Dental Tribune U.S. Edition

Clinical DENTAL TRIBUNE | January/February 20116A understood and the patient returns to the office for three other similar prob- lems on her other first molars. This case is an example of a patient who was a difficult management problem; however, she learned to appreciate the value of a dentist and patient working together to get a good result. The dental microscope enlarged the field of view for treatment and documented the experience so the patient could take ownership of her dental problems. Case No. 3: Crown buildup and preparation for a gold crown Summary of original treatment expec- tations: The upper left molar, #15, had the palatal margin of a gold onlay breakdown (Fig. 3a). There was exten- sive decay. The onlay was removed and a core buildup placed. Then the tooth was prepared for a future gold crown, which was seated. The extensive decay under a filling led to the need for a core build up. The dental microscope was used to refine the margins of the preparations. Notice the magnification (10x to 12x) that allowed the buildup tooth mar- gin to be refined. The white buildup material could clearly be seen, which allowed the margin of the buildup to be placed above the crown margin (Fig. 3b). The preparation was also adjust- ed at similar high magnification and two slots were placed in the buildup to increase retention for the crown. The impression was sent to the dental laboratory, Opus One Laboratories in Agoura Hills, Calif. At the delivery appointment, the temporary was removed and the resid- ual temporary cement was sandblast- ed away. The crown was checked for fit and occlusion and was cemented with Relyx Unicem cement by 3M ESPE. The delivery appointment took about 15 to 20 minutes. In my office, a tooth that needs an extensive buildup typically takes 30 minutes. The preparation and impres- sion appointment time is 45 to 60 minutes. My initial learning curve took about two months to feel comfortable in using the microscope for most den- tal procedures. AD f DT page 5A Case No. 1: Removal of amalgam stain and micro crack discovery Fig. 1a Fig. 1b Fig. 1c Fig. 1d Case No. 2: Removal of an old tooth-colored filling that had severe decay Fig. 2a Fig. 2b Fig. 2c Fig. 2d