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News Bulletin : ADA News Bulletin March 2011
28 MARCH 2011 aesthetic update Guest article by Tony McClelland CASE STUDY A 35-year-old male patient in good health presented initially in 1999 for a dental consultation regarding his worn dentition. His dental treatment was sporadic and emergency-based over the next ten years due to out of town work commitments in the mining industry. Diet analysis failed to illicit a cause for his erosion / attrition (corrosion). Stomach acid reflux was a possible contributing factor but the patient declined a referral to a physician for further investigation. Bicarbonate morning mouth rinses and a fluoride gel regime were prescribed. Saliva testing later in this period found the salivary pH to be basic. The 34, 35, 46 and 21 all required endodontic therapy on an emergency basis due to cervical/occlusal corrosion in this period. Aesthetic concerns prompted a visit in 2004 and a treatment plan involving bite opening and bonding 15 to 25 was contingent on a stable treatment result for the cervical resorptive defect on the distal root of 21 (Fig 1). The tooth was root filled following surgical curettage and trichloracetic acid cauterization to arrest the resorption. The access cavity was restored with Fuji VII pink. Fig 1. The patient presented six years later to reinstigate the 2004 treatment plan (Fig 2). The pre-operative photo shows generalised corrosion, with further recession since the repair of the cervical resorptive defect of 21, revealing Fuji VII pink cervically and surprisingly pink stippled marginal gingiva. Initial thoughts of placing a carbon fibre post were dismissed as being a risk to the apparently stable repair of the root resorptive defect. Fig 2. Teeth 15 to 25 were bonded in August 2010. Incisal and labial restorations were removed and a chamfer placed in the Fuji VII at the gingival margin of 21. The tooth was bonded with a self- etching resin [Prelude Dental Adhesive -- Danville, Amalgadent] bond and an opaquing tint in OAI shade [Kerr Corporation, Halas] was used to mask the stained dentine. Tooth build up to ideal proportions was accomplished with a microfill resin in OAI; A2; WE shades [Estelite E quick Tokuyama, Amalgadent] with the cervical margin in pink resin [Voco Comp Natur, Erskine] (Fig 3). The 11 was built to match proportions cervically and incisally, 13 and 23 were then placed to guide the occlusion. Silicone tape was placed around 13; 11 and 21; 23 in turn, to allow layered build- up of 12 and 22, after removal of old fillings and freshening tooth surfaces with a red band flame diamond [Diatech 862-314-012-8- F, Jaydent]. The 22 didn't have a pink cervical placed. Bite opening/ bonding labial smile (Fig 3) and palatal view (Fig 4). Aesthetic occlusal reconstruction with COMPOSITE RESIN
ADA News Bulletin February 2011
ADA News Bulletin April 2011