended composite that reflects light much like the surrounding tooth structure. If the color is off, the result will still look respectable.


The “Poor Man’s” CEREC Crown

Introduction to the case

I posted this technique before but wanted to show it with a little more detail: link to technique.

#3 has distal decay, existing large MO filling, separate buccal and lingual amalgam fillings and some ugly looking cracks. Tooth is periodontally involved and is also unopposed. What do you do for this tooth? In my view it’s only value is for esthetics unless she opts to restore the bottom. Considering that and the perio, I hate to recommend an expensive crown. I would also hate to try an MODBLXYZ filling. This is the perfect scenario for the poor man’s cerec crown.

  • 1. Preop dual arch impression.

  • 2. Remove all decay and old restorative – in this case that didn’t leave me with much othere than a few thin cusp tips.

  • 3. Prep for full coverage staying supra G where possible and preparing a nice readable should margin and smooth edges- much like a cerec prep.

  • 4. Using the impression, place dual cured composite (I use Injectafill) in the tooth site just as you would to make temporary.

  • 5. Remove at exactly 1:30 sec.

  • 6. Allow to self cure or hit it with light.

  • 7. Trim as you would a temp- gotta get this part right becaus this is the definitive restoration. You can leave a little excess buccal and lingual as you’ll have access to finish the margins.

  • 8. Try in and verify fit.

  • 9. Sandblast internal.

  • 10. Bond as you would any other composite/all ceramic crown.

  • 11. Clean excess, finish margins, adjust occlusion (shouldn’t be much to adjust given that it is identical to their original tooth.


Full Arch Implants – Welded Conometric Case

Bill Schaeffer


The Implant Centre


Introduction to the case

Nothing new in the technique here – this is just one of my standard welded conometric cases. It just turned out nicely so I thought I’d post it. The plan is to remove the lower molar and all the upper teeth and to place some implants lower left and upper jaw.

The only tough decision I had was whether to do this case as a hybrid (pink and white) or as a socket-fit bridge (just white).

The patient has lost quite a lot of vertical height of bone – but not evenly – so I decided to go with the nice and simple hybrid. I have just added his PAs from Monday’s review and integration check. These are from two months after implant placement and loading.


First Margin Elevation Case

Introduction to the case

I’ve taken a number of courses and have seen some great cases on here with margin elevation, so I found a case worthy of trying my hand at it. I would really like some feedback for those of you who’ve done a number of these. The patient had mild sensitivity on the gingiva for a few days but said it has felt fine since.

Overall I thought the tissue looked pretty good considering. I bonded on an emax crown and the margin height made the process easy and ensured complete isolation.

We ran out of time so no final crown pic or XR.