Dental Tribune U.S. Edition

COSMETIC TRIBUNE | June 2011 Clinical 3B Case No. 2 In my practice, I am seeing more patients with decay that I believe to be related to taking or abusing medications that dry the mouth in combination with high sugar intake. We as dentists have recognized for a long time the implications of reduced salivary flow in increas- ing caries as related to radiation treatment and have become more aware in recent years of similar clinical conditions related to medi- cations that cause decreased sali- vary output. Figure 6 shows our patient with decay that was limited to facial areas yet quite severe. Her his- tory indicated using medications that decrease salivary output while drinking an excessive amount of sugary drinks. Although the preparation to remove decay was extensive, as shown in Figure 7, much more tooth structure was retained by doing direct nanohybrid restora- tions as compared with prepara- tions for lab-processed restora- tions. Gingival hemorrhaging from tis- sue contouring was quickly arrest- ed with Ultradent Astringedent X, followed by cleaning the remaining residue with Ultradent Consepsis. I have found no matrix system to compare to the Greater Curve band Conclusion Direct bonding with nanohybrid composites create exciting oppor- tunities in our practices to offer multiple treatment options that are extremely predictable when done with products and techniques that maximize adhesion and prevent microleakage. Patients appreciate the cost savings, conservation of tooth structure and immediate esthetic improvements. Helping patients through chal- lenging financial times with multi- ple treatment options that match their financial condition can create the kind of trust that creates patients for life. For me, this adds to the enjoyment of practicing den- tistry. Happy bonding! CT AD About the author Dr. Bruce J. LeBlanc provides seminars nationally on adhesive dental techniques. His practice offers adhesive and cosmetic solutions that minimize tooth removal. He is a product con- sultant to dental manufacturers and has published internation- ally on his adhesive technique. LeBlanc is course direc- tor and presenter for “Master- ing Posterior Esthetics” at LSU School of Dentistry as well as presenter for the LSU Cosmetic Continuum. He is also the president of the F. Harold Wirth Foundation established at LSU School of Dentistry to enhance the den- tist patient relationship and the enjoyment of practicing den- tistry. LeBlanc may be reached via e-mail at bjleb@cox.net. for doing these types of whole tooth composites. Figure 8 shows how we positioned the matrix in a way that a gingival seal was achieved and a perimeter created to mold the composite. The case was completed with a rinse/etch multi bottle bonding system and a single shade A3.5 of nanohybrid composite. The final picture in Figure 9 shows restora- tions that blend seamlessly with the teeth and are natural in appear- ance. With this treatment, the patient was offered a final chance to save her teeth. We discussed at length the dietary changes and mainte- nance requirements that would offer the best long-term clinical outcome. About the AACD The AACD is the world’s largest non-profit member organization dedicated to advancing excellence in comprehensive oral care that combines art and science to opti- mally improve dental health, esthet- ics and function. Composed of more than 6,300 cosmetic dental profes- sionals in 70 countries worldwide, the AACD fulfills its mission by offer- ing superior educational opportuni- ties, promoting and supporting a respected accreditation credential, serving as a user-friendly and invit- ing forum for the creative exchange of knowledge and ideas, and provid- ing accurate and useful information to the public and the profession. CT f CT page 1B