The videos that you are about to watch were taken in my office using my Global G6 Microscope and attached high Definition Camera. These Videos are for Educational Purposes only and are aimed at showing how to treat varying conditions, and also how to achieve the Highest Quality Dental Restorations. If there are any questions please email me at firstname.lastname@example.org. More videos to come.
This patient presented from another office with a crown which had fallen off 4 times on tooth #7. The Stainless steel post was not placed deep enough within 5 mms of the apex and the crown was actually sitting right on the post, causing it to come loose. After removing the stainless steel post with the piezo ultrasonic handpiece, we placed a new composite post. As you can see from the pre-op x-ray on #7, the post was not placed within 5 mm's of the apex and was placed too far coronally, where the patient's existing crown was riding on the post causing the crown to fall off.
Now in the post-op film, you can see we placed a bonded composite post to the appropriate depth, and later we proceeded with the buildup and digital scan for the new Emax crown.
This 70 year-old patient came to see us reporting a bump under her lip in her gum that had been there for years, but recently started giving her a foul odor in her mouth. She had a root canal done years ago and remembers the bump never going away. What she has is a fistula, which is a drainage tract emptying pus from the source of infection at the apical root end. This chronic infection full of bacteria can thrive for years as long as ample blood supply is available to bring in nutrients. As long as the infection can drain, it might remain small and contained without any symptoms of pain. This patient did not have pain because their was no pressure buildup, due to the release of pressure through the opening in her un-attached gingiva.
Here is the Initial Extra-oral Photo of #8 showing the fistula about to erupt with Pus. :
Here is the Initial Pre-treatment Digital x-ray of #8:
Our treatment consisted of simultaneously retreating the root canal and thoroughly cleaning out the fenestration defect. We started by removing the old gutta percha material using a piezo ultrasonic under the microscope. Then after thoroughly reshaping and irrigating with NaoCL/Qmix, we placed a cotton pellet in the access. We then made a semi-lunar incision at the proximal line angles of #7 and #9, reflecting a full thickness flap to gain access to the fenestration defect. We then thoroughly debrided the apical area with a #6 round bur using copious saline irrigation treated with amoxicillin. After thoroughly debriding the bony defect, we also removed the soft tissue defect where the infection had been communicating with the mouth. We then proceeded to obturate the canal with guttacore and intentionally expressed the guttacore out the apex with firm pressure as we watched from the apical end. After the guttacore solidified, we then cleaned the apical root surface with the piezo so as to have a tight seal of the foramen. As you can see from our post-op xray, the seal is very good and the canal has been dis-infected and sealed. We then established some bleeding points, which is crucial for healing of the defect, then filled the defect with bio-oss followed by a collagen membrane.
A 3-month follow up x-ray and picture are coming soon.
Implant treatment with Sinus Lift, Implant, Laterally Positioned Gingival Graft, and Screw Retained Zirconia Crown and Abutment
This 65 year old retired male presented from his Family Dentist requesting an Implant in his missing tooth number 3 area. He reported that his Dentist could not do the entire implant procedure and he did not want to goto to the Oral Surgeon, Periodontist and then back to his general Dentist for the crown. The patient reported having the tooth removed over 20 years ago and has recently decided to replace it with an implant and had declined a fixed bridge from his general Dentist.
For simplicity sake, the Pre-op Data Gathering, Treatment Plan etc will not be discussed in detail.
Phase 1 - We performed a Lateral window Sinus Lift, lifting the sinus 8 mms, due to the ridge only being 6.5 mm pre-op, followed by placement of 2 collagen membranes on the inferior surface of the Schneiderian Membrane, then we filled the cavity with Bio-oss soaked in saline, followed by 2 layers of collagen membrane over the new lateral window, then sutured the "Trap Door" incision with 2 horizontal mattress sutures along with 4 interrupted sutures using 4-0 PTFE suture.
Phase 2 - After 6 months of healing we placed a 5-13 mm implant, allowing it to integrate for 4 months. Upon evaluation of the lateral window, it was filled with solid/dense bone.
Phase 3 - Implant Integrated and ready to restore.
Phase 4 - Flap design allows us to 1) Uncover the Implant and place a Healing Abutment and simultaneously increase the volume of Keratinized Attached Gingiva on the buccal, thereby ensuring a nice full quantity and quality of gingiva around the Implant which is very important.
Phase 5 - Screw retained Zirconia Abutment and crown seated. Notice the excellent quality and quantity of gingiva that we were able to re-build around the Implant. Implant protected Occlusion is required for long term health of all implants.