Copp Dental Group

1 week ago

Amalgam replacement with a stress-reduced direct composite. About as clean and “simple” as it gets.

First, we start with an isolation with a rubber dam. Next, any leakage around the clamp is sealed with the liquid dam. Then, the amalgam was removed. Next, caries were removed with the aid of caries-detecting dye. Next, the proximal enamel walls beveled. Then the surface was cleaned and the smear layer was compacted with air abrasion.

Of course, we had to take photos and show them to the patient. Needless to say, they were pretty grossed out after showing them the photo.

Then we used selective etch (more like cavosurface etch to reduce the risk of marginal stain while not getting etch on dentin). SE Protect Primer & Adhesive. We laid a thin bond with a microbrush, not by air drying. Then, build proximal walls. Resin coat, then build dentin, then enamel layers.

After the procedure, we took a new photo and showed the patient. The patient is now slightly less disgusted by the after picture.

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Copp Dental Group

2 weeks ago

Minimally invasive adhesive dentistry and preservation of the enamel biorim mean protecting and respecting the natural tooth structure. Evidence supports the concept that the overlying enamel on a tooth protects the underlying dentin from damaging forces. Therefore, by preserving the correct areas of the tooth, we are able to protect it from forces that could lead to further fracture and stress.

The final result did not compromise on aesthetics, as we were able to choose the correct shades and blend the margin into the patient’s natural tooth structure.

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Copp Dental Group

1 month ago

This patient came in for a routine checkup and the fractures surrounding her old filling were noted. Although she was not experiencing any pain on the tooth, we had a discussion to determine if the risk of the fractures worsening warranted replacement, and ultimately we decided to move forward with restoring this tooth. It was clear that the existing restoration on #14 was no longer protecting the tooth on dissection.

Instead, the stress of the failing filling was being transferred to the tooth itself. Note the spider web of fractures marked by arrows in the second photo. Dr. True dissected these fractures, which extended deeper than anticipated (the deepest fracture on the pulpal floor was removed to a depth of 5mm). The patient and dentist are happy with the result!

After sealing the dentin with Clearfil SE Protect primer/bond, a thin layer of Majesty Flow was placed, followed by small increments of AP-X with Ribbond buried in the first layer to help reduce the residual stress surrounding the deepest fracture. Enamel replacement was completed with EvoCeram. C-factor was lowered by onlaying the distal-lingual cusp.

As a side note, we are always looking for ways to improve our techniques, and photography gives us a way to evaluate our work honestly. In this case, the rubber dam is not fully inverted. Something to improve for next time!

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Copp Dental Group

1 month ago

When we need to replace a failing filling, our goal is to recreate what nature gave us, copying and restoring the natural tooth with respect to biology, aesthetics and mechanics.

The way a tooth bends and flexes helps us determine how to treat the tooth to restore proper biology and mechanics. If a tooth is not bending and flexing in a normal range, we can deem the tooth as structurally compromised. Then, the tooth is treated with a stress-reduced restoration to avoid further fracture, pain or the need for a root canal. In the case above, Dr. Copp was able to manage a pair of compromised molars and customize the best approach for each tooth.

The nitty-gritty details: The second molar (#2) was treated with a stress-reduced direct composite, and the first molar (#3) was treated with a stress-reduced indirect porcelain restoration. After removing the old amalgam filling on #3, the remaining cusp was thinner than 2 mm.

To reduce the ratio of bonded to unbonded surfaces (aka c-factor), this cusp was overlaid. Next, both teeth were air abraded and the dentin was sealed with Clearfil SE Protect/Majesty Flow. The biobase was then established using AP-X. Finally, enamel replacement was completed using EvoCeram on #2 and lab-fabricated IPS e.max on #3.

The final restorations blended in seamlessly.

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Copp Dental Group

2 months ago

We love restoring our patient’s confidence in their smiles. This patient had an unfortunate accident years ago that left him with two broken front teeth. He came to our office after one of the old fillings broke off and the other was beginning to chip and stain. After a round of Opalescence GO whitening, Dr. True used direct composite bonding to rebuild the patient’s broken tooth and replace the worn-down filling next door. Now we wait for the rest of the teeth to rehydrate.

We love what we can do in one appointment with a bit of bonding magic and a lot of attention to detail.

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