Dental Tribune U.S. Edition

DENTAL TRIBUNE | January/February 2011 Clinical 5A with decalcification on the margins, and there is a large occlusal compos- ite that appears intact visually. She is apprehensive about treatment (Fig. 2a). The silver filling is removed and there is extensive decay (Fig. 2b). The tooth-colored composite is difficult to distinguish from dentin. The dental microscope enlarges the area so that The dental microscope is an out- standing tool. Every general dentist should consider incorporating the abil- ity to have multiple magnifications in his or her office. The following case studies illustrate their effectiveness. I use the microscope every time I touch a tooth with a burr. The photos shown here are snapshots of proce- dures that have been videotaped. The videos have been edited and can be found on www.YouTube.com under the case name. Go to www. YouYube.com and search for “craigs kohler” and the name of the case. Case No. 1: Removal of amalgam stain and micro crack discovery Summary of original treatment expec- tations: Patient needs a simple two- surface silver amalgam filling, #3 MO replaced. The patient would like to have a tooth-colored restoration. The silver amalgam is removed and carious tooth structure is found as well as extensive staining from the old silver filling (Fig. 1a). An intra- oral sandblaster (Danville Engineering MicroEtcher IIA) was used to remove the stain and decay. The stain at the gingival margin was more difficult to remove and a second application of the sandblaster removed it (Fig. 1b). Upon close inspection of the preparation, there was a small crack found in the enamel at the gin- gival margin and another crack under the mesial buccal cusp (Figs. 1c, 1d). The dentist can evaluate and dis- cuss the options that the patient has regarding the restoration of the tooth. If the patient can see the situation, he or she can make a more informed decision. Possible future problems can be traced back to the original stress frac- tures in the tooth if the patient elects to have a simple filling placed. This patient decided to have the simple filling and was willing to risk possible tooth fracture and sensitivity. In my office, a full crown is considered over treatment, but a conservative ceramic onlay with proper occlusal guidance may be the best enduring restoration (Figs. 1e, 1f). A gold onlay has the clinical history to last the longest, but it would not satisfy the esthetic demands of most patients’ in my demographic area. Case No. 2: Removal of an old tooth colored filling that had severe decay Summary of original treatment expec- tations: A 14-year-old female with a history of bad dental experiences at her pediatric dentist has decay on her lower right molar (#30). The tooth has a silver amalgam all of the old composite and decay can be removed. As more dentists are using com- posite that blends with the dentin, the removal of the entire old filling is get- ting more difficult to discern. In this case, there was decay behind most of the composite filling. A sandblaster and a slow-speed round burr removed the composite. Decay detector identi- AD fied the active caries and illustrated to the patient and her mother the serious- ness of the situation (Fig. 2c). The final filling was a temporary measure and the patient can expect endodontic therapy someday in her future (Fig. 2d). The necessity of vigilant recalls is By Craig S. Kohler, DDS, MBA, MAGD The dental microscope for general dentistry g DT page 6A