Conservative Restorations Following Orthodontic Therapy

171 Rating(s).


Posted on By Gerald Benjamin In Anterior/Esthetic

I strongly believe that removing all the enamel from a tooth in order to fabricate a crown is less than ideal treatment. Ideal treatment maintains the most amount of natural tooth structure for as long as possible with the goal be to maintain one tooth for one life.
The patient was first treated with Invisilign therapy. Teeth #6 and 11 were extracted for this 69 year old patient. Following completion of moving teeth, I removed all of the amalgam restorations and replaced them with direct bonded resin restorations under a rubber dam.

Pre-Op of Maxillary Arch
Pre-Op of Mandibular Arch

Completed Treatment of Maxillary Arch
Completed Treatment of Mandibular Arch
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21 Comments

Great work Dr.Gerald. Highly conservative.


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Gerald, what a change! My compliments for such a great diagnosis and treatment outcome.
Regards
Jorge


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Thanks so much Ashok and Jorge.
My posterior direct resins are lasting 20+ years, regardless of size.
Regards,
gerald


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Hi Dr.Gerald, please share, what are the basic rules you follow for such a long term prognosis, 20 + yrs is really amazing, we can cut less tooth to a great extent. Regards, Ashok


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Dr. Ashok; 1. Rubber Dam 2. Remove all caries verified with caries detection solutions 3. Bevel all cave-surface margins especially interproximally 4. Sandblast all surfaces that will be etched 5. Place a sectional matrix and secure with a V-Ring. (Make sure that the interproximal surface of the adjacent tooth is flat and adapt the sectional matrix to that surface using 2 instruments simultaneously so as to secure a perfect contact.) 6. Place acid etch and rub the etch continually 7. Place Tublicid Red on all dentin surfaces in the thinest possible layer ( the wetness is as if you licked your fingernail.) 8. Flood the prep with bonding agent and continuously agitate. Blow out excess bonding agent and light cure. 9. Place flowable resin inside the prep and rub/flow it everywhere and cure. 10. Build your contacts against the sectional matrix in thin (1 mm) layer of resin (Filtek Supreme Ultra*) and condense completely against the matrix. Cure the thin layer and remove the V-Ring. (When doing a Mesial and distal surfaces, place both sectional matrixes and secure the second one with a wedge but no V-Ring) 11. Inject (Carpules) Filtek Supreme Ultra into the entire cavity prep and condense thoroughly. i.e. bulk fill 12. Carve the surface to an ideal height, contour and morphology using a Christmas tree burnisher, a #15 endo file held in a curved hemostat and a #2 sable brush. Use each of these instruments until the surface is perfectly carved. The brush is always the last instrument used before curing to make sure that the resin is pulled over the bevel to insure no open margin or leakage. 13. Using two powerful lights (Valo by Ultradent) simultaneously from buccal and lingual cure for a total of 15 or so seconds. Then cure from the occlusal surface for another 15 seconds. 14. Remove the sectional matrix and any excess resin. Remove the rubber dam and check the occlusion. Very few adjustments are usually needed. *If a section of a buccal or palatal wall is missing, it is possible to create the wall using Filtek because one of its properties is that it does not slump and stays where I place it. It is cured prior to bulk filling. Yes a lot of steps and attention to detail but that is what makes the restoration last 20+ years. Dr. M Salama tells us that one abutment one time is the best protocol. I would like to go one step further by saying one tooth, one life. Dentists should virtually never removal all enamel for a crown in a 20,30,40 or even 50 year old patient if we expect that a tooth will survive a lifetime.


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Thanks for your detailed explanation Dr. Gerald.
Congratulations once again. Regards


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Hey Gerald

Beautiful work...

Rocco


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It is absolutely amazing, minimal invasive and beautiful!
Congratulations, please continue to share with us your proven protocols!
Best regards
Snjezana


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Gerald. Big smile and congratulations. Real Dentistry! Quite inspirational in a world of implants. Best regards. Chuck


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Thanks Snjezana and Chuck.
It is so easy to impress surgeons...Just teasing.
Regards,
gerald


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Beautiful conservative dentistry.
I'm surprised though that the orthodontist asked for upper cuspids to be removed!!


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Hi Laurent;
You, the orthodontist and I were all surprised by the extraction of the cuspids. I cannot recall the rational for removing the cuspids.
When I sent these photos to the orthodontist, he commented that this was one of the best outcomes of his career.
Regards,
gerald


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Dear Gerald, Your work and that of the orthodontist was well planned and executed.....I would have preferred to see more photos and xrays before and after..... please repost again, we can all learn something from this. Sincerely, Gerald Rudick Montreal, Canada


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Hi Gerald; Additional photos

Retracted View
Pre-Op Smile


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Additional photos

Right lateral smile
Left lateral smile


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no doubt, Gerald, this is ideal dentistry and I cannot understand the logic or wisdom in reducing good enamel for crowning teeth like this. Nevertheless, it is being done much too much not for good judgement but for good income.


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A case like this just came into our office and Ron Goldstein insisted on orthodontics prior to any restorative dentistry in the patient's best interest. Great work my friend.


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Great work Dr. Gerald Benjamin. It's very easy to say but really difficult to do removing all the enamel from a tooth in order to fabricate a crown. I really appreciate your work.


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Thank you so much, Lucia. The best part is doing the dentistry!!!


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Nice Gerald. Always ortho first. Try to center occlusal pic for better case documentation. Regards, Miguel


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Miguel;
I am old, the camera is heavier everyday and I am slightly off balance.
I have been doing photography for almost 50 years...Aging has taken its toll......................but not for the actual clinical dentistry.lol


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