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Dental Tribune U.S. Edition

tral incisor was initiated. Retrac- tion cord was used to expose sub- gingival caries. Ragged and sharp enamel edges were removed and the enamel opening was expanded using a 330-carbide bur (Fig. 2). A #6 Smartburs II instrument (SS White) was used at 15,000 rpm to begin gross caries removal (Fig. 3). This instrument was used until the size of the bur head could no longer access smaller areas for effective caries removal (Fig. 4). This was followed by complete removal of the remaining infected tooth material with a #4 Smartburs II instrument (Fig. 5). In order to achieve a harmoni- ous, seamless and esthetic transi- COSMETIC TRIBUNE | February 2011 Clinical 3C composite (shade A2) and white tint to mimic calcification patterns (Fig. 7). Studies have shown that the use of micro-particle size com- posites demonstrates lower polym- erization contraction stresses and a decrease in marginal leakage when compared to hybrid com- posites. The remaining Class V and Class III carious lesions were prepared (Fig. 8) and restored (Fig. 9). At the next appointment one week later, the patient was seen for continued treatment. The gingival margins demon- strated significant improvement owing to the corrected emergence profiles (Fig. 10). CT New option for missing teeth of metal and porcelain, the system uses a resin and titanium bridge res- toration that replaces up to 12 teeth and is supported on five or six dental implants. It is not intended for peo- ple requiring single tooth implants, but rather sectional or complete mouth restoration. The teeth look, feel and function just like healthy, natural teeth and last a lifetime. As with conventional implants and unlike dentures, they sit on implants rather than the gum line for greater comfort, allow people to eat and chew as they would with their own teeth, and stimulate the jawbone (thereby preventing the “caved in” look found in people with years of denture wearing). While a fixed bridge or remov- able dentures works for cosmetic reasons, and allows the individual to eat and speak clearly, they also pose restrictions — fixed bridges require the filing down of healthy teeth, can weaken adjacent teeth and inhibit maintenance (e.g., you can’t floss between them). Meanwhile, removable dentures can slip, cause embarrassing click- ing sounds and lead to bone loss around teeth they are hooked onto. “The efficiency and precision of the fabrication with the Hybridge system allows us to keep the fee far lower than traditional implant treatment for those patients who need to replace an entire upper or lower archway,” said Spector, who has been at the forefront of dental implants for many years and taught implantology at NYU Dental School. “While dental implants remain the ‘gold standard’ for patients replacing single teeth, the cost makes them prohibitive for many who require full mouth or arch restoration, as many older people do.” Patients for the Hybridge system tend to be older, according to the American Association of Oral and Maxillofacial Surgeons, and by age 74 more than one in four American adults have lost all their permanent teeth. Yet, Spector said that he has also recommended Hybridge for patients who have lost their teeth as a result of early periodontal disease, trau- matic injuries and eating disorders, such as bulimia, which cause tooth decay. CT About the author Dr. Ian Shuman maintains a full- time general, reconstructive and esthetic dental practice in Pasadena, Md. Shuman is a master in the Acad- emy of General Dentistry, a fellow of the Pierre Fauchard Academy and a member of the ADA and the AAID. Since 2005, he has been voted one of the Top 100 Clinicians in Continuing Dental Education in North America by Dentistry Today and was voted Baltimore’s Top Doc by Baltimore Magazine in 2008 and 2009. He is also the official dentist and a regular guest on Baltimore’s No. 1 morning radio show, “98 Rock.” Contact Shuman at ian@ian shuman.com. tion at the marginal interface, a beveled chamfer was created using an 868-024 flame-shaped coarse diamond (SS White) (Fig. 6). In class V composite cavity prep- arations, bevels have been shown to enhance retention, decrease micro-leakage and improve esthet- ics. To maximize the amount of light diffraction and the final esthetic outcome, a wavy striation pattern was created. Following total acid etching and the application of a primer/bond- ing agent (Optibond, Kerr), com- posite resin was applied. A thin layer of flowable composite resin in shade A3.5 was placed along the cervical margin and light cured. It has been reported that the application of a thin layer of flow- able composite at the cervical mar- gin enhances the marginal adapta- tion of the restoration. An initial base layer of medium- flow shade A3.5 composite resin was then placed along the pulpal floor as a complete dentin substi- tute and light cured. The restoration was completed with a micro-hybrid enamel shade Fig 10: Tissue appearance after one week. Fig 8: The remaining carious lesions were accessed, cleaned and prepared. Fig 9: The finished direct resin restorations. For many years, people with chronic dental problems or missing teeth had limited options. They could continue with the end- less cycle and expense of root canals, crowns and other restorations; live with the chewing, speaking and comfort problems often associated with dentures; or pay the extremely high costs of dental implants. Now Drs. Andrew Spector and Michael Migdal, practitioners in Haworth, N.J., who have long been at the forefront of dental implant technology, are one of a relative handful of dentists throughout the country (and the only ones in the New York metropolitan area) to offer patients the benefits of “permanent teeth” at about half to one-third the cost of implants, and in a fraction of the time. Hybridge™ — a hybrid bridge sys- tem — is a mix between a conven- tional fixed bridge and a denture. Unlike a conventional bridge made inDustry news Dr. Andrew Spector Dr. Michael Migdal