In the following case Dr. Todd Snyder shows how he replaced crowns on teeth #8 and #9 using ACTIVA BioACTIVE-CEMENT.
Pre Op Smile
Pre Op Retracted View
Prep Shade Photo
Final Preparations
HeatWave Impression Tray (Clinicians Choice) with PVS Impression Material
Bite Registration (DMG LuxaBite)
Retracted View of Provisionals after using Bead Line Technique
Provisional Restorations (Luxatemp Ultra)
Applying Activa Cement to the Crown
Retracted View of #8 & #9 after cementation with Activa Bioactive Cement, prior to removal of excess cement.
Retracted view after cementing #8 & #9 and bonding on the veneers #6, 7, 10, 11 with Bisco All Bond Universal Adhesive and Choice 2 Resin Cement.
Cemented Crowns on #8 & #9 (Activa)
Post Op Smile showing new Crowns and Veneers
Retracted View of New Restorations one week later
About Dr. Todd Snyder
Dr. Todd Snyder received his doctorate from the UCLA School of Dentistry and trained at the F.A.C.E. institute. He is an Accredited Fellow of the American Academy of Cosmetic Dentistry, a Member of the American Society for Dental Aesthetics and a member of Catapult Education. Dr. Snyder created and co-direct at UCLA the first two-year graduate program in Aesthetic and Cosmetic Restorative Dentistry. He lectures internationally and has authored numerous articles in publications worldwide. Dr Snyder is a consultant for numerous companies and has his own online training program known as Legion Pride. Dr Snyder also owns two software companies, is a professional race car driver and entrepreneur.
Older patients are at increased risk for root caries because of gingival recession that exposes root surfaces and increased use of medications that produce xerostomia. Age related visual impairment and decreased dexterity also can lead to higher caries rates and a decreased ability to adequately maintain good oral hygiene. This makes the margins of restorations particularly susceptible to recurrent decay. Choosing a cement that will not only retain the restoration but also help stimulate remineralization is extremely beneficial for these patients.
ACTIVA BioACTIVE-CEMENT helps stimulate apatite formation, supporting the natural remineralization process and helping seal the margin between the tooth and the restoration. ACTIVA helps to prevent microleakage, maintain the integrity of a sealed margin, and keep the restoration, tooth and surrounding tissues healthy. ACTIVA BioACTIVE-CEMENT is a combination of bioactive resin, rubberized resin and ionomer glass filler. It is dual cure, moisture tolerant, and indicated for all indirect restorations except veneers. ACTIVA is very easy to use, with no additional etching or adhesive steps, and clean-up is simple and quick.
This 93-year-old female patient had mobility in her upper central and lateral incisors. A four-unit splinted HT Zirconia restoration was indicated for functionality and to increase the likelihood of keeping these teeth for the duration of the patient’s life. Previous PFM crowns were removed and the central and lateral incisors were prepared for a four-unit splinted zirconia restoration.
93-year-old patient with mobile central and lateral incisors with previously placed PFMs on the centrals.
The patient had +1 mobility on the central and lateral
incisors (Figure 1). After removal of the old crowns, the visible areas of
demineralization on the central incisors and dark staining on the preps were
noted (Figure 2). New splinted crowns would increase a favorable prognosis for
these teeth.
PFMs were removed and laterals were prepped for 4-unit splinted restoration. Note the demineralization and dark staining on central preps.
Because of the oral health challenges facing geriatric patients (gingival recession, xerostomia, and home care issues), the margins of this new restoration have an increased susceptibility to recurrent decay. I chose ACTIVA BioACTIVE-CEMENT because of its bioactive properties, which help support the natural remineralization process and seal the margins.
Restoration seated with ACTIVA BioACTIVE-CEMENT.
At the insert appointment, the provisional restoration was removed, the preps were cleaned, and the restoration was tried in. After assuring the fit of the restoration, it was cleaned with Ivoclean, loaded with ACTIVA BioACTIVE-CEMENT, and seated (Figure 3). The restoration was initially flash cured to set the excess cement to the gel-like set. The excess cement was then very easily removed (Figure 4). The bioactivity and the ease of use of ACTIVA BioACTIVE-CEMENT make it an excellent choice, not just for geriatric applications like this, but also for many other indirect restorations where recurrent caries is a concern.
Easy clean up after flash cure
About Dr. Susan McMahon Dr McMahon, an University of Pittsburgh School of Dental Medicine graduate, is in private practice in Pittsburgh and at University Dental Professionals in Chicago. She is an accredited member of the American Academy of Cosmetic Dentistry, the American Society for Dental Aesthetics, and a fellow in the International Academy of Dental Facial Esthetics. She is the Director of Product Evaluation for Catapult Education and a member of Catapult Speaker’s Bureau. She can be reached at 412.298.2734 or drsusan@wowinsmile.com.
The following case demonstrates how to place a minimally invasive restoration using the caries detection mode of an intraoral camera and ACTIVA BioACTIVE-RESTORATIVE.
Figure 1 is an occlusal view of tooth number 29 taken with caries detection mode of an intraoral camera (SoproCare: Acteon USA) showing active caries in the central fissure of the tooth. It is important to note that this lesion is not yet able to “stick” with an explorer because of the depth of this narrow fissure and inability of the explorer tip to reach the lesion due to its larger size. A fissurotomy bur (micro NTF 6066: SS White) is used to carefully eradicate only the area that fluoresced positive (looks clinically like stain).
Figure 1. Occlusal view of tooth #29 taken with caries detection mode of an intraoral camera showing active caries in the central fissure of the tooth.
As the preparation is made, the intraoral camera on caries detection (Cario) mode can be used to check for complete active caries removal (Figure 2).
Figure 2. Intraoral camera on caries detection mode shows extent of caries removal.
Because ACTIVA supports the natural remineralization process with release of calcium and phosphate, “white” areas of decalcified enamel can be preserved rather than removed during preparation. After using a total etch protocol, adhesive placement and light curing, ACTIVA BIOACTIVE-RESTORATIVE is placed into the micro-preparation using its automix tip with a bendable cannula (Figure 3).
Figure 3. Placement of ACTIVA BioACTIVE-RESTORATIVE using automix tip with bendable metal cannula.
Figure 4 shows a view of the completed restoration taken with the intraoral camera. Note that it is difficult if not impossible to detect the restoration even at extreme magnification. Restorative margins are imperceptible. The tooth looks untouched like virgin enamel.
Figure 4. Intraoral camera image showing completed restoration.
References
Ferracane JL, Pfeifer CS, Bertassoni LE, “Biomaterials for Oral Health”, Dental Clinics of North America, vol.61, no.4, October 2017, pp. 651-872.
Chao W, et al. Deflection at break of restorative materials. J Dent Res 94 (Spec Iss A) 2375, 2015 (iadr.org).
Slowikowski L, et al. Fluoride ion release and recharge over time in three restoratives. Paper presented at: AADR Annual Meeting & Exhibition 2014; March 19, 2014; Boston, MA.
Garcia-Gadoy F, Morrow BR, Pameijer CH, “Flexural Strength and Fatique of Activa RMGICs”, College of Dentistry UTHSC, Memphis and UConn School of Dentistry, Farmington, CT, White Paper Presentation at IADR, 2014.
Maj J, Merritt J, Ferracane J, “Adhesion of S. Mutans Biofilms on Potentially Antimicrobial Dental Composites”, J dent Res 96 (Special Issue A); 2560, 2017.
Comba A, Breschi L, et.al., J Dent Res 97 (Special Issue A) 0273, 2018.
About Robert A. Lowe, DDS Robert A. Lowe, DDS, received his Doctor of Dental Surgery degree from Loyola University School of Dentistry. After completing his residency, Dr. Lowe went into private practice and began to pursue another passion: clinical teaching. While running his own practice, Dr. Lowe served as a Clinical Professor in Restorative Dentistry at Loyola University School of Dentistry until its closure in 1993. In 2000, he relocated to Charlotte, NC.
Well-known dentist and educator Dr. Susan McMahon will present “Just Do It… Better – Digital Diagnostics and Regenerative Restorative Materials Team Up For Better Restorations,” a Continuing Education (CE) webinar on October 23, 2019 at 7:00 PM ET/ 4:00 PM PT. This live webinar is free and open to the public.
For many years dentists have used metal explorers and radiographs to detect dental decay. These approaches work best when there is extensive decay that can be felt with an explorer or seen in the radiograph. In this webinar Dr. McMahon will share how to use advanced diagnostic tools to detect dental decay earlier and restore teeth using bioactive materials.
About Dr. Susan McMahon Dr McMahon, an University of Pittsburgh School of Dental Medicine graduate, is in private practice in Pittsburgh and at University Dental Professionals in Chicago. She is an accredited member of the American Academy of Cosmetic Dentistry, the American Society for Dental Aesthetics, and a fellow in the International Academy of Dental Facial Esthetics. She is the Director of Product Evaluation for Catapult Education and a member of Catapult Speaker’s Bureau. She can be reached at 412.298.2734 or drsusan@wowinsmile.com.
India is a colorful world of remarkable diversity and
extremes. Nowhere is this more apparent than in the distribution of wealth and
accessibility to health care.
I am so happy! Today, I treated the son and daughter of
the man who refuels my car at my local petrol pump station. When I saw him
recently, I asked him how his children were. “They complain of aches in their
teeth,” he said, and I asked him to bring them over to my clinic.
Mehak, age 9, and her brother Abdul, age 6, live with
their parents in a slum behind the petrol station. Children in this
socio-economic class receive little or no dental care in India, and over the
years I have provided free treatment to many underprivileged children living in
my town. I feel a noble quaking in my core after each treatment. Parents
see their happy children and shower me with gratitude, but I insist that I am
simply doing good work, and I like doing it.
Case 1 Mehak complained of pain when eating, and clinical evaluation revealed extensive decay on her lower left E (Fig. 1). After caries removal with a round bur and hand excavator, without pulpal exposure, the cavity was cleaned, and Etch-Rite 38% phosphoric acid etch gel was placed for 15 seconds and rinsed well (Figure 2). A thin layer of ACTIVA BioACTIVE-RESTORATIVE (Pulpdent USA) was placed as an insulating layer, massaged for 20 seconds, and light cured (Figure 3). The cavity was bulk filled with ACTIVA without the use of a bonding agent and allowed to self-cure for 40 seconds before light curing for 20 seconds. The self-cure time reduces polymerization stresses while the light provides a more complete cure of dual cure resin materials. The restoration was contoured, finished and polished (Figure 4), and Mehak was all smiles (Fig. 5). She was ready to come back for her next appointment when her abscessed lower right E would be treated.
Fig. 1. shows extensive decay of #75, lower left E, on 9-year-old patient. The pulp is not exposed.
Fig. 2. After caries removal on lower left E, the tooth was thoroughly cleaned, isolated, and etched for 15 seconds with Etch-Rite (Pulpdent USA).
Fig. 3. ACTIVA Restorative A3 shade was placed as a thin insulating layer, massaged 20 seconds and light cured. Restoration was then bulk filled with ACTIVA, allowing material to self-cure 40 seconds before light curing. No adhesive was used in this case.
Fig. 4. Checked occlusion, contoured, finished and polished.
Fig. 5. A happy nine-year old, eager to come back for her next appointment after a pain-free visit to the dentist.
Case 2 Six-year-old Abdul also suffers from discomfort and needs considerable dental work. On this visit, I restored his upper right D, #54, which was decayed but without pulpal involvement (Fig. 6). The decay was removed with a round bur and a tapered fissure bur, and a bevel was placed on the occlusal margin. The prepped tooth was cleaned and isolated. Etch-Rite was applied for 15 seconds and thoroughly rinsed, followed by hi-vacuum suction and blotting with cotton pellets. This leaves the tooth lightly dried but not desiccated. After placing a sectional matrix, Activa A2 shade was placed, allowed to self-cure for 40 seconds, and then light cured for 20 seconds. Occlusion was checked, and the restoration was contoured, finished and polished. Abdul will also need restorations on 51, 52, 61 and 62, and we have scheduled follow-up appointments for those treatments.
Fig. 6. Tooth #54, upper right D, is decayed, but there is no pulpal involvement.
Fig. 7. Decay was removed using a round bur and a tapered fissure bur. A fine bevel was placed on the occlusal margin. The tooth was etched, rinsed, and lightly dried wiht high-vacuum and cotton pellets, but not desiccated.
Fig. 8. Shows sectional matrix and placement of ACTIVA A2 shade. After 40-second self-cure, light cure for 20 seconds.
Fig. 9. The bite was checked, anatomy was contoured, and the restoration was finished and polished.
Fig. 10. A happy 6-year-old with his dentist.
Both Mehak and Abdul were given proper brushing instructions and taught how to best maintain their oral hygiene. Providing this education to both the children and their parents is imperative for their future oral health. I could see the glee on the children’s faces as they checked their teeth, felt no pain, and said “Thank you so much!” Their father was moving his hand to the wallet in his shirt pocket, but I stopped him. “There is no need,” I said, I am just happy to help you and your children. Ask them to take care, and may the Great One watch over you!”
About Dr. Rumpa Wig Dr. Rumpa Wig is a graduate from Govt. College of Dentistry, Indore. She has completed PG (Certification) in Aesthetic Dentistry from New York University, USA. She is the Vice-President on the Board of Indian Academy of Aesthetic and Cosmetic Dentistry (IAACD). As the Key Opinion Leader for some of the leading international companies, for India and ASEAN countries, she has delivered over 280 lectures, and workshops, internationally and nationally on topics in Aesthetic Dentistry. Her comprehensive hands-on courses are widely sought out and highly appreciated. She has many articles in various journals to her credit. She maintains a private practice in Bhopal, and focuses mainly on Aesthetic, Restorative, Adhesive and Minimally-invasive dentistry.
Poor oral health and limited access to care are the daily reality in the communities of El Rama, Muelle de los Bueyes, Bluefields and Kukra Hill in Nicaragua. California-based pediatrician Dr. Gina Johnson has participated in five mission trips to these communities under the auspices of International Ministries. On her most recent trip, Dr. Johnson brought 800 applications of Embrace Fluoride Varnish donated by Pulpdent.
The communities served by International Ministries suffer from severe dental caries, poor nutrition and a variety of other health concerns. Access to healthcare is extremely limited and community members travel for miles on foot and motorized bicycle to receive primary care, wellness exams, dental screenings and fluoride varnish treatments from Dr. Johnson and her team of clinicians. Community members were very receptive to receiving varnish treatment and expressed that Embrace had a much more pleasant taste than other varnishes they had used in the past.
The purpose of these mission trips is to educate community members about systemic health. Dr. Johnson addresses the root causes of disease and illness, and explains the connection between oral healthcare, good hygiene and overall health.
