Correct Diagnosis is very Important !!

This young man has a history of trauma due to which his left central incisor was extracted . The bridge from right central incisor to left lateral incisor was fabricated and cemented in the U.S. There were three attempts at the same by dentists in the States since every few days the prosthesis used to get dislodged  .The cause of the same was not diagnosed by them.

 

He visited me at my office and at his first consultation I took photographs and impressions to make study models.Fremitus test was done to check trauma from occlusion also the misalignment of the lower incisors was considered.On removal of the bridge bone loss in the pontic area was noticed with midline shift and canting.Keeping all these diagnosis in mind the best treatment plan for him was designed.

 

Treatment plan:The fremitus was corrected ,incisal edges and body of the lower anterior teeth were adjusted to achieve an overjet and overbite of 1.5 mm with the present situation of existing FPD.Four laminates of emax were cemented on the mandibular incisors.A bridge was fabricated in metal free empress emax with an ovate pontic after rest seat preparation to achieve natural and esthetic papilla and emergence profile.

 

This case was done 2 and half years back and is still going strong. I am happy to have restored this handsome boys smile justifying dentofacial aesthetics.

 

 

https://www.facebook.com/DrLele.SmilesForever

 

Smile Rejuvenation!

New case. this is in continuation with the previous one.

young patient age 22 reported for "Smile Rejuvenation!"  The pic before shows missing #21 (upper left central!!). the lateral has AQUIRED place of central. ( the orthodontist missinterprited for positioning of lateral mesially instead of DISTAL movement.
After view shows , following modified thought process to get the result,
1. the #22 (upper left lateral) was converted in form, shape and size into #21 with slow and timely build up in composite with squeezing papilla technique.
2. the #23 ( upper left canine was coverted into illlusive lateral incisor by altering shape and form. ( gingafill, gum coloured composite was used at cervical end to mask inside tooth (white portion)
3. upper left 1st premolar was modified by augmenting it inciso labially to mimick canine.
4. contralateral teeth retouched ( cosmetic countering) to match arch form.
5. this case is done three and half years back ( only composite restorations)
6. patient comes regularly for periodic chk up.

unsightly placed lateral incisor

Patient reported with unsightly placed lateral incisor, affecting her acting carrier.

After photograph shows hot cured composite bridge (shofu) replacing lateral incisor in most esthetic region . ( lateral incisor was extracted six weeks back with immediate FRC bridge. ( fibre reinforced composite) as provisional. right central incisor has been contoured cosmetically to suit facial parameter.

Case- Discolored and ill-fitting crown on 11.

Patient came to the clinic with a discolored and ill-fitting crown on 11. 

Line of treatment- extraction of 11with periotome to conserve soft tissue and bone, Elective endo of 12,21 and 41.Final Prosthesis Empress E Max ovate pontic bridge

My note - 28th AACD (American Academy of Cosmetic Dentistry Conference).

Hi guys!!!

As I came back from Washington DC, life was very busy with backlog…everywhere!! Right from home front to clinical work to Catching up with IPL league!!!

I must take you back to Washington DC, where I attended 28^th AACD (American Academy of Cosmetic Dentistry Conference). This conference was held at a very serene and cool place at the water front in Gaylord Convention Center from 1^st May to 5^th May 2012. It was a well attended conference by more than 4000 delegates all over the globe!!

An interesting thing to boast upon was there were 369 accredited members from this academy (from the year 1985 to 2011) who gathered to share views /thoughts from the entire world. I was one of the 369 members to keep the flag of India rising high!!

This get together of Accredited members is very useful to understand and learn quiet few innovative procedures which help you back in your country while treating cases. This time one of my professional colleagues Dr.  Ali Tunkiwala got this honor of “Accreditation” in a massive gathering, which was well attended.Congrats to Dr. Ali, for this great achievement!

In all we were 9 Indian delegates, who attended this conference. I must mention here, that this time at least five dentists from India appeared for the written exams which are a qualifying round to get into the process of Accreditation.

Apart from India chapter, this time the lectures and the star speakers were awesome.

As a speaker and visiting professor, I got to learn so many minor and finer points, which are extremely important to make your speech interesting and immaculate.

Will keep on updating, as getting time to pen down is a real art and I am YET to master it. You got it, what I mean??!!

Soft but perfect smile

Pretty faced Apoorva landed at our office for Quick fix smile! The demand of the role was a ‘soft but perfect smile ‘in addition to pretty face and acting as well!

The task for us was as under

Imagie 1

·         Remove the overlap of two centrals and align the right central. ( see image 01.)

·         Take the right canine palatally till it almost matches contra lateral canine inclination.

·         After the centrals, it was major concern for the left lateral, as I wanted to incline it mesially at the same time wanted to maintain “face of the tooth “unaltered.

·         The right lateral needed a little body to match the contralateral.

 After taking couple of snaps of smile, full face and intercuspal teeth position, I made impressions for study model. The director of the this serial wanted me to fix Apoorva’s smile in two days ( 48 hours!!)due to delay in shoot!!

I took the challenge and called her the next day to fix the desired effect.

On the day of photography and study model,  me and my associates worked on study models for virtual mock up in composites. My wife sushama made digital mockup for Apoorva's smile.

And we were all set to fix Apoorva’s smile, the next day!!

I started with two centrals by keeping the silicon key (made on study model) in the anterior area from palatal side. It took me two hours to get central in alignment.

Then it was the turn for right canine. To get the best result, always start preparing the labial surface to your desired location as per digital imaging and mock up (does not matter even if it exposes the pulp chambers while doing so!) 

In Apoorva’s case pulp exposure was very much expected beyond doubt. But trust me, as the canine had enough labial width before I could land into pulp, except a pink spot situation, nothing unusual took place..

I primed and bonded the open area of canine and finished the top layers without spending much time. The lateral on left was a challenge as it needed mesial built up, at the same time it was much broader mesiodistally because of the existing space.

There I have added plenty of ochre and brown colour from paint on brush kit.  Fig 03(before) then  fig 04(after)

That mellowed down the distal position of lateral making it virtually invisible!

(I would be happy to get your comments on this)

My take on - Dr. Doug Disraeli Shares Tips on Holiday Foods That Help Maintain a Healthy Smile

I certainly endorse the opinion and advice given by Dr. Disraeli for a cavity free  holiday.

I personally would like to add, few important points, based  on science and experience for the last thirty years of dental practice.

An  ‘Exposure Theory ’ reveals to mankind that 1^st bite of chocolate (especially milk and cocoa based) or any sweets is well tolerated by Human teeth enamel. (Animals DO NOT each chocolates unless pampered as PETS!)

It is an extreme urge to plunge in to the second exposure of sweets, where the whole sad story for holes (cavities) starts with.

Sweets, being sugar based , the moment it comes in contact with smooth or rough surfaced enamel along with saliva in the mouth, it starts becoming ACIDIC with lowering PH.

1^st exposure though, is easily well tolerated by sound and smooth enamels it is the second and the 3^rd  that roughens the enamel of premolar or molars ( mainly because of the anatomy and morphology to chew and then the burrowed wasp in the cusps & grooves of grinders  act as ware house effect,  supplying residual sugar from entrapped sweets to weaken the burrows further and making them deep.

In a holiday tour, one is bound to eat sweets and sugary items because of the apt mood. If one can avoid the 2^nd and 3^rd exposure of sweets , say within 30 to 45 minutes of the 1^st one , it is quite ok to indulge in sugary diet.

It also depends on how vulnerable is the qualitative enamel of one’s teeth.  Some human are blessed  with toughened enamel ,which can resist n number of exposures to sweets.  But if not so strong, (might be genetics plays major role) BEWARE of multiple exposure of sweets in one go.

Take of the thought     Lesser  the Better !!!  :)

"About Dr. Disraeli's Tips for tooth friendly holidays "

Hillcrest San Diego Dentist Doug Disraeli agrees with the saying 'You are what you eat' when it comes to the health of your teeth, and recommends incorporating foods such as dairy (except for those that are lactose intolerant) products and high fiber fruits and vegetables into your holiday meal for a tooth-friendly feast.

"Holiday meals offer starchy and sweet foods that increase plaque buildup on teeth, which can lead to cavities or gingivitis," says Dr. Disraeli. "Combating unhealthy options with tooth-friendly foods such as asparagus or milk promotes a healthy holiday smile."

High fiber fruits and vegetables act as a detergent, helping to remove plaque, and promote saliva flow, which aids in neutralizing acids that attack tooth enamel. Suggestions: Peas, onions, broccoli, kale, apples, pears, raspberries.

Dairy products provide calcium that builds stronger enamel, offering protection from sugars and starches. Suggestions: milk, yogurt, cheese.

Items to consume in moderation during the holidays include:

--  Sugar - the #1 culprit causing cavities.
        --  Alcohol - wears away tooth enamel, discolors teeth and makes teeth
            vulnerable to cavities.
        --  Energy drinks, such as Gatorade and Red Bull - highly acidic and can
            wear away enamel at a faster rate than normal.
        
        

Dr. Disraeli is the owner of the Hillcrest, San Diego dental practice Doug Disraeli, D.D.S. specializing in cosmetic, implant, restorative and general dentistry. Dr. Disraeli is available to offer comments on healthy eating and drinking habits during this holiday season.