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12 Minutes to Pain Relief and Cosmetic Nirvana

Dr. Brian Gray – Washington, DC

The challenge:  My referring endodontist’s office manager, Jen, is in for a hygiene visit and has a sensitive tooth.  I just sent two emergency patients to their office, causing a bit of chaos – so she needs to get back there ASAP.  Of course, her treatment is free because we love her and her office and the fact that they see our patients on short notice.  Jen has meticulous hygiene and regular recare but a nagging abfraction lesion on the facial of #11, which has cold and tactile sensitivity.  Worse yet, she told me about it last time and we kind of blew it off (You know, the “shoemaker’s kids” syndrome).

So, how can I numb her up, place a composite that looks highly esthetic, and get her back to work in the most efficient and effective way I know how? Easy. I’m even going to take photos during the entire restoration and still get it done in less than 15 minutes using Tokuyama Dental’s new OMNICHROMA composite. The first truly UNIVERSAL ONE-SHADE COMPOSITE.

  1. 20 seconds: Pre op photo. I anesthetized Jen in the hygiene chair with Mepiviciane 4%, no epi.  Note the Carbocaine injection site delivered during prophy.
    Brian Gray fig2
  2. 20 seconds: Place moderate bevel with fine diamond.
  3. 20 seconds: MicroAirAbrasion (Danville, PrepStart), with Zekrya Gingival Protector (DMG America (Zenith)), for superior bond strength and no gingival trauma.Brian Gray fig4
  4. 60 seconds: Full etch and rinse.Brian Gray fig5Brian Gray fig6Brian Gray fig7
  5. 90 seconds: Gluma desensitizer (Kulzer), Tokuyama Universal Bond (Tokuyama Dental), air dry. Bond requires no agitation or curing light!

     

  6. 60 seconds: OMNICHROMA placement. Note the white-opaque color - no worries, it will cure to match the adjacent tooth structure.Brian Gray fig8
  7. 30 seconds: Light cure.Brian Gray fig9
  8. 60 seconds: 13 fluted carbide (Brassler), smooth and contour.
    Brian Gray fig10Brian Gray fig11
  9. One minute: Polish with Enhance (Dentsply Sirona) and PoGo (Dentsply Sirona) system.Brian Gray fig12Brian Gray fig13
  10. One minute: Admire the restoration. Take some more photos.

     

    Brian Gray fig14 Brian Gray fig15

     

  11. Two more minutes admiring that new composite, WOW! No time spent on shade selection, easy placement, great polishing, durable stuff, reliable company. Alright, you go Tokuyama, we are loving your OMNICHROMA!
  12. OK everyone, back to work. We’ve got patients to treat. And we better order more OMNICHROMA because we are using it all the time!
Brian Gray, DDS maintains a fee for service cosmetic restorative practice in Washington, DC.

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12 Minutes to Pain Relief and Cosmetic Nirvana

Dr. Brian Gray – Washington, DC

Composite Applications for Our Pediatric Patients

By Carla Cohn DMD There are so many excellent composite resin materials to choose from in the dental market today that it can be overwhelming to know which to use, and when. Many of the composite resin materials come with features that are compelling. Bioactivity, bulk fill, sonic fills, ultra-polishable, low shrinkage, self leveling, nano hybrid, specialized aesthetic shading systems, universal use, the list of attributes available goes on and on. Ultimately, we want the very best for our patients and their restorations. At the same time, it is inconceivable that we carry the inventory in our practice of each material that has a distinct attribute. A simple and unique solution is OMNICHROMA, a resin restorative material manufactured by Tokuyama Dental America. OMNICHROMA combines a number of excellent properties such as excellent esthetic properties due to uniform sized 260 nm supra-nano spherical SiO2-ZrO2 filler particles. These fillers result in unprecedented color matching, extremely high polishability, and color stability. Physical-mechanical properties due to the types of fillers and high fill content of 79% weight/68% volume give the material high wear resistance, high compressive strength, and exceptional handling. As the name implies OMNI = all, or universally + CHROMA = a quality of color combining hue and saturation (Merriam Webster Dictionary). OMNICHROMA is a universal shade that blends and reflects allowing us to be able to use this one OMNICHROMA composite shade for a multitude of different tooth shades. Little patients have little patience. When treating children, simplicity and durability of materials is key to successful restorations. The less time spent in a child’s mouth, the better. Although primary dentition is transitional, the occlusal forces, bruxing, and wear and tear are substantial in a short period of time. Intracoronal restorative materials for primary teeth must deliver reliable physical and mechanical properties in order to have successful long-lasting restorations. In my experience, highly filled composite resin combined with excellent isolation and technique yield reliable restorations. Case study #1  4-year-old boy presented with early childhood caries. I completed full mouth rehabilitation under general anesthetic consisting of full coverage crowns, intra-coronal composite restorations, and extractions. The focus and feature in this case study is a simple intra-coronal restoration on primary tooth H / 63. Pre-operative photos showing caries and a shade guide for reference. Teeth were prepared using a high-speed Pana-Max (NSK) with a #556 carbide bur ensuring an adequate undercut in preparation to incorporate some mechanical retention. Figures 1 - 2. Enamel was etched using phosphoric acid etch and Bond Force (Tokuyama Dental America) as adhesive in a selective etch technique and light cured. In this case, due to some remaining dark dentin, OMNICHROMA BLOCKER (Tokuyama Dental America) was used and light cured. Figure 3. OMNICHROMA (Tokuyama Dental America) was placed in bulk (2mm), as the lesion was minimal in depth and light cured. Figures 4 - 5. Resulting restoration shade blended beautifully providing a functional and aesthetic result. Figure 6.

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