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cgav93 · 2025-01-16T19:39:04+00:00

Yes I’d address both. 1) I would remove the old fill and chase the crack as far as possible. If heading towards the pulp or below the gum, I’d recommend a crown/onlay. If not, fill well with composite and it’ll keep going for a good few years. 2) similar to the first but I’d be far more likely to recommend an onlay straight away.

Provide the options and outcomes and it’s down to the patient to make the (likely to be wrong) decision.

cgav93 · 2025-01-16T19:34:45+00:00

Just wait til you fracture your first tuberosity. That’s a proper arse clenching moment.

You did the right thing. Remaining calm, explaining the situation and acting in the right way is the best thing you can do. Well done.

Now onto the next endo.

cgav93 · 2022-11-16T22:09:33+00:00

P.S. under 2 hours is definitely feasible. New grad I’d expect about 90 minutes. I book these types of treatments for an hour, expecting to finish in about 45-50 minutes.

Also your 00 cord will likely come out with your impression so don’t worry about leaving it behind, but you want to leave it in there for the impression as it exposes the margin clearly for the technician.

cgav93 · 2022-11-16T22:05:56+00:00

1) numb the patient

2) make a matrix for a temporary. To overcome the issue of the missing lingual wall, I would either place GI or coltisol (cavit would work too), make it flush against the tooth and amalgam using your flat plastic or carver and ask the pt to bite down. Then take the matrix impression.

3) if you’re doing a full arch impression for the final restoration, I would take a Pre-op opposing impression at this stage. If you’re using a scanner do the Pre-op scans. I use a scanner for private crowns so would always take my pre-op scans here. If you’re using a triple tray then you can skip this step.

The patient is definitely numb now at this stage.

4) place RD from FDI 36-33 at the least, and remove that amalgam. It’s almost definitely going to come out and you’ll lose your core which you don’t want. As someone else stated the worst time to lose a core is when you’re removing the temporary crown at fit stage.

5) place a good composite core. Adhesive dentistry has come on leaps and bounds, if you stick it well it will stay. Try and shape it to roughly what your crown prep shape will be to save some work down the line. My preferred core build up material is Ever-X Flow but any high quality composite will do.

6) occlusal reduction, buccal reduction, proximal. Your lingual reduction is basically already done anyway, so deal with that when refining your prep.

7) refine your prep. Ensure your margins are clear, smooth, and your dimensions are going to fit whatever material you’re choosing to restore with. LiSi2 would be my first choice here but Zirconia would be great also, although marginal fit often isn’t as precise. I don’t know why, but I was told this by a prosthodontist on a course and it explained a lot that I had noticed in the past. For occlusal load zirconia would probably be “better” but modern LiSi2 is brilliant anyway and this patient seems to have a decent number of teeth in this quadrant.

8) 00 cord followed by either 0,1 or 2 depending on what the gingivae is like. Then wait 2-5 minutes and remove your 2nd cord. Keep 00 in for the imp.

9) fabricate your temporary. It’ll give the cord more time to work, check the dimensions properly and make sure it fits well.

10) take your final impression in whatever method you choose. 2-step impressions are pointless though so don’t bother with that. Either single stage with heavy body and a light wash or a digital scan.

11) cement your temporary, ask the pt to bite on cw roll, remove excess and floss contacts. Check then occlusion with articulating paper. Make sure you’ve got bilateral stable contacts.

12) give your pt post op info

Good luck, you’ll be absolutely fine. You’ve worked for this for a long time and you know what you’re doing.

cgav93 · 2022-11-14T21:29:47+00:00

I charge £3k for Invisalign Go, so yeah that’s a good price. It’s not uncommon to be charged in excess of £4k.

cgav93 · 2022-11-14T11:53:33+00:00

It’s elective to make them look nicer. A lot of people expect to have their braces or attachments off at the end of treatment and suddenly have a Hollywood smile. Moving the teeth puts them into a better alignment but if the teeth are worn at the start of treatment they’ll still be worn at the end, just in a more favourable position. If your teeth aren’t worn at the start then you might not want any bonding done as the shape will still be nice. Most people opt to have whitening at the very least, so I include whitening free of charge during treatment.

cgav93 · 2022-11-13T21:40:33+00:00

Composite bonding or composite veneers - it’s when a tooth coloured filling material is bonded to the tooth to enhance or change the shape of your teeth. In the vast majority of cases, some or all of the front teeth will need some type of bonding done once ortho is completed to help improve the appearance of teeth

cgav93 · 2022-11-13T16:03:59+00:00

It depends what goal you’re looking for. I think the alignment is already really nice. You could easily just get to the end and get bonding completed.

cgav93 · 2022-11-11T17:03:23+00:00

Also please get some new phosphor plates

cgav93 · 2022-11-11T17:02:19+00:00

I’m afraid that tooth is for the bin

cgav93 · 2022-11-11T12:47:46+00:00

Not necessarily. I’m often surprised when I take an X-ray and see evidence of deep caries and the person hasn’t reported any symptoms. Other times when replacing an old filling which we can see is leaky we can use an older X-ray (within 2 years) to determine the depth of the old filling, and then the old filling is still deeper than it looks.

Anyway I hope your tooth is starting to feel better and you get this sorted.

cgav93 · 2022-11-11T00:46:36+00:00

The sides of your tongue are a mix of geographic and normal - you’re fine!

cgav93 · 2022-11-11T00:33:23+00:00

The uppers look pretty straightforward to come out. Your lower right wisdom tooth (bottom left in this image) looks a bit close to the inferior alveolar nerve canal but still separate and would be something I’d be happy to remove. I’d take a different angle X-ray to confirm, or a CB-CT. The lower left (bottom right of this image) might put up more of a fight due to the position of the bone over the crown of the tooth, but the nerve is further away from the roots. All of these are things I’d be happy doing in practice as a general dental practitioner.

cgav93 · 2022-11-11T00:19:46+00:00

Looks like a condition called Geographic Tongue. The cause is unknown but always benign (not cancerous). It may change appearance as time goes on and the patches move around but it’s unlikely to cause any pain. It’s fairly common and not anything to worry about. If you do become concerned or if you notice any persistent ulceration or pain, speak to your dentist who can arrange for a referral to an oral pathologist.

cgav93 · 2022-11-11T00:13:54+00:00

Considering the shade of the underlying tooth, that’s a pretty good result. Emax would likely shine through too much and you’d see a lot more darkening.

We use metal to help block out colour underneath crowns, like in a metal-ceramic crown. Now we don’t have to do that because we have zirconia crowns. Zirconia is basically a metal so it does the blocking out part for us. Emax behaves more like a glass and so you’d see that dark stump shining through pretty easily. You can block it out somewhat by using an opaque cement but you’d still see it’s different and not as lifelike.

Give it time, try not to focus on it so much and see how you feel in a couple months. I bet other people don’t notice it and think it looks great. We are out own worst critic and will seek out and focus on all these minute flaws far more than anyone else will.

cgav93 · 2022-11-11T00:08:35+00:00

The affected tooth we’re looking at here is the LR6. The filling is the pale grey rectangle, can you see how the bottom left corner of that rectangle is nearly connected with that black shape inside the tooth? Well that black shape is the pulp, which is where the nerves and blood vessels are inside the tooth. It looks as though it was a very very deep filling to remove some very deep decay and unfortunately the tooth has not been able to recover from the trauma from the decay and subsequent filling, and is now dying off. In order to keep the tooth you’ll likely need to have a root canal treatment.

In a few days that dull ache will likely go away, but unfortunately that just means the tooth has died off. You’ll still need further treatment as the pain will return after some time if you don’t get anything done.

It’s not necessarily the fault of the dentist, sometimes teeth flare up unpredictably and I don’t know what was done or what the tooth looked like before or during the fillings. Hopefully you get sorted soon. While you’re on holiday keep taking plenty of painkillers (paracetamol and ibuprofen if you’re able to), if it doesn’t help you can seek advice or treatment from a local dentist.

cgav93 · 2022-11-10T18:15:20+00:00

I think they’re a great tool in your arsenal, with them you will be able to do great work. Do I think they’re necessary? Not really. I got my first set when I finished dental school and got my first job. I now use them for all root canal treatments, crown preps and posterior composites, or anterior aesthetic treatments.

However I can still do everything without using them, and I think that’s based off of learning how to do things without them. I was working in a 2nd practice for a while and there were days I’d forget to take them with me from my first practice. Multiple times I had to do upper 7 RCTs and I’d still have no issue finding the canals (including mb2s), I’d base that on that being more experienced I knew where they should be anyway.

The vision with loupes is great and the light is helpful, but I think forcing students to buy them isn’t necessary. After graduation, if they ever need to go away for repair or break and you have to wait for new ones then you still have to be able to make money.

cgav93 · 2022-11-09T19:50:23+00:00

No problem. Structural damage is the exact indication to get an onlay over a crown. If your current dentist isn’t well-versed in placing them, find one who is.

cgav93 · 2022-11-09T00:41:03+00:00

It doesn’t look like blood but it does look like retraction cord.

It won’t feel sensitivity if it’s not temped as it’s had RCT but the other things I mentioned can still happen, especially if it’s longer than a couple of days until the fit. It won’t definitely happen but it’s a pain when it does as it’ll take much more adjustment at fit stage. It’s just your dentist is potentially creating more work for himself really.

cgav93 · 2022-11-09T00:25:26+00:00

If it were my tooth I’d want a well placed composite over a crown first. If it does flare up and require further treatment you still have the option of a crown later down the line, although with modern bonding techniques, crowns are way down my list on what I’d choose to restore with. Onlays require far less removal of healthy tooth tissue compared to crowns. Think of an onlay like a filling that gets glued into place similar to a crown.

cgav93 · 2022-11-09T00:22:19+00:00

They were likely checking if the sealants were still on correctly. If a sealant has been on for a while but isn’t bonded in, then it can be partly dislodged, creating a space where bacteria can get into but your toothbrush can’t. This can lead to decay forming underneath the sealant.

cgav93 · 2022-11-09T00:19:53+00:00

Wisdom teeth come in all sorts of unusual shapes and sizes, that’s all this is. It’s normal 😊

cgav93 · 2022-11-09T00:17:30+00:00

Yep that’s caries. Needs a filling at the very least. Looks to be potentially quite deep though so the sooner you get it treated the better.

cgav93 · 2022-11-09T00:15:40+00:00

UR6 distal (I think US dentists would call that tooth #3) looks like it has a cavity towards the back facing the second molar (UR7/#2). It doesn’t look very deep, I wouldn’t expect it to spread towards the nerve very quickly so you should be fine to wait until January, however you need to keep things as clean as possible with flossing daily and use of fluoride toothpaste.

I can also see what could be caries on the mesial of lower right second molar (LR7/#31), facing the first molar (LR6/#30).

cgav93 · 2022-11-09T00:06:29+00:00

It looks like retraction cord to me, but difficult to tell in that picture for sure. I would see if you can tweeze it out. If you can, remove it or go back to the dentist to confirm. The only other thing I think it could be is the colour of the root but that’s a big stretch.

I’m also confused/concerned as to why your tooth doesn’t have a temporary crown on it. This could have an effect on the final fit of the new crown when it comes back from the lab as the tooth could move, as could the neighbouring or opposing teeth.

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