Few of patient before visiting dentist , visit google and come along with diagnosis and treatment. Doctor i want to save tooth without rootcanal treatment as i read some were. Or there is new treatment where tooth can be saved without rootcanal treatment. Most of time patients come with such an attitude that he or she knows treatment and dentist not. For us its not new we are that much updated about new trends or treatments in dentistry. But with google knowledge , few people feels that they know everything, sometimes more than dentist. Here the kind of tooth which i treated here is without rootcanal with indirect pulp capping treatment with theracal lc material followed with restoration. Tooth can be saved or treated by or without rootcanal treatment.. Its a clinical decision dentist take it while treating tooth.as few decisions doctors have to take while treating it . after cleaning tooth of deacy ,dentist decides to do rootcanal treatment or restoration
.4 year young man visited my clinic for toothache with 46 ( Lower Right First Molar ). After check up i saw fracture line on his tooth . So gave him medicine to relieve from pain. Called him after one week as i was knowing that medicine is not final cure for it . He has infection with tooth, it can be resolved only after doing ROOTCANAL TREATMENT.
In This case my Patient (15 yr) lost her teeth because of accident. At this age implant is not possible as body grows. If i place the implant at this age after few yearstooth remains at upper level than her adjucent teeth. Like natural teeth, implanted tooth doesnot move with the growth of her jaw. If its done it creates discripancy. Since front teeth were missing it will be life long which is difficult to correct. So i advised my patient to wait till age of 18 after that those teeth can be replaced with implants . The only disadvantage of not doing implant immediately that bone shrinks after tooth loss. This loss is because of loss of active pressure from teeth which maintains health of bone in both width and height wise. Implants once place generate pressure on bone and maintain dimension of bone surrounding it, maintaining its normal form and shape. It is same as that of natural tooth.
When this girl comes to me after few years that time i have to do bone grafting to replace missing bone. After tooth extraction missing tooth place looses bone faster. Its more in upper jaw as compare to lower , as upper jaw has more soft bone . I informed her all thses things as patient is college going girl she wanted fixed solution for her teeth. She decided to go for ceramic fused to metal kind of Bridge. As patient was not happy with the length of teeth, i reduced it according to her suggestion.
in the last week-
treatment was very good. dr. is very friendly. clinic is well maintained and clean. staff is also very nice. i did not face any problem after getting treated here. it was agreat experience by getting treatment done here. all thanks to dr.pandit.dit.
This is picture of decayed tooth of 15 yr young boy . In such cases most common dental practice is to do indirect pulp capping followed by cap . Cap is advised here as most of tooth is replaced with restorative material which cannot last for longer period in such cases . Most of chewing forces goes on restorative material , which is not very strong to sustain for longer period . I always advised to my patient that life of restoration is inversely proportional to size of it. If size of restoration is more the life of it reduces , and if size of restoration is small it last for longer period.
As patient is very young i advised him to restore it with onlay. Onlay is made up of lithium disilicate which has more strength when it is adapted to tooth with stronger adhesive. Here dentist do not have to prepare tooth very aggressively which is the necessity in cap where dentist has to trim tooth from all side (5). Since onlay is fitted with adhesive technology ,saves lot of stronger natural tooth structure. This kind of restoration last for longer period . This is called indirect restoration where lost tooth structure is developed in dental lab. The finishing and quality of it is more super. Once the tooth is cleaned (Decay Removed ), dentist take the measurement of tooth which is sent to lab to prepare onlay. Till that time dentist fill tooth with temporary filling material. This material was removed by dentist after 4-5 days once onlay gets ready, and fitted in patient"s tooth.
Dentist do not have to work for longer time in patient's mouth as it is manufactured in dental lab. Fees of this indirect restoration (Onlay) is more as compare to other treatment options. But life of this restoration is more than other one so its cost effective in long run.
I was thinking of preparing presentation on my clinical cases of Composite For Class I to Class V Restorations , Direct Laminates ,Diastema Closure , Restoration Of mutilated dentition, Smile Designing. This Time Dr Ganesh Ware& Dr Swati Ware requested me to prepare presentation as they wanted to organise first scientific session at Kamothe Navi Mumbai.Because of His constant motivation finally i prepared the presentation on this topic which i loves most in Dentistry. According to me there is very good scope of composite restoration as it is one of the best, most conservative restoration till date available . Has lots of applications in dentistry. In country like India where economy matters most for dental treatment, it is the best treatment option dentist can give it to patients . By enhancing skills in restoration of teeth with composite dentist can deliver best dental treatments at affordable fees.
23 yr young female came to my clinic with broken old silver filling. Looking at her tooth condition i advised her x ray to rule out chances of rootcanal treatment.Looking at her x ray even i convinced her for rootcanal treatment, as i was not sure that i can finish it with Indirect Pulp capping treatment. This is done when cavity is in close proximity to pulp chamber of tooth which contains blood vessels and nerves . This pulp tissue provides nutrition to tooth. Since patient is not having any pain and x ray was not showing any signs of infection i advised her that i can save it without doing rootcanal treatment. Final decision will be made after removal of decay portion , if i get sound tooth structure i can do indirect pulp capping. If pulp chamber gets open then i have to do rct as Direct pulp capping is not very predictable . But indirect pulp capping is more predictable as i have treated so many teeth with this treatment option successfully without jumping on RCT. This is the best most conservative way of saving tooth without doing Root canal treatment.
After removal of decay portion when i am working near to pulp tissue i use my hand instruments to remove decay as rotary instruments accidentally will lead to exposure of pulp tissue. Here the decayed portion is very soft and comes out easily with hand instruments .After doing this i found the sclerotic dentin ,its reparative dentine formed beneath the decay portion. From this reparative dentine layer, pulp is hardly less than one mm or very close.
Here restorative materials used routinely for filling cavities can be toxic and can kill pulp tissue. I used GIC light cure material , has fluoride inside . It releases fluoride and arrest further spread of decay. One its done i filled rest of cavity with layering technique to reduce microshrinkage and post operative sensitivity.
This is the case of gap closure of 28 yr young female. Earlier she closed the gap with composite from other dentist, now it was broken. I suggested her four option to close gaps . My patient opted for third option because of its more aesthetic value and long life as compared to previous one.
1) With Braces or Aligners - Duration 12 months . According to me this is the best way of reducing the gaps between teeth .Its not only close the gap but even it brings the teeth in proper alignment. Since the gap is closed by bringing teeth close to each other, it maintains the health of teeth for longer duration. The only disadvantage is it takes more time , not immediate as compare to other three option mentioned below. In all three options mentioned below needed maintenance as your dentist is adding artificial material, which is not as strong as your healthy enamel. Whatever the material used has its own life has wear and tear so needs to be replaced after few years.
2) Composite laminate -duration one sitting but life and aesthetic isn't as good as ceramic laminates. Its the most conservative way of closing the gaps as dentist has to apply layer of composite on tooth structure without reducing healthy enamel which is the requirement for ceramic laminates , crowns.
3) Ceramic Laminates - duration 5 days it has more aesthetic value than composite. Life of ceramic laminate is better than composite. Dentist has to shape the tooth for placement of laminates.
4) Crown - duration 5 days . Its not very good way for closing the gap as dentist has to shape the tooth very aggressively. He has to remove healthy enamel while shaping tooth making it weak , reducing its strength
This is 34 yr female , wanted to correct her upper front teeth. Before this also she did composite laminates so i suggested her Lithium Disilicate laminates as its long lasting , high aesthetic value and more durable. But she has other dental treatment , so decided to go for composite laminates. Took study model impressions for putty index to restore lost anatomy after removal of her old restoration. In First sitting started with first two teeth , then in second sitting finished other two. Finishing and polishing in third sitting. It is possible to complete all in one sitting but patient has to sit for longer period
40 yr young lady wanted to enhance her smile as she lost enamel from upper front 10 teeth and developed gaps with lower teeth .Here i advised full mouth rehabilitation as patient lost both canine guidance and incisal guidance. It was possible only with full mouth rehabilitation. As patient was not ready for this because of budget constraint , I decided to go with composite laminates with her upper front ten teeth (11 12 13 14 15 21 22 23 24 25) and lower 6 teeth (31 32 33 41 42 43).
After this treatment teeth behind caninies are not occluding on both sides , i kept it under observation as it will take further 2 to 3 months for patient to get familiar with this new situation of teeth.
After completion of this treatment now she is happy as she can smile confidently.
Dr Yogesh Pandit
To make people aware about dentistry ,new technology different treatment modalities.To share views about dentistry