tag:blogger.com,1999:blog-11339556232110564902024-03-13T09:23:07.615-07:00Bauer Dentistry & OrthodonticsDentist, Orthodontist, Pediatric Dentist Wheaton, IllinoisUnknownnoreply@blogger.comBlogger191125tag:blogger.com,1999:blog-1133955623211056490.post-69117904440326223092020-05-17T21:24:00.001-07:002020-05-17T21:24:29.170-07:00Tooth gem<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-cost.jpg?fit=801%2C233&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Thinking about getting a tooth gem?</h1>
<p>Tooth gems can be a fun non-permanent way to personalize your smile!</p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-cost.jpg?ssl=1"><img class="aligncenter wp-image-14963 size-full" title="Tooth gem cost" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-cost.jpg?resize=801%2C233&ssl=1" alt="What does a tooth gem cost?" width="801" height="233" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-cost.jpg?w=801&ssl=1 801w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-cost.jpg?resize=300%2C87&ssl=1 300w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-cost.jpg?resize=768%2C223&ssl=1 768w" sizes="(max-width: 801px) 100vw, 801px" data-recalc-dims="1" /></a></p>
<h2>How do we place tooth gems?</h2>
<p>We use the same bonding steps that a dentists uses when placing a white filling or braces. There is a weak acid that etches the tooth. Then a bonding agent helps connect the tooth to a resin that the gem sits in. Most gems have a backing that has lots of surface texture. This surface texture allows the resin to grab onto the gem. When you decide to remove the the tooth gem a dentist can pop it off for you and polish up your tooth. There is no cutting of your tooth and you do not need to get numb. You will not feel anything during this process. It is very similar to getting <a href="https://www.bauersmiles.com/wheaton-braces/" target="_blank" rel="noopener noreferrer">braces</a> on but only for one tooth, instead of all of your teeth.</p>
<h4>Who can place a tooth jewelry?</h4>
<p>Anyone can place some tooth jewelry for you, including you! However, like most things in life, the people with the most experience will do a better job. No one has more experience bonding teeth than dentists but that does not mean only a dentist can do it. Putting people in order of least likely to most likely to do a good job it goes you if you try yourself, a tattoo artist, a general dentist, and then a <a href="https://www.bauersmiles.com/cosmetic-dentistry/" target="_blank" rel="noopener noreferrer">cosmetic dentist</a>. If someone is advertising that they do them they are likely pretty good at it, no matter what their profession is.</p>
<p><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-before-and-after-picture.jpg?ssl=1"><img class="aligncenter wp-image-14962 size-full" title="Tooth gem before and after photos" src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-before-and-after-picture.jpg?resize=825%2C274&ssl=1" alt="Tooth gem before and after photos." width="825" height="274" srcset="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-before-and-after-picture.jpg?w=825&ssl=1 825w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-before-and-after-picture.jpg?resize=300%2C100&ssl=1 300w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-before-and-after-picture.jpg?resize=768%2C255&ssl=1 768w" sizes="(max-width: 825px) 100vw, 825px" data-recalc-dims="1" /></a></p>
<h3>Who can get tooth jewelry?</h3>
<p>Anyone can but most people are young adults from later teenagers to in their twenties. They are most common among young women. However, as you can see below men can get them too and we see football players and other athletes are the ones doing it.</p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-for-men.jpg?ssl=1"><img class="aligncenter wp-image-14964 size-full" title="Tooth gem on a college football player." src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-for-men.jpg?resize=837%2C275&ssl=1" alt="A tooth gem for men?" width="837" height="275" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-for-men.jpg?w=837&ssl=1 837w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-for-men.jpg?resize=300%2C99&ssl=1 300w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem-for-men.jpg?resize=768%2C252&ssl=1 768w" sizes="(max-width: 837px) 100vw, 837px" data-recalc-dims="1" /></a></p>
<h3>What does a tooth gem cost?</h3>
<p>That depends who is placing your tooth gem, how much the jewelry itself cost, and where you live. A dentist will be the most expensive and likely charge a couple hundred dollars, plus the costs of the gem itself. We currently only offer this service to existing patients.</p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem.jpg?ssl=1"><img class="aligncenter wp-image-14965 size-full" title="Tooth gem" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem.jpg?resize=825%2C216&ssl=1" alt="Images of a tooth gem." width="825" height="216" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem.jpg?w=825&ssl=1 825w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem.jpg?resize=300%2C79&ssl=1 300w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/tooth-gem.jpg?resize=768%2C201&ssl=1 768w" sizes="(max-width: 825px) 100vw, 825px" data-recalc-dims="1" /></a></p>
<h4>Where do I buy tooth gems?</h4>
<p>You can bond almost anything to your tooth. However, the jewelry made specifically for teeth will last longer on your tooth. We like the selection that <a href="https://twinkles.net/" target="_blank" rel="noopener noreferrer">Twinkles</a> has and that is who we use.</p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/05/tooth-gem.html/">Tooth gem</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-39564947249110816462020-05-14T23:24:00.001-07:002020-05-14T23:24:21.742-07:00Black tongue<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?fit=590%2C593&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What are the causes for a black tongue?</h1>
<p>A black tongue can result from a number of <a href="https://en.wikipedia.org/wiki/Black_hairy_tongue" target="_blank" rel="noopener noreferrer">different causes</a>. No matter the cause better hygiene can improve the condition, that means using a tongue scraper daily.</p>
<h2>The main cause of a black tongue is a susceptible person who is not cleaning their tongue.</h2>
<p>Susceptible individuals include those with <a href="https://www.bauersmiles.com/2012/08/sjogrens-syndrome-xerostomia-dry-mouth.html/" target="_blank" rel="noopener noreferrer">dry mouth</a> and smokers. If someone has a dry mouth and or smokes their tongue may turn black if they do not clean their tongue.</p>
<h3>Another common cause can be a reaction with a medication.</h3>
<p>There are many medications that can cause a black tongue. <a href="https://www.bauersmiles.com/2013/09/dry-mouth-medication.html/" target="_blank" rel="noopener noreferrer">Many medications dry out the mouth</a> and can cause it indirectly. Other medications are more direct; like Pepto Bismol, or any other substance containing b<span class="st">ismuth subsalicylate. The bismuth reacts with sulfur, <a href="https://www.bauersmiles.com/2016/03/halitosis-bad-breath.html/" target="_blank" rel="noopener noreferrer">which is produced from bacteria</a>, and makes the harmless black substance <a href="https://en.wikipedia.org/wiki/Bismuth(III)_sulfide" target="_blank" rel="noopener noreferrer">bismuth sulfide</a>.</span></p>
<p>Iron supplements are another source of possible cause for a dark tongue.</p>
<div id="attachment_14672" style="width: 600px" class="wp-caption aligncenter"><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?ssl=1"><img aria-describedby="caption-attachment-14672" class="wp-image-14672 size-full" title="Balck tongue" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?resize=590%2C593&ssl=1" alt="Image of a black tongue." width="590" height="593" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?w=590&ssl=1 590w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?resize=298%2C300&ssl=1 298w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?resize=150%2C150&ssl=1 150w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/black-tongue.jpg?resize=45%2C45&ssl=1 45w" sizes="(max-width: 590px) 100vw, 590px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14672" class="wp-caption-text">You can see the black substance can be wiped off but not all of it.</p>
</div>
<h4>Bacterial causes</h4>
<p><span class="ILfuVd"><span class="e24Kjd">Chromogenic bacteria cause b<a href="https://www.bauersmiles.com/2018/09/black-stain-on-childrens-teeth.html/" target="_blank" rel="noopener noreferrer">lack staining of teeth</a> and tissue and can be to blame for a black tongue.<br /></span></span></p>
<h2>How do you eliminate the black color on your tongue?</h2>
<p>You can get rid of the black tongue with just a little extra effort each day. If you know the cause you may be able to stop it by eliminating the cause. However, stopping smoking is about the only realistic thing that you can do and quitting is not easy. The other causes you likely just need to deal with the consequences.</p>
<p>So to eliminate the dark color of your tongue you need to clean the tongue twice daily. This is not difficult and should only take a few seconds each time. Get yourself a nice tongue scraper that you like and use that. If you want to do even more there are tongue brushes that you can add some sort of antimicrobial to. We recommend adding a little hydrogen peroxide to the tongue brush and using that on your tongue. It will quickly kill a lot of the bacteria on your tongue and will help eliminate your black tongue. Again only a few seconds is needed to clean your tongue.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/05/black-tongue.html/">Black tongue</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-62951487016705069462020-05-13T14:53:00.001-07:002020-05-13T14:53:28.932-07:00Mistakes wearing surgical masks<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Mistakes-wearing-surgical-masks.jpg?fit=564%2C423&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;"><strong>Top mistakes wearing surgical masks during a pandemic or flu season.</strong></h1>
<p>Mistakes wearing surgical masks are rampant and we see them everywhere. Let’s fix a few easy ones.</p>
<h3>Is wearing a mask during a pandemic helpful?</h3>
<p>The research is not great but seems to point to the answer being yes according to <a href="https://www.bmj.com/content/369/bmj.m1435.short" target="_blank" rel="noopener noreferrer">BMJ 2020 Greenhalgh</a>. The biggest hurdle is that individuals are making mistakes when wearing surgical masks. These mistakes are making those individuals more prone to infection. Overall the recommendations are to wear masks in public but we can make that recommendation more definitive by decreasing the mistakes people are making.</p>
<p>We assume if someone is willing to wear a mask they will bother to do it correctly. Wearing it correctly and avoiding the simple mistakes are fairly easy if one is aware of the mistakes. We feel many of these mistakes come about because people feel the mask is a perfect permanent barrier and that is not true.</p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Mistakes-wearing-surgical-masks.jpg?ssl=1"><img class="aligncenter wp-image-14950 size-full" title="Common mistakes when wearing surgical masks" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Mistakes-wearing-surgical-masks.jpg?resize=564%2C423&ssl=1" alt="Common mistakes wearing surgical masks" width="564" height="423" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Mistakes-wearing-surgical-masks.jpg?w=564&ssl=1 564w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Mistakes-wearing-surgical-masks.jpg?resize=300%2C225&ssl=1 300w" sizes="(max-width: 564px) 100vw, 564px" data-recalc-dims="1" /></a></p>
<h2>Mistake number 1 when wearing a surgical mask – Stop touching the front of the mask!</h2>
<p>A mask is not a 100% full proof barrier to all infective agents. Some can and do get through. The older and the more damp your mask gets, from your breath or air humidity, the worse the mask is. If you touch your mask, you put whatever is on your hands on the mask. That’s the air you are breathing!</p>
<p>Your hands go everywhere! Consider your hands to have active infection on them at all times and wearing gloves just means that your gloves have infection on them. So do not touch the front of your mask with anything! To remove your mask do so by the ear strap. Try not to adjust your mask. If you find you need to constantly adjust your mask then you need a different mask. Constant adjustments of the mask can increase your risk to infection vs no mask at all.</p>
<h2>Mistake number 2 – Masks do not last forever.</h2>
<p>Many people have 1 or 2 masks they wear all day for days or weeks at a time. You are almost certainly doing more harm than good with that strategy. You either need to disinfect your mask, letting it sit in a paper bag for 4 days is enough to kill many viruses, or wash your mask if it is cloth. Do not wear your mask in situations you do not need to. In general, the longer you wear it the less effective it will become. For instance, take it off in your car.</p>
<p>Not covering your nose and mouth, makes wearing a mask useless.</p>
<p>This should go without saying but you’ll commonly see this mistake. The mask needs to cover your breathing holes, it the nose and the mouth. Having it off the nose means yhou get the risk of cross contamination of wearing the mask but none of the benefits.</p>
<h3>Other common mistakes wearing surgical masks.</h3>
<p>Other mistakes are fairly minor. Having a poor fit by not adjusting the metal strip over your nose, decreases the usefulness of a mask. Some spray the mask with disinfectant, thinking that will help. Wet masks do not work as well.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/05/mistakes-wearing-surgical-masks.html/">Mistakes wearing surgical masks</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-49779834846248125832020-05-12T19:53:00.001-07:002020-05-12T19:53:25.516-07:00Pediatric dental medication<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Pediatric-dental-medication.jpg?fit=440%2C431&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What is the correct pediatric dental medication for the child?</h1>
<p>Pediatric dental medication will depend on the weight of the child. That and any allergies are the two most important pieces of information you will need to write a pediatric RX. Personally I have found the easiest method to write a script for a child is to use an app. Dental Drugs and DentalMeds are my favorite but Pedi QuikCalc is good too.</p>
<h2><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Pediatric-dental-medication.jpg?ssl=1"><img class="aligncenter wp-image-14875 size-full" title="Pediatric dental medication" src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Pediatric-dental-medication.jpg?resize=440%2C431&ssl=1" alt="Pediatric dental medication from the app DentalMeds" width="440" height="431" srcset="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Pediatric-dental-medication.jpg?w=440&ssl=1 440w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Pediatric-dental-medication.jpg?resize=300%2C294&ssl=1 300w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/Pediatric-dental-medication.jpg?resize=45%2C45&ssl=1 45w" sizes="(max-width: 440px) 100vw, 440px" data-recalc-dims="1" /></a></h2>
<h2>Antibiotics for children with dental infection.</h2>
<p>The most common is Amoxicillin 125mg/5ml or 250mg/5ml depending on their weight. Remember most infections we can and should eliminate surgically and <a href="https://www.ingentaconnect.com/content/aapd/pd/2013/00000035/00000007/art00017" target="_blank" rel="noopener noreferrer">reduce our overuse</a> of antibiotics.</p>
<p>Amoxicillin 125mg/5ml</p>
<p>Disp: 150 ml</p>
<p>Sig: 1 tsp q8h for 7 days</p>
<p>Penicillin VK is written the same way. Clindamycin is for those with allergies to amoxicillin or similar.</p>
<p>Clindamycin 75mg/5ml</p>
<p>Disp: 150ml</p>
<p>Sig: 1 tsp 8h for 7 days</p>
<h3>Prescription pain medication for children</h3>
<p>Alternating Tylenol and Advil is very effective and really all many need. However, when that is not enough codeine is the next level. Again child weight is critical and you should check for the proper dose for the child’s weight.</p>
<p>Acetaminophen w/ Codeine (125mg/12mg codeine)/5ml</p>
<p>Disp: 150 ml</p>
<p>Sig: 1 tsp q8h prn pain</p>
<h3>Fluoride for children</h3>
<p>We have an entire post on <a href="https://www.bauersmiles.com/2013/06/fluoride-supplements.html/" target="_blank" rel="noopener noreferrer">fluoride for children</a>.</p>
<h2>Prescription pediatric dental medications and proper dosages</h2>
<p>Patients should always follow their <a href="https://www.bauersmiles.com/pediatric-dentist/" target="_blank" rel="noopener noreferrer">pediatric dentist’s</a> recommendations in terms of dosing. Dentist’s should rely on apps, charts, or <a href="https://www.bauersmiles.com/wp-content/uploads/2020/05/Children-dental-medication-codeine-antibiotic.pdf" target="_blank" rel="noopener noreferrer">drug reference guides</a> that utilize the child’s weight to avoid any errors.</p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/05/pediatric-dental-medication.html/">Pediatric dental medication</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-84966355669622379522020-05-11T09:14:00.001-07:002020-05-11T09:14:05.974-07:00Black stain on children’s teeth?<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2015/06/Bauer-family-looking-up.jpg?fit=2640%2C1976&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Is chromogenic bacteria the cause for black stain on children’s teeth?</h1>
<p>Chromogenic bacteria is the primary cause for black stain on children’s teeth. We see it almost exclusively on children and it is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354720/" target="_blank" rel="noopener noreferrer">fairly common</a>.</p>
<h3>What is chromogenic bacteria?</h3>
<p>There are several species of bacteria that we all carry in the upper respiratory tract. They are anaerobic gram negative rod bacteria that form black colonies, which appears to us as black staining. It is unclear what role they play exactly in the forming of the stain. The lit review by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354720/" target="_blank" rel="noopener noreferrer">Żyła 2015 in</a> <span class="cit"><span role="menubar">Biomed Res Int. finds Actinomyces spp play a role as well</span></span></p>
<h2>Is chromogenic bacteria the cause for your child’s black stain on their teeth?</h2>
<p>Most likely this is the cause but your dentist can say for sure. The appearance is pretty easy to diagnosis but some decay may look similar, so you should let a dentist diagnosis any black stain.</p>
<h3>How do we remove the black stain from children’s teeth?</h3>
<p>Your dentist can remove the stain with our cleaning instruments. This is not something that home products will be able to remove.</p>
<h2>How do we prevent the black stain on children’s teeth from returning?</h2>
<p>Without knowing the cause, prevention is difficult. If you find the cause then you may be able to eliminate the black stain. Some staining is from iron supplements which may be more beneficial than the staining is harmful. Iron fortified rice is another example of something that may cause the black satin on children’s teeth.</p>
<p>If the stain is from chromogenic bacteria, which is highly probable if it is not <a href="https://www.bauersmiles.com/2014/04/dental-caries-decay-cavity-cavities.html/" target="_blank" rel="noopener noreferrer">decay</a>, then we do have ways to eliminate it. Some children have had luck using <a href="https://closys.com/" target="_blank" rel="noopener noreferrer">CloSys mouth rins</a>e, as it targets sulfur producing bacteria. If the stain is from chromogenic bacteria, then <span class="ui_qtext_rendered_qtext">oxygenating mouthwashes will get rid of it. Amosan or just hydrogen peroxide in the brown bottle will work.</span></p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/05/black-stain-on-childrens-teeth.html/">Black stain on children’s teeth?</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-52383583243034049792020-05-04T07:40:00.001-07:002020-05-04T07:40:22.576-07:00Impression issues<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2012/07/dental-impression-failure.jpg?fit=461%2C697&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">PVS dental impression problems</h1>
<p>Dental impression problems will arise no matter how experienced you are or what material you use. However, with experience and <a href="https://www.sciencedirect.com/science/article/abs/pii/002239139290192D" target="_blank" rel="noopener noreferrer">knowledge</a> the number of issues decreases significantly.</p>
<h2>Dental impression problems that have to do with materials</h2>
<p>These can be unavoidable. Perhaps the material was in an area of the office that is very cold and the time to set was off. Maybe there was some minor manufacturing issue. Perhaps you the dentist are trying a new material or left some bonding agent on the tooth that the impression material interacts poorly with. Some materials set at different times and mixing and matching different companies may mess with proper setting.</p>
<h3>Failure to set properly will likely either be a material issue or timing.</h3>
<p>A failure of a dental impression material to set has many possible causes. Material that is bad or has expired can cause issues. Temperature plays a role as does not enough time. There are also many products that can interfere with the setting of the material, most common is bonding agent. This often occurs when dentists are experimenting with <a href="https://www.bauersmiles.com/2012/09/immediate-dentinal-sealing.html/" target="_blank" rel="noopener noreferrer">Immediate Dentinal Sealing</a> for the first time.</p>
<p>Below is an example of impression material failing to set. Possible causes are too short of time, expired or poor material, cold material, impression setting inhibited by some unknown product.</p>
<div id="attachment_14303" style="width: 471px" class="wp-caption aligncenter"><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2012/07/dental-impression-failure.jpg?ssl=1"><img aria-describedby="caption-attachment-14303" class="wp-image-14303 size-full" title="Dental impression failure" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2012/07/dental-impression-failure.jpg?resize=461%2C697&ssl=1" alt="Dental impression failure to set." width="461" height="697" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2012/07/dental-impression-failure.jpg?w=461&ssl=1 461w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2012/07/dental-impression-failure.jpg?resize=198%2C300&ssl=1 198w" sizes="(max-width: 461px) 100vw, 461px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14303" class="wp-caption-text">To see the high resolution image <a href="https://www.bauersmiles.com/wp-content/uploads/2019/11/high-res-dental-impression-failure.jpg" target="_blank" rel="noopener noreferrer">click here</a>.</p>
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<h2>Dental impression problems that have to do with technique or patient management</h2>
<p>Some of these are dentist’s issues, which is a nice way of saying mistakes. Some are patient management issues that with time the dentist will learn to avoid. Timing is likely the main issue with inexperienced doctors or assistants. Every brand has a set time in which you must have the material in place or the impression will not turn out properly. Missing margins and other poor impressions will often be a combination of difficult situation and lack of experience. Poor positioning is a dentist error that will decrease with experience.</p>
<h3>Biting on the dental impression tray</h3>
<p>Biting on the impression tray will cause an issue and certainly will interfere with the labs ability to set the bite correctly. This is most often seen when a patient has a third molar in occlusion and they do not have much room for the tray to fit.</p>
<p>The images below show an impression where the patient bit on the metal tray and was not able to close all the way. The two images on the right show how you check to verify this did not occur. When you hold the impression up the light you should be able to see through it. That proves their teeth were touching. If you can not see through the impression material then you need to investigate the cause.</p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/dental-impressions-problems-bite-on-metal-tray.jpg?ssl=1"><img class="wp-image-14864 size-full aligncenter" title="Dental impression problems" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/dental-impressions-problems-bite-on-metal-tray.jpg?resize=1421%2C625&ssl=1" alt="Dental impression problems include biting on the metal tray. " width="1421" height="625" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/dental-impressions-problems-bite-on-metal-tray.jpg?w=1421&ssl=1 1421w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/dental-impressions-problems-bite-on-metal-tray.jpg?resize=300%2C132&ssl=1 300w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/dental-impressions-problems-bite-on-metal-tray.jpg?resize=1024%2C450&ssl=1 1024w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/05/dental-impressions-problems-bite-on-metal-tray.jpg?resize=768%2C338&ssl=1 768w" sizes="(max-width: 1000px) 100vw, 1000px" data-recalc-dims="1" /></a></p>
<h3>Tips to avoid and detect dental impression problems</h3>
<ul>
<li>Follow the instructions of your manufacturer. Don’t mix and match materials and set times. Don’t use expired materials.</li>
<li>Using higher magnification is always helpful for everything. You will be capable of seeing issues with margins with higher magnification much easier.</li>
<li>Don’t use cold material or know that if it is cold you need to let it set longer.</li>
<li>Try in your impression tray beforehand so you know it fits properly. Also have them bite together so you can see how their teeth fit.</li>
<li>If doing IDS or any bonding procedure be sure to rinse all the excess away with alcohol and rinse that with water.</li>
<li>Check the margins of the impression. Next check the other teeth near by for voids. Then check the opposing for voids and pulls.</li>
<li>Finally, hold the impression up to the light to ensure you have the patient biting.</li>
</ul>
<p>For more information on dental impressions <a href="https://www.bauersmiles.com/2012/07/dental-impression.html/" target="_blank" rel="noopener noreferrer">click the link</a>.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/05/dental-impression-problems.html/">Impression issues</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-5957541276071817302020-04-30T12:49:00.001-07:002020-04-30T12:49:01.459-07:00dental stitch fell out<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?fit=445%2C445&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Dental stitch fell out, now what?</h1>
<p>Dental stitch fell out and you don’t know what to do? Well you will need to contact your dentist to know for sure if that is OK or not. However, we can tell you in general what you need to do and if it is OK.</p>
<h3>Are you sure it’s a dental stitch?</h3>
<p>It probably is if you think it is. However, maybe it is something else. Also there are some stitches we place that dissolve and will come out and some that we want to stay in.</p>
<div id="attachment_14855" style="width: 455px" class="wp-caption aligncenter"><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?ssl=1"><img aria-describedby="caption-attachment-14855" class="wp-image-14855 size-full" title="dental stitch out" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?resize=445%2C445&ssl=1" alt="Dental stitch fell out? Now what?" width="445" height="445" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?w=445&ssl=1 445w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?resize=300%2C300&ssl=1 300w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?resize=150%2C150&ssl=1 150w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-stitch-fell-out.jpg?resize=45%2C45&ssl=1 45w" sizes="(max-width: 445px) 100vw, 445px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14855" class="wp-caption-text">A PTFE dental stitch that fell out. This one is easier because the knot is still there. Most will not still have the knot.</p>
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<h2>Is it OK that the dental stitch fell out?</h2>
<p>That really depends on what you had done and how long ago it was.</p>
<h5>How long ago was your surgery?</h5>
<p>No matter what was done the more healing that has occurred the less likely it is that losing a stitch will matter. In other words, the later the better.</p>
<h5>What kind of dental surgery did you have?</h5>
<p>For a <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">dental implant</a> the stitch coming out a little early is probably fine. However, if there was bone grafting done at the time of the dental implant then that may be a problem. If the stitch fell out after an <a href="https://www.bauersmiles.com/tooth-extraction/" target="_blank" rel="noopener noreferrer">extraction</a>, then as long as 2 or 3 days have past, it’s almost certainly fine. If you had <a href="https://www.bauersmiles.com/2012/10/guided-bone-regeneration-gbr.html/" target="_blank" rel="noopener noreferrer">major bone grafting</a> by itself or some sort of <a href="https://www.bauersmiles.com/2018/09/soft-tissue-gum-graft.html/" target="_blank" rel="noopener noreferrer">soft tissue grafting</a>, then a stitch coming out can be a big problem. No matter what it is likely best to call your dental office and let them know.</p>
<h3>What do dental stitches look like?</h3>
<p>There are <a href="https://www.healthline.com/health/sutures#types" target="_blank" rel="noopener noreferrer">far too many kinds</a> of stitches in use in dentistry to even give you an answer on this one. However, the most common will be either black, white, purple, and flesh colored. <a href="https://www.bauersmiles.com/2018/05/dental-teflon-tape.html/" target="_blank" rel="noopener noreferrer">PTFE</a> is one of the most common and it is always white. Silk is another common suture and is black. There are several purple sutures. Gut sutures are flesh colored.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/04/dental-stitch-fell-out.html/">dental stitch fell out</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-17233305253341813682020-04-28T13:31:00.001-07:002020-04-28T13:31:33.912-07:00Dental aerosol evacuation<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/surgically-clean-air-Dental-aerosol-evacuation.jpg?fit=447%2C491&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Best methods for dental aerosol evacuation</h1>
<p>Dental aerosol evacuation or reduction is a major issue with the COVID-19 virus and dentists are buying up all kinds of filtration devices without any testing or knowledge of effectiveness.</p>
<h3>Why is dental aerosol dangerous?</h3>
<p>Dental aerosols are small droplets which remain suspended in air and consist of blood, saliva, tooth debris, dental plaque, calculus and restorative materials. An infected person will <a href="https://www.sciencedirect.com/science/article/pii/S1876034114001853" target="_blank" rel="noopener noreferrer">cover anyone</a> working on them with dental aerosols that have the potential to infect those individuals. Although this is not likely to be the main method in which dental professionals can contract diseases from patients, it very possible. Prior to <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html" target="_blank" rel="noopener noreferrer">COVID</a>, dental aerosol was <a href="https://academic.oup.com/occmed/article/68/7/454/5041979" target="_blank" rel="noopener noreferrer">not seen as a major risk</a> to our profession and that may continue but right now, no one knows.</p>
<h4>Differences between true large droplet transmission and airborne transmission</h4>
<p>True aerosol transmission or airborne transmission require the disease agent to be transmissible in the 10 μm and under particles. 10 μm and under is the definition of aerosol. 20 μm and over are large droplets and have different properties, they only need surgical masks for PPE. This typically means that those droplets fall to the floor quickly but airflow issues make that complicated. The 10-20 μm particles are the gray area. <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3707-y" target="_blank" rel="noopener noreferrer">Tellier 2019 <span class="c-journal-title__text">BMC Infectious Diseases</span></a> 50 μm particles are considered splatter in dentistry and are definitely not of a concern in regards to aerosols. <a href="https://jada.ada.org/article/S0002-8177(14)61227-7/pdf" target="_blank" rel="noopener noreferrer">Harrel JADA 2004</a></p>
<h4>How long do aerosols stick around?</h4>
<p>Complicated question because it depends. However, a true aerosol may be present in the air of the operatory for up to 30 minutes after a procedure. <a href="https://www.wiley.com/en-us/Aerosol+Technology%3A+Properties%2C+Behavior%2C+and+Measurement+of+Airborne+Particles%2C+2nd+Edition-p-9780471194101" target="_blank" rel="noopener noreferrer">Hinds 1999</a></p>
<h2>When do we produce aerosols in dentistry?</h2>
<p>Dental handpieces, ultrasonic scalers and piezo units, air polishers and air abrasion units produce the most visible aerosols.</p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-production.jpg?ssl=1"><img class="aligncenter wp-image-14846 size-full" title="Dental aerosol producing procedures" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-production.jpg?resize=502%2C317&ssl=1" alt="Dental aerosol producing procedures" width="502" height="317" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-production.jpg?w=502&ssl=1 502w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-production.jpg?resize=300%2C189&ssl=1 300w" sizes="(max-width: 502px) 100vw, 502px" data-recalc-dims="1" /></a></p>
<h3>Are HEPA filters the answer right?</h3>
<p>Yes, they are. Some will say that since the HEPA filter is rated for .3<span class="st">μm</span> and viruses are around .1<span class="st">μm</span> that means they will not work on viruses. Well that’s not true. The hardest particle size to capture is .3<span class="st">μm</span> but both larger AND smaller are actually easier to catch. The rational is counter-intuitive but is easily understood once you read the <a href="https://smartairfilters.com/en/blog/what-is-pm0-3-why-important/" target="_blank" rel="noopener noreferrer">attached article</a>.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/surgically-clean-air-Dental-aerosol-evacuation.jpg?ssl=1"><img class="aligncenter wp-image-14847 size-full" title="HEPA filtration unit for dental aerosol" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/surgically-clean-air-Dental-aerosol-evacuation.jpg?resize=447%2C491&ssl=1" alt="HEPA filtration unit for dental aerosol evacuation or elmination." width="447" height="491" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/surgically-clean-air-Dental-aerosol-evacuation.jpg?w=447&ssl=1 447w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/surgically-clean-air-Dental-aerosol-evacuation.jpg?resize=273%2C300&ssl=1 273w" sizes="(max-width: 447px) 100vw, 447px" data-recalc-dims="1" /></a></p>
<h4>The problem with N95 masks</h4>
<p>N95 filter more particles in the lab but when it comes to real life studies they repeatedly perform no better than surgical masks. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868605/?fbclid=IwAR0bbd9ocoYsJ9CDfAJ-PJtMuAxx6k39lDZ0f0gFaCQIki3-1sRAFfG0KMI" target="_blank" rel="noopener noreferrer">Smith 2016</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/32167245?fbclid=IwAR3R8rNKBZm_wXRSaJ82ys5NWxIIT5md-tetJhfspH30hbB8Eur4vzVuUIg" target="_blank" rel="noopener noreferrer">Long 2020</a> One can find lab studies that show surgical masks by themselves could prevent corona virus and influenza. <a href="https://www.nature.com/articles/s41591-020-0843-2#menu" target="_blank" rel="noopener noreferrer">Leung 2020</a> It is my opinion that the PPE is not the weak link and making it better isn’t helping. Stopping people from touching their face and increasing hand washing will help. The biggest thing we can do IMHO is to reduce the creation of aerosol or eliminate it quickly.</p>
<h2>What are dental professionals using today to reduce our risk from aerosol?</h2>
<p>Dentists currently use <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437160/" target="_blank" rel="noopener noreferrer">pre-procedural rinses</a>, standard and cone modified high evacuation suction, rubber dams, and things such the Isolite to reduce aerosol. The rubber dam reduces nearly all the infectious aerosol. Additionally, simply using a high-volume evacuator reduces the contamination by more than 90%. JADA 2004Harrel However, none of these are <a href="https://www.ncbi.nlm.nih.gov/pubmed/12271865" target="_blank" rel="noopener noreferrer">100% effective</a> and we are unlikely to ever hit that number. We can lower the amount and lower our risks but there will never be a perfect solution. We are currently doing a very good job but there is always room for improvement, the question is at what cost. <a href="https://pubmed.ncbi.nlm.nih.gov/20651774/" target="_blank" rel="noopener noreferrer">Fox 2010</a></p>
<p><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-elmination.jpg?ssl=1"><img class="aligncenter wp-image-14845 size-full" title="elminate dental aerosols" src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-elmination.jpg?resize=792%2C385&ssl=1" alt="Methods to help elminate dental aerosols." width="792" height="385" srcset="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-elmination.jpg?w=792&ssl=1 792w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-elmination.jpg?resize=300%2C146&ssl=1 300w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/04/dental-aerosol-elmination.jpg?resize=768%2C373&ssl=1 768w" sizes="(max-width: 792px) 100vw, 792px" data-recalc-dims="1" /></a></p>
<h2>What methods are there to reduced dental aerosol?</h2>
<p>Will mainly discuss the new aerosol units that are popping up everywhere. There is a nice <a href="https://www.dentaltown.com/messageboard/thread.aspx?s=2&f=3369&t=341928&v=1&utm_source=DT&utm_medium=topic&utm_campaign=auto" target="_blank" rel="noopener noreferrer">dt thread</a> on the issue. It is my opinion a central exhaust or chair-side external exhaust unit would be best to eliminate the contaminated aerosol outside instead of trying to filter and kill the viruses and bacteria. Theoretically these units could actually make us more sick. These units increase the airflow which prevents droplets from falling to the floor. Furthermore, they can not filter out all of the virus and could possibly end up spreading the virus even further. Overall, I feel they significantly reduce the viral load in the air but that is not known.</p>
<h5>Office HEPA units</h5>
<p><a href="https://scadental.com/" target="_blank" rel="noopener noreferrer">Surgically clean air</a> is the unit we have in our office. It does not get the aerosol directly and is more like a high level stand-alone HEPA filtration system you buy at the store.</p>
<h5>Chair side dental aerosol evacuation units.</h5>
<p>The <a href="https://www.iqair.com/commercial/compact-stand-alone-air-filtration/dental-series" target="_blank" rel="noopener noreferrer">IQAir unit</a> does have some <a href="https://www.nature.com/articles/sj.bdj.2010.952" target="_blank" rel="noopener noreferrer">research.</a></p>
<p>The <a href="https://www.youtube.com/watch?v=Q4_-K7zhVig" target="_blank" rel="noopener noreferrer">VacStation</a> looks similar to many “generic” units available. Another similar <a href="https://www.alibaba.com/product-detail/Portable-Pure-Air-PA-300TS-IQ_60792464638.html?spm=a2700.galleryofferlist.0.0.41696e43G9MvcZ" target="_blank" rel="noopener noreferrer">generic unit</a>. The <a href="https://www.vaniman.com/product/gold-mobile-extraoral-dental-suction/" target="_blank" rel="noopener noreferrer">Vaniman</a> looks very similar to the two units before this but you will be able to get more data and talk to someone from this company. It should be more trustworthy. Another <a href="https://www.airpurifiersandcleaners.com/electrocorp-clean-breeze-3-dx-vocarb-air-cleaner" target="_blank" rel="noopener noreferrer">unit</a> that was not meant for dental but should work well.</p>
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<div dir="ltr">The <a href="https://www.dentairvac.com/lit.html" target="_blank" rel="noopener noreferrer">DentAirVac</a> has been in dentistry for a long time. It’s primary use was for air abrasion units and holistic dentists removing amalgam. <a href="https://www.youtube.com/watch?v=8sCHof9aZXM" target="_blank" rel="noopener noreferrer">Ajax</a> is the unit that we have bought, only because that is what our rep can get us at this time.</div>
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<div>I worry about the practically of these units and how much sound they make.</div>
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<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/04/dental-aerosol-evacuation.html/">Dental aerosol evacuation</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-20474422317268452992020-04-23T12:42:00.001-07:002020-04-23T12:42:28.620-07:00Soft tissue lesions<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2015/06/Bauer-family-looking-up.jpg?fit=2640%2C1976&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">A list of a few of the less common dental soft tissue lesions</h1>
<p>Dental soft tissue lesions that I think are interesting.</p>
<h2>Epulis granulomatosa</h2>
<p>Epulis granulomatosa is found in poorly healing post extraction sites. The lesion just needs excision. I</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/04/soft-tissue-lesions.html/">Soft tissue lesions</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-78308911838260676922020-02-26T15:12:00.001-08:002020-02-26T15:12:19.795-08:00All on 3<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/02/all-on-3.jpg?fit=309%2C258&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What is an all on 3?</h1>
<p>All on 3 is the short name for an implant supported prosthesis that is only on 3 implants instead of the traditional <a href="https://www.bauersmiles.com/all-on-4-ao4/" target="_blank" rel="noopener noreferrer">minimum of 4</a>. It is definitely more controversial but seems to work well in the lower jaw.</p>
<h2>All on 3 (AO3) research</h2>
<p>An AO3 works according to <a href="http://www.quintpub.com/journals/omi/abstract.php?iss2_id=1085&article_id=12706&article=36&title=All-on-Three%20Delayed%20Implant%20Loading%20Concept%20for%20the%20Completely%20Edentulous%20Maxilla%20and%20Mandible:%20A%20Retrospective%205-Year%20Follow-up%20Study#.UNCprHfhd8E" target="_blank" rel="noopener noreferrer">Oliva 2012</a>, but this was a small study where all but 1 case was loaded conventionally. <a href="https://www.ncbi.nlm.nih.gov/pubmed/30716142" target="_blank" rel="noopener noreferrer">Bedrossian JOMI 2019</a> states AO3 is fine but should use wider diameter implants.</p>
<p>The <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">dental implants</a> seem to hold up with same percentage but the prosthesis may have more issues according to <a href="http://www.quintpub.com/journals/omi/abstract.php?iss2_id=1545&article_id=18593&article=11&title=Impact%20of%20Implant%20Number%20on%20Mandibular%20Implant-Supported%20Profile%20Prostheses:%20A%20Systematic%20Review#.W4W0T7gnaUk" target="_blank" rel="noopener noreferrer">Lima JOMI 2018.</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/30779822" target="_blank" rel="noopener noreferrer">Mezzari JOMI 2019</a> has a 5 year study on the all on 3 showing 97% success at 5 years when done in the mandible.</p>
<p>The example below is from a multi-national study and is showing success. <a href="https://www.ncbi.nlm.nih.gov/pubmed/31923298" target="_blank" rel="noopener noreferrer">Kenji 2020 JOMI</a></p>
<div id="attachment_14737" style="width: 319px" class="wp-caption aligncenter"><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/02/all-on-3.jpg?ssl=1"><img aria-describedby="caption-attachment-14737" class="wp-image-14737 size-full" title="All on 3 prosthesis" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/02/all-on-3.jpg?resize=309%2C258&ssl=1" alt="The all on 3 prosthesis can work" width="309" height="258" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/02/all-on-3.jpg?w=309&ssl=1 309w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2020/02/all-on-3.jpg?resize=300%2C250&ssl=1 300w" sizes="(max-width: 309px) 100vw, 309px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14737" class="wp-caption-text">This one is a novel all on 3 design.</p>
</div>
<h3>All on 2 and all on 1 or fixed-on-1 and fixed-on-2</h3>
<p>This can work in the right circumstance. It is very outside the normal treatment regimen though and should be a last effort on a very old patient opposing a denture. <a href="https://www.ncbi.nlm.nih.gov/pubmed/31116190" target="_blank" rel="noopener noreferrer">Cannizzaro JOI 2019</a></p>
<h3>What are the steps for the AO3?</h3>
<p>The steps are the same as any <a href="https://www.bauersmiles.com/implant-supported-dentures/" target="_blank" rel="noopener noreferrer">implant supported denture</a>.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/02/all-on-3.html/">All on 3</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-48663871658121849812020-02-02T23:05:00.001-08:002020-02-02T23:05:23.628-08:00White bump in a baby’s mouth<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/small-white-bump-in-babys-mouth.jpg?fit=209%2C146&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Did you find a small white bump in your baby’s mouth or on your baby’s gums?</h1>
<p>A white bump in your baby’s mouth or on their gums is almost always going to be a <span class="ILfuVd"><span class="e24Kjd">benign</span></span> keratinous cyst. That means it is nothing to worry about and it will go away on it’s on.</p>
<h2>What are the small white bumps in your baby’s mouth?</h2>
<p>They are likely <a href="https://emedicine.medscape.com/article/910405-overview" target="_blank" rel="noopener noreferrer">milia,</a> which are <span class="ILfuVd"><span class="e24Kjd">benign, keratinous cysts that commonly look like tiny white heads on the face of newborn babies. When these milia are present in the mouth they are known as Bohn nodules or Epstein pearls.</span></span></p>
<h4>What are Bohn nodules?</h4>
<p>That is the name given to the cysts if they form on the gums of your baby. <a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/small-white-bump-in-babys-mouth.jpg?ssl=1"><img class="aligncenter wp-image-14675 size-full" title="small white bump in your baby's mouth" src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2020/01/small-white-bump-in-babys-mouth.jpg?resize=209%2C146&ssl=1" alt="An example of a small white bump in your baby's mouth, also known as a Bohn's nodule" width="209" height="146" data-recalc-dims="1" /></a></p>
<h4>What are Epstein pearls?</h4>
<p>That is then name given to the cysts if they form on the palate or roof of the mouth of your baby.</p>
<p> </p>
<h3>What should you do about these cysts in your baby’s mouth?</h3>
<p>Nothing they will go away on their own. Keratin is what hair and nails are made of and this is somewhat similar. There is no need to see a dentist for this, some may not even know what it is because they are unimportant. A <a href="https://www.bauersmiles.com/pediatric-dentist/" target="_blank" rel="noopener noreferrer">pediatric dentist</a> will likely be able to identify it for you very easily though. As we mentioned though, you should be able to diagnosis this yourself with the help of an image internet search for the terms Bohn nodule or Epstein pearl.</p>
<h4>How do these Bohn nodules and Epstein pearl cysts go away?</h4>
<p>The cysts grow and rupture on their own over the course of 2 weeks to 5 months. They are most often gone by the time a baby is 3 months of age. However, older babies can get them and they can last longer, it’s just rarer.</p>
<p><span class="ILfuVd"><span class="e24Kjd"> </span></span></p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/02/white-bump-in-a-babys-mouth.html/">White bump in a baby’s mouth</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-49031236598960114862020-01-17T18:01:00.001-08:002020-01-17T18:01:07.503-08:00The implant retained denture<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2015/01/Before-and-after.jpg?fit=4504%2C2816&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What are implant retained dentures or locator denture?</h1>
<p>Implant retained dentures are a type of overdenture that you can take in and out to clean and attaches to <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">dental implants</a>. It differs from the <a href="https://www.bauersmiles.com/2012/10/implant-supported-bar-overdenture.html/" target="_blank" rel="noopener noreferrer">bar overdenture</a> in that the implants attach directly to the denture instead of to an intermediary bar.</p>
<h3><b>Implant and Tissue Supported Overdenture or Implant retained overdenture<br /></b></h3>
<p><b>Implant and Tissue Supported Overdenture</b> is a patient removable prosthesis that gets support from both dental implants and patient tissue. I prefer the term implant retained denture. It has either a bar or studs on the implants. Requires fewer implants than any other option. Ensure if bar with clips only one as multiple inadvertently creates a supported prosthesis.</p>
<p>For mandible 2 with bar is best and clip with intimate contact OR 2 individual and want lateral throat form</p>
<p><a href="http://www.quintpub.com/journals/omi/fulltext.php?article_id=12481" target="_blank" rel="noopener noreferrer">Best location for 2 implant mand OD is in lateral incisor area with short attachments</a></p>
<p>Some reinforce acrylic with metal mesh to reduce acrylic fractures. 4 is minimum in maxilla with no palatal coverage but full tuberosity coverage. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17974117" target="_blank" rel="noopener noreferrer">JOMI 2007 Cavallaro Tarnow</a> 2 implants then denture works just like traditional denture.</p>
<p>Minimum requirement vertically is about 10mm with an ideal breakdown of 2mm for tissue, 2mm for denture acrylic base, 3mm for denture teeth, and 3.35mm for a locator. For horizontal space constraints a Micro-ERA is 4.43mm so 8mm total is minimum, that leaves 2mm acrylic both sides. For a locator overdenture you need about 9mm vertical and horizontal, but would like to see 10-12mm <a href="http://www.ncbi.nlm.nih.gov/pubmed/16473082" target="_blank" rel="noopener noreferrer">Lee 2006 JPD</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/17618916" target="_blank" rel="noopener noreferrer">Sadowsky 2007 JPD</a></p>
<p><a href="http://www.dentistrytoday.com/implants/6634-efficient-placement-of-implant-overdenture-attachments" target="_blank" rel="noopener noreferrer">Reference</a></p>
<h3>How do we measure vertical space for a locator denture?</h3>
<p>To measure the space available we have 3 main options</p>
<ol>
<li>Make radiographic template (code 6190) and have them wear during CBCT</li>
<li>Measure existing/new denture or area with boley gauge, this method is the least diagnostic.</li>
<li>Matrix capture of denture teeth, if not doing CBCT then this is best method.</li>
</ol>
<h4><b>CBCT option </b></h4>
<p>This is a double scan technique. One in which they are first scanned wearing the prosthesis and then the prosthesis is scanned by itself.</p>
<ol>
<li>If patient is edentulous then make a duplicate of the finished temporary prosthesis with to wear as a radiographic template.</li>
<li>If patient has some teeth remaining do same thing, just remove the teeth that are still present from the duplicated finished temporary prosthesis</li>
<li>To make the radiographic template use 1:3 ratio barium sulfate powder (Hypaque Sodium by Amersham Health) OR</li>
<li>#6 round but to 1/2 depth around the lingual flange and fill with gp and polish off with rubber OR</li>
<li>Add radioopaque glass beads</li>
<li>Can mark attached tissue like seen in <strong><a href="http://jiacd.com/journal/titanium-mesh-guided-bone-regeneration/" target="_blank" rel="noopener noreferrer">A Technique to Identify Attached Gingiva During Virtual Implant Planning</a></strong></li>
<li>Patient wears during CBCT and besides reading bone levels can measure space available.</li>
</ol>
<h4><b>Matrix option</b></h4>
<ol>
<li>Once have approved wax baseplates can just remove from mounted models and measure.</li>
<li>There is several <a href="http://www.thejpd.org/article/S0022-3913%2810%2960107-2/abstract" target="_blank" rel="noopener noreferrer">much more complex Aug 10</a>ways to do this but I don’t see how they are a whole lot more informative.</li>
</ol>
<h3>Implant retained denture dental code = Locator denture dental code</h3>
<p>This would be a locator or ERA retained denture. These would be dentures that are retained by implants (actually some type of abutments), but are supported by tissue as well as the implants.</p>
<p>D5862 per each Precision attachment (set of male and female components reported as one precision attachment) (so locator or ERA)</p>
<p>D5110 or D5120 denture might be easier to use but D5863 or D5865 Complete Overdenture is the correct code.</p>
<h3><a href="https://www.bauersmiles.com/2012/12/implant-overdenture-attachments.html/" target="_blank" rel="noopener noreferrer">Attachment options</a> for implant retained dentures are found in the link.</h3>
<h2>Treatment planning of the implant overdenture</h2>
<p class="post-title entry-title">Implant retained overdenture is very similar to <a href="https://www.bauersmiles.com/category/wheaton-denture/" target="_blank" rel="noopener noreferrer">denture</a> and a <a href="https://www.bauersmiles.com/2010/09/converting-denture-into-fixed.html/" target="_blank" rel="noopener noreferrer">fixed detachable provisional</a></p>
<h2 class="post-title entry-title"> Implant overdenture procedure in a step by step format</h2>
<h4 class="post-title entry-title"><b>Steps for the initial impression for the implant overdenture<br /></b></h4>
<ol>
<li>Measure depth from implant platform to most coronal aspect of surrounding gingival tissue for depth locators</li>
<li>Take alginate impression</li>
</ol>
<h4 class="post-header"><b>Steps for the final impressions for the implant overdenture<br /></b></h4>
<ol>
<li>Seat locator abutments to specified torque</li>
<li>Place implant impression copings</li>
<li>Clear thermoplastic tray by Massad or custom tray</li>
<li>Paint tray with PVS adhesive</li>
<li>Rigid PVS on palate, tissue areas, and directly over implant copings to act as stops.</li>
<li>Trim most away most material except for solid stops on palate, tissue both sides, and on copings. Leave just enough for positive seat of copings, do not come up sides.</li>
<li>Med PVS on periphery and light inside border mold.</li>
<li>Ask for processed denture base with metal subframe mesh support (probably? some say rather no and let acrylic break before implant does) with holes to pick up locators exactly.</li>
<li>Also want wax rim with central SR Phonares set in wax</li>
<li>Follow denture thread instructions from here</li>
</ol>
<h4><b>Steps if picking up overdenture intra-orally</b></h4>
<ol>
<li>Place locator block out spacer ring and then titanium cap with black processing male (1 at a time? 2 at a time? just not all)</li>
<li>Ensure locators with metal housing not hitting</li>
<li>GC fit check</li>
<li>Adjust as needed and then place undercuts with #8 bur</li>
<li>Place vent hole to palatal or lingual</li>
<li>Refine occlusion now</li>
<li>Adhesive painted on denture area</li>
<li>Petroleum jelly in areas don’t want maybe</li>
<li>Block out undercuts on implant (if any) with silicone like fit check or Fit Test C&B VOCO</li>
<li>Place resin in hole and seat denture self cure or LC if can</li>
<li>Have the patient feel their masseter with their hands as they close and then clench and repeat until they can tell when the muscle is starting to clench. Tell them you want them to close but not clench at all when doing your reline.</li>
<li>Remove and fill small voids with LC resin</li>
<li>Remove processing male insert and place appropriate strength</li>
</ol>
<h2>Implant retained denture loading and other instructions</h2>
<p>Early loading of the implant overdenture is anytime we load between 48 hours and 3 months. Loading lower unsplinted implants at <a href="http://journals.lww.com/implantdent/Fulltext/2012/06000/A_Comparative_Study_Between_Early_Occlusal_Loading.16.aspx" target="_blank" rel="noopener noreferrer">1 week has same results as at 6 weeks</a> with 14mm <a href="https://www.bauersmiles.com/wheaton-dental-implants/" target="_blank" rel="noopener noreferrer">implants</a> and a flapless surgery. While still healing recommend a soft diet and removal at night with thorough oral hygiene instructions. Should fabricate a night guard for removable overdentures in order to protect abutments from any para-functional activity.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/01/the-implant-retained-denture.html/">The implant retained denture</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-11113700833852882812020-01-04T20:48:00.001-08:002020-01-04T20:48:14.313-08:00Bifurcated IAN<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2015/01/before-and-after-Toni-with-implant.jpg?fit=6477%2C1355&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">The bifurcated inferior alveolar nerve (IAN)</h1>
<p>Bifurcation of the inferior alveolar nerve is a common anatomical variance but can be difficult to detect.</p>
<h2>How common is a bifurcated IAN?</h2>
<p>It most likely occurs between 13-37%, which you can find in <a href="https://www.ncbi.nlm.nih.gov/pubmed/29964244" target="_blank" rel="noopener noreferrer">Yoon Gen Dent 2018</a>. This is a wide range and there is almost certainly going to be regional genetic variation making the number trickier to pin down. The main point of these numbers is to know it exists in fairly high numbers. However, most dentists are not familiar with bifuraction of the IAN because we don’t see them. That is fine because often we don’t have a care or need to look for it. Studies show that less than 1% of the bifurcations will show up on a <a href="https://www.bauersmiles.com/2018/08/radiolucency-on-pano.html/" target="_blank" rel="noopener noreferrer">pano</a>. So similar to the <a href="https://www.bauersmiles.com/2013/01/mandibular-incisvie-canal-mic.html/" target="_blank" rel="noopener noreferrer">mandibular incisive canal</a>, the better equipment we have the and the better we are at looking for it, the more we find.</p>
<h3>When does a bifurcation of the inferior alveolar nerve matter?</h3>
<p>A bifurcation could be the reason a patient is difficult to numb even though the IAN block is successful. Essentially you would need to have 2 successful IAN blocks to fully numb. To learn a few other tricks on those <a href="https://www.bauersmiles.com/2013/02/dental-local-anesthetics.html/" target="_blank" rel="noopener noreferrer">hard to numb patients</a> check out the end of our blog on anesthetics.</p>
<p>Knowing the anatomy of the IAN is also be important in <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">dental implant</a> placement because damage to either branch would cause issues.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2020/01/bifurcated-ian.html/">Bifurcated IAN</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-89698541854401338562019-12-19T10:39:00.001-08:002019-12-19T10:39:31.478-08:00ADA codes 2020<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/ADA-dental-code-2020-changes.jpg?fit=417%2C536&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">ADA dental code changes for 2020</h1>
<p>Information about new <a href="https://www.ada.org/en" target="_blank" rel="noopener noreferrer">ADA</a> code changes for 2020. <a href="https://www.bauersmiles.com/2018/12/ada-codes-2019.html/" target="_blank" rel="noopener noreferrer">2019 codes</a> are in another post.</p>
<h2>What are the changes this year?</h2>
<p>A lot of the changes have to do with re-cementing space maintainers or orthodontic appliances and could have been left the same. Many deal with titanium crowns, which I suppose we need.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/ADA-dental-code-2020-changes.jpg?ssl=1"><img class="aligncenter wp-image-14548 size-full" title="ADA 2020 dental code" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/ADA-dental-code-2020-changes.jpg?resize=417%2C536&ssl=1" alt="The ADA 2020 dental code book is out." width="417" height="536" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/ADA-dental-code-2020-changes.jpg?w=417&ssl=1 417w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/ADA-dental-code-2020-changes.jpg?resize=233%2C300&ssl=1 233w" sizes="(max-width: 417px) 100vw, 417px" data-recalc-dims="1" /></a></p>
<h3>Diagnostic ADA code changes</h3>
<p>We have a code for salivary flow measurement now. It is D0419.</p>
<h3>Preventive and Orthodontic dental code changes for 2020</h3>
<p>These dental codes all deal with re-cementing and removing space maintainers. We now have them for specific arches which is probably not something that we need.</p>
<h3>Restorative Implant and Pros changes</h3>
<p>Many of these deal with titanium being an option for the metal work. Under the implant section there is a whole series for implant supported crowns which are useful for one piece implants like many of the <a href="https://www.bauersmiles.com/2017/05/zirconia-dental-implants.html/" target="_blank" rel="noopener noreferrer">zirconia implant systems</a>.</p>
<h3>Removable dental code changes</h3>
<p>There are now unilateral removable denture codes for the newer materials like <a href="https://www.bauersmiles.com/2018/03/metal-free-partial-denture.html/" target="_blank" rel="noopener noreferrer">Duraflex</a>.</p>
<h3>Oral surgery ADA code update</h3>
<p>This one is a useful code but I doubt insurance companies are going to pay on it. The placement of intra-socket dressing to aid in hemostasis and clot stabilization is now code D7922.</p>
<p> </p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/12/ada-codes-2020.html/">ADA codes 2020</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-36558240381680483562019-12-12T02:59:00.001-08:002019-12-12T02:59:17.953-08:00Decompression<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2015/01/RCT-molar.jpg?fit=1600%2C1200&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Decompression of a dental abscess</h1>
<p>Decompression of a dental abscess is something that is rare but beneficial with large lesions. Endodontists and oral surgeons are probably the main too specialists with training in this area.</p>
<h2>Steps for decompression of a dental abscess</h2>
<p>The steps for decompression depend to some degree on where it is in the mouth. There needs to be some way to maintain the opening to allow drainage and healing of the lesion.</p>
<ol>
<li>Aspirate with a 18 gauge needle.</li>
<li>Incisional biopsy trying to get as large a piece(s) of the lesion as possible.</li>
<li>Curettage lesion</li>
<li>Saline rinses of lesion</li>
<li>Place some sort of tubing into the lesion and stabilize it with sutures. Examples from literature are 3.5mm long pediatric endotracheal tube, polyvinyl tubing, radiographic latex tubing, cannula, customized removable denture, iodoform gauze, and orthodontic stainless steel tube.</li>
</ol>
<h3>What does the patient need to do?</h3>
<p>After a few days of healing the patient will remove the tubing and flush the inside of the lesion and the tubing daily with saline. They will need to trim the length of the tubing as the lesion heals and the defect fills in. Eventually the tubing will not longer stay in place.</p>
<h3>What causes the need for decompression?</h3>
<p>A large lesion is often one that we may want to treat with decompression instead of immediate removal. Anything larger than 2.5 cm or any through and through lesion are lesions that will have unpredictable healing potential with root canal treatment alone. Lesions is critical areas as also candidates, such as near the nasal floor, IAN, and adjacent root apex. There are several types of lesions that benefit from this procedure. The diagnosis will help determine the appropriate course of action. Some large radicular lesions of odontogenic nature benefit from decompression as it makes the lesion smaller and more manageable surgically. The <a href="https://www.bauersmiles.com/wheaton-root-canal/" target="_blank" rel="noopener noreferrer">root canal</a> is usually done at the same time for these lesions.</p>
<h4>Other names in the literature for decompression</h4>
<p>Decompression is not a new procedure, it has been around around for over a century. Decompression is also seen as marsupialization and exteriorization. The term fistulative surgery is also in endodontic literature. <a href="https://www.jendodon.com/article/S0099-2399(18)30874-4/abstract" target="_blank" rel="noopener noreferrer">Tian JOE 2019</a> has a nice case study with lots of info.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/12/decompression.html/">Decompression</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-47874484543867257222019-12-05T06:54:00.001-08:002019-12-05T06:54:22.251-08:00Crestal bone loss<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/crestal-bone-loss-from-implant-surgery.jpg?fit=526%2C405&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What causes initial crestal bone loss from implant surgery?</h1>
<p>Crestal bone loss from an <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">implant surgery</a> is inevitable. Some of the bone will die from the trauma of the surgery. Where and how much is not totally in our control, but we can to some extent predict high risk areas. Note the crestal bone loss we are discussing is not the same as the bone one loses from <a href="https://www.bauersmiles.com/2012/09/peri-implantitis-peri-implant-mucositis.html/" target="_blank" rel="noopener noreferrer">peri-implantitis</a> or natural <a href="https://www.bauersmiles.com/2012/08/bone-loss.html/" target="_blank" rel="noopener noreferrer">bone loss</a>. This bone loss occurs during the initial healing phase.</p>
<div id="attachment_14475" style="width: 536px" class="wp-caption aligncenter"><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/crestal-bone-loss-from-implant-surgery.jpg?ssl=1"><img aria-describedby="caption-attachment-14475" class="wp-image-14475 size-full" title="Crestal bone loss from implant surgery in dense cortical bone." src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/crestal-bone-loss-from-implant-surgery.jpg?resize=526%2C405&ssl=1" alt="Crestal bone loss from implant surgery in dense cortical bone." width="526" height="405" srcset="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/crestal-bone-loss-from-implant-surgery.jpg?w=526&ssl=1 526w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/crestal-bone-loss-from-implant-surgery.jpg?resize=300%2C231&ssl=1 300w" sizes="(max-width: 526px) 100vw, 526px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14475" class="wp-caption-text">Unsure if would call this crestal bone loss but this was very dense bone in general. There is thick cortical bone.</p>
</div>
<h3>What is the cause of the bone loss?</h3>
<p>Trauma, or more precisely the interference and destruction of oxygenated blood flow to the area, is the cause. This occurs in the crestal area because cortical bone has a lower blood supply and fewer osteoprogenitor cells in comparison to the trabecular bone. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24412092" target="_blank" rel="noopener noreferrer">Kristensen 2014 AJPath</a> Cortical crestal bone has the highest strain levels during dental implant surgery yet is the most sensitive to bone loss. <a href="https://www.ncbi.nlm.nih.gov/pubmed/30938536" target="_blank" rel="noopener noreferrer">Pikos Comp 2019 ref 10 and 11</a>. This is a recipe to guarantee some crestal bone loss.</p>
<h2>What areas of are more at risk for bone loss from the dental implant surgery?</h2>
<p>Cortical bone is at high risk of being lost because it starts with a much lower blood supply. Therefore, people with thick cortical bone are at higher risk.</p>
<div id="attachment_14474" style="width: 165px" class="wp-caption aligncenter"><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/thick-cortical-bone.jpg?ssl=1"><img aria-describedby="caption-attachment-14474" class="wp-image-14474 size-full" title="Thick cortical bone." src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/thick-cortical-bone.jpg?resize=155%2C193&ssl=1" alt="Thick cortical bone xray." width="155" height="193" data-recalc-dims="1" /></a>
<p id="caption-attachment-14474" class="wp-caption-text">An example of thick cortical bone.</p>
</div>
<p>Areas of bone with low blood supply are at higher risk of crestal bone loss. There could be many reasons someone has low blood supply to the bone, such as radiation treatment.</p>
<p>Areas that are more traumatized and have lost more blood supply are at higher risk. This is why flapping causes more bone loss as the bone loses the blood supply from the periosteum.</p>
<p>Thin bone is at higher risk because it is more likely to be all cortical bone and there will be even less blood supply in thinner bone.</p>
<p>Areas of very dense bone are at higher risk.</p>
<p><iframe src="https://www.youtube.com/embed/RDXIV6ycMDg" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<h3>How can we limit the changes in bone from occurring?</h3>
<p>Know the anatomy of the area, and particularly the thickness of the cortical bone, ahead of time will help you know your risks. High insertion torques in areas of thick cortical bone will increase the likelihood of crestal bone loss. <a href="https://www.ncbi.nlm.nih.gov/pubmed/24750281" target="_blank" rel="noopener noreferrer">Simons COIR 2015</a> recommends bone tapping to help prevent high insertion torques at sites with thick cortical bone.</p>
<p>If a osteomy site has no bleeding in it at all there are clinicians who recommend letting the area heal for 2-4 weeks and then coming back and placing the implant. This makes a lot of sense but does require a second visit which no one wants.</p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/12/crestal-bone-loss-implant-surgery.html/">Crestal bone loss</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-69487372445384237422019-12-04T11:54:00.001-08:002019-12-04T11:54:15.867-08:00Air abrasion<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/cojet-air-abrasion-dentistry-1.jpg?fit=433%2C746&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Air abrasion use in dentistry</h1>
<p>Air abrasion use in dentistry is a nice tool with various applications from hygiene, clinical, and laboratory.</p>
<h2>What are the different materials in use for air abrasion?</h2>
<p>The material choice decides what the goal of air abrasion is. The more coarse material is the more it cuts into tooth structure.</p>
<h3>Aluminum oxide air abrasion</h3>
<p>This is the main type of particle we use to cut into tooth structure or other materials. Particles come in sizes from 30-90 μm. The larger particles are more abrasive. We use aluminum oxide to roughen old composite when adding new composite to it. Other uses include roughening of metal, ceramics, and acrylic before adding anything to them or bonding to them. Aluminum oxide does a great job of cleaning any surface.</p>
<h4>So what is the ideal size for aluminum oxide air abrasion?</h4>
<p>That is a debatable topic. Typically research shows better bonding with air abrasion but differences in findings on particle size. <a href="https://www.thejpd.org/article/S0022-3913(19)30546-3/abstract" target="_blank" rel="noopener noreferrer">Shimoe JPD 2019</a> finds size differences from 25-125μm and pressure differences between .1-.4 MPa do not result in clinical differences. They did find that there are significantly higher bond strengths after cycling with the alumina air abrasion.</p>
<h4>Aluminum oxide in tribochemical treatments of zirconia</h4>
<p>When we want to bond to zirconia the gold standard is tribochemical. We accomplish this bonding with CoJet sand, which consists of 30 μm silicanized Al₂O₃ particles. <a href="https://www.ncbi.nlm.nih.gov/pubmed/26114165" target="_blank" rel="noopener noreferrer">Bielen 2015 J Ad Dent</a> For the exact steps you can check out our <a href="https://www.bauersmiles.com/2013/02/zirconia-dental-crown.html/" target="_blank" rel="noopener noreferrer">zirconia page</a>.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/cojet-air-abrasion-dentistry-1.jpg?ssl=1"><img class="aligncenter wp-image-14519 size-full" title="CoJet air abrasion" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/cojet-air-abrasion-dentistry-1.jpg?resize=433%2C746&ssl=1" alt="CoJet air abrasion dentistry is great for bonding zirconia." width="433" height="746" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/cojet-air-abrasion-dentistry-1.jpg?w=433&ssl=1 433w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/12/cojet-air-abrasion-dentistry-1.jpg?resize=174%2C300&ssl=1 174w" sizes="(max-width: 433px) 100vw, 433px" data-recalc-dims="1" /></a></p>
<h3>Glass particles</h3>
<p>Typically these particles are 50-90 μm. They are less abrasive than aluminum oxide. We can use these products to clean temporaries or plaque from dentures. If going to bond or add to these then we prefer just using the aluminum oxide. Bioactive glass particles have a use as a tool to prevent sensitivity.</p>
<h3>Cleaning particles</h3>
<p>This category is for cleaning only. Some use these for their cleaning appointments to remove the biofilm or to remove biofilm before bonding to uncut enamel. Products in this category include sodium bicarbonate, glycine, calcium sodium phosphosilicate, calcium carbonate, and aluminum trihydroxide. A nice review of these are in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23986410" target="_blank" rel="noopener noreferrer">J Dent Hyg 2013 Graumann</a>. Glycine is the only one that has not been found to abrade to any extent at all on glass ionomer or composite according to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26054183" target="_blank" rel="noopener noreferrer">Barnes J Clin Dent 2014</a>. Some of these are even course enough to complete microscopic air abrasion. Aluminum trihydroxide is a popular product for biofilm removal prior to <a href="https://www.bauersmiles.com/2019/05/black-triangle-bioclear.html/" target="_blank" rel="noopener noreferrer">Bioclear composites</a>.</p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/12/air-abrasion.html/">Air abrasion</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-80920702257943172702019-11-26T16:11:00.001-08:002019-11-26T16:11:20.510-08:00Retrograde peri-implantitis<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis-dental-implant.jpg?fit=686%2C666&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Retrograde peri-implantitis of dental implants</h1>
<p>Retrograde peri-implantitis, or implant periapical lesion, is a radiolucent lesion at the apical portion of a <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">dental implant</a>. Typically one will develop in the first few months post insertion.</p>
<p> </p>
<h2>What is the cause of retrograde peri-implantitis?</h2>
<p>The cause is bone death and or infection. We believe this is often due to bone necrosis from overheating. The cases in the literature often seem to have another factor in common and that is minimal bone in area of lesion. This makes sense as very thin bone is more likely to necrosis from the trauma of the surgery due to it being cortical bone with low blood supply.</p>
<h3>These lesions consist of active and inactive.</h3>
<p>Active lesions are symptomatic and include signs of gingival swelling, pain, swelling, and presence of a fistula. While surgical treatment may be necessary it is our experience that this can resolve on own without intervention.</p>
<p>Inactive retrograde peri-implantitis lack symptoms. We monitor these lesions for changes, both clinically and radiographically. The retrograde peri-implantitis lesion below went from active on 8/8 to inactive on 9/3. It is still currently in the inactive state. It is my opinion that case has a lesion because a bone expander was used in close proximity to the buccal cortical bone. You can view the CBCT of the case on our <a href="https://youtu.be/cOvylBYcTtk" target="_blank" rel="noopener noreferrer">Youtube channel here</a> or at the bottom of the page.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis-dental-implant.jpg?ssl=1"><img class="aligncenter wp-image-14459 size-full" title="Retrograde peri-implantitis case study" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis-dental-implant.jpg?resize=686%2C666&ssl=1" alt="X-rays from a retrograde peri-implantitis case study." width="686" height="666" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis-dental-implant.jpg?w=686&ssl=1 686w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis-dental-implant.jpg?resize=300%2C291&ssl=1 300w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis-dental-implant.jpg?resize=45%2C45&ssl=1 45w" sizes="(max-width: 686px) 100vw, 686px" data-recalc-dims="1" /></a></p>
<h3>How do we treat active lesions?</h3>
<p>There are two methods for treatment of retrograde peri-implantitis. One involves accessing and cleaning the implant and the other involved removing a portion of the dental implant.</p>
<h4>Surgical access and cleaning of an implant with retrograde peri-implantitis</h4>
<p>Surgical access and curettage and irrigation of the implant. Much like the treatment of <a href="https://www.bauersmiles.com/2012/09/peri-implantitis-peri-implant-mucositis.html/" target="_blank" rel="noopener noreferrer">peri-implantitis</a> the methods of cleaning the threads are many. A <a href="https://www.bauersmiles.com/2012/10/guided-bone-regeneration-gbr.html/" target="_blank" rel="noopener noreferrer">guided bone regeneration (GBR)</a> finishes up the procedure.</p>
<h4>Apicoectomy treatment approach</h4>
<p>One can also simply remove the lesion and the offending apical portion of the dental implant as <a href="https://www.ncbi.nlm.nih.gov/pubmed/17465352" target="_blank" rel="noopener noreferrer">Balshi 2007 JOMI</a> does. This method may be better if the dental implant is apically outside the bone contours or very close. This is somewhat likely as the real reason there is an apical radiolucency may be perf or near perf with the dental implant. This can even be seen in some papers. Not sure these are true retrograde peri-implantitis though.</p>
<h4>Is retrograde peri-implantitis real or a result of slightly less than ideal surgery?</h4>
<p>Some of the cases in the literature and ones we have seen are clearly the result of less than ideal placement resulting in the apical portion outside the bone or in an area with very thin cortical bone only. The x-ray below is from an article in <a href="https://www.dentistrytoday.com/" target="_blank" rel="noopener noreferrer">Dentistry Today</a> Oct 2019. Does this x-ray show retrograde peri-implantitis or simply less than ideal placement? It seems obvious to me this implant is simply too far buccal but depends on where this screen shot is taken from as we move around the arch. It may look better or worse than this as one scrolls through the axial view.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis.jpg?ssl=1"><img class="wp-image-14458 size-full aligncenter" title="Retrograde peri-implantitis x-ray or poor placement?" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/retrograde-peri-implantitis.jpg?resize=110%2C122&ssl=1" alt="Retrograde peri-implantitis x-ray or poor placement?" width="110" height="122" data-recalc-dims="1" /></a></p>
<p>This implant below is slightly too buccal and is likely partially the reason for the retrograde peri-implantitis lesion.</p>
<p><iframe src="https://www.youtube.com/embed/cOvylBYcTtk" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/11/retrograde-peri-implantitis.html/">Retrograde peri-implantitis</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-21539690953496357642019-11-18T16:52:00.001-08:002019-11-18T16:52:04.749-08:00Dental implant checklist<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/dental-implant-checklist.jpg?fit=855%2C407&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Dental implant checklist and other dental procedural checklists</h1>
<p>Dental implant checklists are an important step to help ensure simple mistakes are made less frequently. Many of the small mistakes that can occur in the dental field are far from life threatening, but we need to take our our profession seriously.</p>
<h2>Why the need for an implant checklist?</h2>
<p>The simple answer is to avoid stupid human errors that we are all prone to making.</p>
<h3>What should the list consist of?</h3>
<p>Dental implant checklists need to be simple and short for most surgical procedures. The <a href="https://www.bauersmiles.com/wp-content/uploads/2019/11/WHO-surgical-checklist.pdf" target="_blank" rel="noopener noreferrer">W.H.O.</a> surgical checklist is a great example of this. Al Faraje has a nice surgical implant checklist from <a href="http://www.quintpub.com/index.php" target="_blank" rel="noopener noreferrer">Quintessence</a>. <a href="https://www.thejpd.org/article/S0022-3913(17)30157-9/pdf" target="_blank" rel="noopener noreferrer">Bidra</a> and <a href="https://www.bauersmiles.com/wp-content/uploads/2019/11/Safety-checklist.pdf" target="_blank" rel="noopener noreferrer">Christman</a> also have checklists. <a href="https://www.ncbi.nlm.nih.gov/pubmed/30982614" target="_blank" rel="noopener noreferrer">Remiszewski</a> with Bidra again have a nice generic checklist.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/dental-implant-checklist.jpg?ssl=1"><img class="aligncenter wp-image-14412 size-full" title="dental implant checklist for implant surgery" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/dental-implant-checklist.jpg?resize=855%2C407&ssl=1" alt="This is a nice dental implant checklist for implant surgery." width="855" height="407" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/dental-implant-checklist.jpg?w=855&ssl=1 855w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/dental-implant-checklist.jpg?resize=300%2C143&ssl=1 300w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/dental-implant-checklist.jpg?resize=768%2C366&ssl=1 768w" sizes="(max-width: 855px) 100vw, 855px" data-recalc-dims="1" /></a></p>
<h4>Normalization of deviance to checklists</h4>
<p>Normalization of deviance is a major issue with all types of checklists everywhere, not just dental implant checklists. The only way to combat this, is to continually train individuals to rely and trust the checklists and to have others oversee checklist in use from time to time.</p>
<h4>Other important resources for the implementation of checklists</h4>
<p>The most difficult of any checklist is getting humans to use them. Despite overwhelming evidence to their benefit most are too proud to use one. Unless mistakes lead to the immediate and large loss of life it is challenging to implement checklists. Pilots are success because of the sever repercussions from a simple mistake. We have found reading <a href="https://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0312430000" target="_blank" rel="noopener noreferrer">Checklist Manifesto</a> gets buy in from more employees.</p>
<h3>Dental implant checklists that we use</h3>
<p>We use several types of checklists for our <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">implant procedures</a>. First off we have the pre appointment checklist. It lists all the kits, materials, and sizes we are likely to need. Next we have the room set up checklist, which is really several photos of the ideal set up with labels. Then we have the step by step checklist that the assistant keeps by her. It has her steps in bright yellow that she is entirely responsible for. She is also responsible to follow along and ensure the doctor is not skipping anything. Finally we have the post op check list. It is esetnially a list of rules for the patient but we review it together.</p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/11/dental-implant-checklist.html/">Dental implant checklist</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-38932446407821521772019-11-12T10:56:00.001-08:002019-11-12T10:56:18.038-08:00Conservative endodontic access<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2012/06/stress-concentration-loading-molar.jpg?fit=353%2C374&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Conservative endodontic access (Ninja access)</h1>
<p>Conservative endodontic access or ninja access is basically an access to complete a root canal that is very small. My bias is that most <a href="https://www.bauersmiles.com/wheaton-root-canal/" target="_blank" rel="noopener noreferrer">root canals</a> we see fail do so from infection and likely ineffective cleansing. To limit ones ability to effectively clean out the inside to reduce the risk of fracture is something only the those with exemption skill should even bother attempting.</p>
<h2>Ninja access research</h2>
<p>The conservative endodontic cavity or access, basically the ninja access, improves fracture strength in lower molars at the expense of instrumentation efficiency. <a href="https://www.jendodon.com/article/S0099-2399(13)01139-4/abstract" target="_blank" rel="noopener noreferrer">Krishan JOE 2014</a> In maxillary molars the conservative endodontic access appears to have no benefit or some depending on the study. <a href="https://www.jendodon.com/article/S0099-2399(16)30581-7/abstract" target="_blank" rel="noopener noreferrer">Moore JOE 2016</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/30803539" target="_blank" rel="noopener noreferrer">Zhang JOE 2019</a> Worse yet it results in more transportation and less canals found with no gain in fracture resistance. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28739013" target="_blank" rel="noopener noreferrer">Rover JOE 2017</a></p>
<p>The contracted endodontic cavity results in greater apical transportation. In general the ninja access results in less preservation of the original canal anatomy. <a href="https://www.jendodon.com/article/S0099-2399(17)31237-2/abstract" target="_blank" rel="noopener noreferrer">Alovisi JOE 2018</a></p>
<p>It appears the roots and any isthmus are just as clean in the ninja access as traditional but the <a href="http://www.jendodon.com/article/S0099-2399(17)31191-3/abstract" target="_blank" rel="noopener noreferrer">chamber is not</a>. Neelakantan JOE 2018</p>
<p>The cervical dentin is what is important not the occlusal enamel and dentin as you can see from this <a href="https://www.aegisdentalnetwork.com/cced/ebooks/submit-information/189" target="_blank" rel="noopener noreferrer">stress concentration image</a> under loading. The conservative endodontic access cavity has no impact on fracture resistance in comparison to a traditional access. <a href="https://www.jendodon.com/article/S0099-2399(18)30319-4/abstract" target="_blank" rel="noopener noreferrer">Sabeti 2018 JOE</a></p>
<p><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2012/06/stress-concentration-loading-molar.jpg?ssl=1"><img class="aligncenter wp-image-12848 size-full" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2012/06/stress-concentration-loading-molar.jpg?resize=353%2C374&ssl=1" alt="Conservative endodontic access or ninja access image." width="353" height="374" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2012/06/stress-concentration-loading-molar.jpg?w=353&ssl=1 353w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2012/06/stress-concentration-loading-molar.jpg?resize=283%2C300&ssl=1 283w" sizes="(max-width: 353px) 100vw, 353px" data-recalc-dims="1" /></a></p>
<h3>Truss endodontic access cavity</h3>
<p>This is similar to above ideas and shows similar results, which means does not appear to be helpful. <a href="https://www.jendodon.com/article/S0099-2399(18)30351-0/abstract" target="_blank" rel="noopener noreferrer">Corsentino JOE 2018</a> found the truss did not increase fracture resistance of the tooth. Truss did help increase fracture resistance in MOD cut teeth <a href="https://www.ncbi.nlm.nih.gov/pubmed/30905571" target="_blank" rel="noopener noreferrer">Abou-Elnaga JOE 2019</a></p>
<h4>Other synonyms in the literature</h4>
<p>As with many techniques there are multiple authors publishing research with different names. Many are attempting to get nomenclature that they like for the technique. Ninja access is slang and conservative endodontic cavity (CEC) or conservative endodontic access are the main terms seen. However, orifice-directed dentin conservation access is another term that is seen in the research.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/11/conservative-endodontic-access.html/">Conservative endodontic access</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-54520671137568215632019-11-08T12:42:00.001-08:002019-11-08T12:42:19.485-08:00Dental art<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/learning-to-draw-dentistry.jpg?fit=576%2C526&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Dental art, drawing, and artwork that we enjoy</h1>
<p>Really like <a href="http://williamjobrien.com/" target="_blank" rel="noopener noreferrer">William J O’Brien’s</a> ceramics and paintings.</p>
<p><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/learning-to-draw-dentistry.jpg?ssl=1"><img class="size-full wp-image-14307 aligncenter" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/learning-to-draw-dentistry.jpg?resize=576%2C526&ssl=1" alt="" width="576" height="526" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/learning-to-draw-dentistry.jpg?w=576&ssl=1 576w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/11/learning-to-draw-dentistry.jpg?resize=300%2C274&ssl=1 300w" sizes="(max-width: 576px) 100vw, 576px" data-recalc-dims="1" /></a></p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/11/dental-art.html/">Dental art</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1133955623211056490.post-90339108013227107762019-10-25T13:39:00.001-07:002019-10-25T13:39:30.415-07:00Pulp cap<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pulp-cap.jpg?fit=421%2C213&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What is a dental pulp cap procedure?</h1>
<p>Dental pulp cap is the partial removal of the dental pulpal tissue and placement of a restorative material over the top of the exposure.</p>
<h2>Historically there are several pulp capping materials but today MTA and Biodentine dominate the direct pulp cap research</h2>
<p>Calcium hydroxide was traditionally the product choice, but that is no longer the case. The MTA family and other <a href="https://www.bauersmiles.com/2018/02/bioactive-dental-materials.html/" target="_blank" rel="noopener noreferrer">bioactive materials</a> dominate pulp capping today.</p>
<div id="attachment_14265" style="width: 431px" class="wp-caption aligncenter"><a href="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pulp-cap.jpg?ssl=1"><img aria-describedby="caption-attachment-14265" class="wp-image-14265 size-full" title="Dental pulp cap bioactive material" src="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pulp-cap.jpg?resize=421%2C213&ssl=1" alt="Dental pulp cap bioactive materials are the best." width="421" height="213" srcset="https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pulp-cap.jpg?w=421&ssl=1 421w, https://i0.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pulp-cap.jpg?resize=300%2C152&ssl=1 300w" sizes="(max-width: 421px) 100vw, 421px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14265" class="wp-caption-text">Dental pulp cap bioactive material RRM Paste</p>
</div>
<h2>MTA capping procedure steps</h2>
<p>Post-Exposure</p>
<ol>
<li>5% NaOCl for 3 minutes. If bleeding does not stop then complete pulpotomy or RCT. Currently I prefer hydrogen peroxide. This is less harmful to the pulp but the downside is that it impacts bonding negatively.</li>
<li>Mix MTA or Biodentine and place thin layer</li>
<li>TheraCal LC over that and cure</li>
<li>Selective etch technique with gluma after etch</li>
</ol>
<p>Alternatively one with the proper equipment can try the <a href="https://decisionsindentistry.com/article/cryotherapy-vital-pulp-treatment/" target="_blank" rel="noopener noreferrer">cryotherapy method</a> for pulp capping. Ice shavings are left on the pulp/tooth for 60 seconds. Following this we irrigate with EDTA for 60 seconds. This has several advantages over NaOCl, but EDTA tends to aggravate the tissue and cause bleeding again. However, the cryotherapy seems to suppress the bleeding issue.</p>
<h3>What are pulp capping failure symptoms?</h3>
<p>The symptoms are the same as those that a tooth exhibits when in need of a <a href="https://www.bauersmiles.com/wheaton-root-canal/" target="_blank" rel="noopener noreferrer">root canal</a>.</p>
<h4>What is the cost?</h4>
<p>We currently do not charge for the procedure. Most offices can and should. We are an entirely fee for service office so we can set out basic filling gfee high enough that it covers the costs when this occurs. In-network dentists should charge extra for this. The fee for your zip code is under <span class="ILfuVd"><span class="e24Kjd">D3110 on <a href="https://www.fairhealthconsumer.org/" target="_blank" rel="noopener noreferrer">fair consumer</a> website.</span></span></p>
<h4>What is the ADA dental code for a direct cap?</h4>
<p>The ADA dental code for direct pulp capping is <span class="ILfuVd"><span class="e24Kjd">D3110</span></span>.</p>
<h4>Direct vs indirect</h4>
<p>The indirect pulp cap is something that has spotty evidence and is irrelevant with most modern bonding and desensitizing techniques.</p>
<h4>Pulp capping vs root canal</h4>
<p>It is our opinion that more meticulous dentists following proper protocols can get away with pulp capping and those that are not will need to jump straight to the root canal.</p>
<h2>Research on MTA pulp cap procedure</h2>
<p>Basic MTA is being beat by the more modern bioactive materials in some of the research.</p>
<p>MTA vs Biodentine both similar but MTA stains more. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28807371" target="_blank" rel="noopener noreferrer">Linu 2017 JOE</a></p>
<p>Can bond immediately over MTA <a href="http://www.jendodon.com/article/S0099-2399%2813%2900546-3/abstract" target="_blank" rel="noopener noreferrer">Tsujimoto 2013</a></p>
<p>MTA = Endocem but only 3 month study <a href="http://www.jendodon.com/article/S0099-2399%2814%2900868-1/abstract" target="_blank" rel="noopener noreferrer">Song JOE 2015 Jan</a></p>
<p>MTA=Biodentine <a href="https://www.ncbi.nlm.nih.gov/pubmed/28216271" target="_blank" rel="noopener noreferrer">Katge 2017 JOE</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/30292451" target="_blank" rel="noopener noreferrer">Awawdeh 2018 JOE</a></p>
<p>MTA=CH but Biodentine better <a href="https://www.ncbi.nlm.nih.gov/pubmed/28917577" target="_blank" rel="noopener noreferrer">Brizuela JOE 2017</a></p>
<p>Biodentine better than MTA <a href="https://www.ncbi.nlm.nih.gov/pubmed/31030980" target="_blank" rel="noopener noreferrer">Wattanapakkavong JOE 2019</a></p>
<h4>Calcium hydroxide research for direct pulp caps</h4>
<p>MTA beats CH <a href="http://www.jendodon.com/article/S0099-2399%2814%2900655-4/abstract" target="_blank" rel="noopener noreferrer">Mente JOE 2014</a></p>
<p>Review MTA better than CH <a href="http://www.nature.com/ebd/journal/v17/n3/full/6401194a.html?WT.ec_id=EBD-201609&spMailingID=52584547&spUserID=NDM4NDI5Mzk5NTES1&spJobID=1024063755&spReportId=MTAyNDA2Mzc1NQS2" target="_blank" rel="noopener noreferrer">EBD 2016 <span class="vcard"><span class="author fn">Rasaratnam</span></span></a></p>
<p id="aug">Meta-analysis – Appears to me that MTA is the best but “not statistically significant”. <a href="http://www.nature.com/ebd/journal/v15/n4/full/6401056a.html?WT.ec_id=EBD-201412" target="_blank" rel="noopener noreferrer"><span class="vcard"><span class="author fn">Ahmed Elkhadem</span></span> and <span class="vcard"><span class="author fn">Inas Sami</span></span> 2014 EBD</a></p>
<p>Meta-analysis – MTA better than CH <a href="http://www.jendodon.com/article/S0099-2399%2815%2900381-7/abstract">Zhaofei Sept 15</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/30098704" target="_blank" rel="noopener noreferrer">Didileschu JADA 2018</a></p>
<h4>Direct pulp Cap DPC info and more research</h4>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25443279" target="_blank" rel="noopener noreferrer">Jang JOE Aug 2015</a><br />
ProRoot MTA = Endocem<br />
Class V DPC less successful</p>
<p>ProRoot MTA = calcium silicate-based cement<br />
Endocem = fast-setting pozzolan-based MTA<br />
Biodentine = calcium silicate based<br />
RetroMTA = 60-80wt% calcium carbonate, calcium zirconia 20-30%, silicon dioxide 5-15%, aluminum oxide 5-10%<br />
TheraCal = resin-modified calcium silicate liner type III portland cement 45 wt%, resin 40%, radiopacifier 10%, silica 5%</p>
<p>Biodentine = MTA > CaOH2 > Bonding agent at forming dentin Human trial good study <a href="http://www.ncbi.nlm.nih.gov/pubmed/26031301" target="_blank" rel="noopener noreferrer">Nowicka JOE Aug 2015</a></p>
<p>ProRoot MTA=RetroMTA>TheraCal dog study in calific barrier formation and lack of inflammation <a href="http://www.jendodon.com/article/S0099-2399%2815%2900342-8/abstract" target="_blank" rel="noopener noreferrer">http://www.jendodon.com/article/S0099-2399%2815%2900342-8/abstract</a>Lee JOE Aug 2015</p>
<h2>Pulpotomy</h2>
<p>Biodentine and MTA beat Theracal likely <a href="https://www.ncbi.nlm.nih.gov/pubmed/29032813" target="_blank" rel="noopener noreferrer">due to resin</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28822566" target="_blank" rel="noopener noreferrer">Bakhtiar JOE 2017</a></p>
<p>MTA beats Biodentine, formocresol and ferric sulfate in terms of radiographic success but clinically there are equal. <a href="https://www.ncbi.nlm.nih.gov/pubmed/31202439" target="_blank" rel="noopener noreferrer">Meta-analysis JADA Shafee 2019</a></p>
<p> </p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/10/pulp-cap.html/">Pulp cap</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-46826385113282604482019-10-02T15:39:00.001-07:002019-10-02T15:39:23.193-07:00Dental pins<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?fit=1109%2C328&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">Dental pins for crowns and fillings</h1>
<p>Dental pin use is way down with the widespread us of <a href="https://www.bauersmiles.com/general-dentist-wheaton-cosmetic-dentist/composite-fillings/" target="_blank" rel="noopener noreferrer">composite bonding</a>. However, there is still a place that they can be useful.</p>
<h3>Dental pins for crowns</h3>
<p>This is probably the most common use today. There are times when a tooth has almost no real structure left, yet there is still enough to put a <a href="https://www.bauersmiles.com/general-dentist-wheaton-cosmetic-dentist/dental-crown/" target="_blank" rel="noopener noreferrer">crown</a> on it. The tooth structure that is left is not the most ideal for bonding and is certainly fair worse than clean enamel. The patients that get these are often older patients that already a crown on the tooth that was lost. The advantage of old age in this case is we are far less likely to hit a pulp. Putting in a few dental pins can make an unrestorable tooth restorable again.</p>
<div id="attachment_14205" style="width: 1119px" class="wp-caption aligncenter"><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?ssl=1"><img aria-describedby="caption-attachment-14205" class="wp-image-14205 size-full" title="Dental pins for crown" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?resize=1109%2C328&ssl=1" alt="Dental pins for crown " width="1109" height="328" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?w=1109&ssl=1 1109w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?resize=300%2C89&ssl=1 300w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?resize=768%2C227&ssl=1 768w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-crown.jpg?resize=1024%2C303&ssl=1 1024w" sizes="(max-width: 1000px) 100vw, 1000px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14205" class="wp-caption-text">4 dental pins in a tooth for a crown build up.</p>
</div>
<h3>What about dental fillings?</h3>
<p>Pins were far more popular in the days of amalgam fillings. Today few dentists will use a pin to place a filling. I imagine those dentists left that place very large amalgam fillings still use pins frequently, but their numbers are declining. Dentists also would use a pin to retain a front white filling. They seem to hold up well also.</p>
<h4>How are dental pins different than dental posts?</h4>
<p>Dental pins are much smaller and we insert them into the peripheral tooth structure. Whereas, dental posts are larger and dentists insert them into the central area of a tooth where the nerve was. We place dental posts in teeth with root canals. Pins can go in either teeth with or without root canals.</p>
<h2>What is the dental code for dental pins?</h2>
<p>There are 2 dental codes when using a dental pin. The most common dental code that dentists use that relates to dental pins is D2950. D2950 is a core buildup, including any pins that we require. The other dental code is D2951. That code is pin retention, is per tooth, and is in addition to the fillings itself.</p>
<div id="attachment_14204" style="width: 710px" class="wp-caption aligncenter"><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-build-up.jpg?ssl=1"><img aria-describedby="caption-attachment-14204" class="wp-image-14204 size-full" title="Dental pins for a crown build up." src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-build-up.jpg?resize=700%2C329&ssl=1" alt="Dental pins for a crown build up dental code" width="700" height="329" srcset="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-build-up.jpg?w=700&ssl=1 700w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/10/dental-pins-for-build-up.jpg?resize=300%2C141&ssl=1 300w" sizes="(max-width: 700px) 100vw, 700px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14204" class="wp-caption-text">Same tooth as above, after the build up was done.</p>
</div>
<h4>Dental pin complications</h4>
<p>The biggest complication we see is that the pin does not go where we want it to go. There are two spots where it can go that are not ideal. The first being into the pulp chamber. The likelihood of a <a href="https://www.bauersmiles.com/wheaton-root-canal/" target="_blank" rel="noopener noreferrer">root canal</a> in the near future of a tooth like that is close to 100%. The second place is perfing out the side of the tooth. Amazingly most dentists have one or two of these in their practice and they are just fine. So while it is far from ideal, it it often not that serious for the tooth.</p>
<p>Another complication of pins is that they increase the likelihood of fracture in that area. We also call dental pins, retentive pins because they help retain the build up. However, while we do improve the retention rate we also increase the fracture rate. There is plenty of support to the widely held view that pins, although helpful in the retention of a large filling, act as a source of weakness within the restoration. <a href="https://www.jopdentonline.org/doi/pdf/10.2341/1559-2863-25-5-1#page=38" target="_blank" rel="noopener noreferrer">Burke 2000 page 38</a></p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/10/dental-pins.html/">Dental pins</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-65037913417418677072019-08-15T11:16:00.001-07:002019-08-15T11:16:39.540-07:00Yellow spot on tooth<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/yellow-spot-on-tooth.jpg?fit=857%2C240&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h2 style="text-align: center;">Do you have a yellow spot on your tooth?</h2>
<p>A yellow spot on your tooth is definitely something that a dentist can fix for you.</p>
<h3>What is the yellow spot?</h3>
<p>If it has always been there then there is a good chance it is enamel <a href="https://www.bauersmiles.com/2013/02/enamel-hypomineralization-treatment.html" target="_blank" rel="noopener noreferrer">hypominerlization</a>. However, if the yellow stain is newer than it is likely a stain or a <a href="https://www.bauersmiles.com/general-dentist-wheaton-cosmetic-dentist/composite-fillings/" target="_blank" rel="noopener noreferrer">white filling</a> whose color is now off. If it is just a stain a dental hygienist may be able to remove with a good dental cleaning and polishing. If it a composite filling the dentist may be able to polish it back.</p>
<h3>Things that cause fillings and teeth to stain yellow.</h3>
<p>Hypomineralization forms at <a href="https://www.ncbi.nlm.nih.gov/pubmed/11310241" target="_blank" rel="noopener noreferrer">very young ages</a> and there are various likely culprits. The why for those is not very important. As for stains, one thing that causes really bright yellow staining is <a href="https://www.bauersmiles.com/2017/07/turmeric-stain-teeth.html/" target="_blank" rel="noopener noreferrer">turmeric</a>. That is not nearly as common as the other major causes though. The major ones are smoking, coffee, and tea.</p>
<h2>How do we fix teeth with a yellow spot?</h2>
<p>Well if polishing it does not work then we will often place a composite over the area. This is a fairly cheap, in dental terms anyway, procedure and if the area is small can be done without numbing.</p>
<div id="attachment_14123" style="width: 867px" class="wp-caption aligncenter"><a href="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/yellow-spot-on-tooth.jpg?ssl=1"><img aria-describedby="caption-attachment-14123" class="wp-image-14123 size-full" title="Yellow spot on tooth" src="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/yellow-spot-on-tooth.jpg?resize=857%2C240&ssl=1" alt="Yellow spot on tooth fixed with white filling. " width="857" height="240" srcset="https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/yellow-spot-on-tooth.jpg?w=857&ssl=1 857w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/yellow-spot-on-tooth.jpg?resize=300%2C84&ssl=1 300w, https://i2.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/yellow-spot-on-tooth.jpg?resize=768%2C215&ssl=1 768w" sizes="(max-width: 857px) 100vw, 857px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14123" class="wp-caption-text">We remove the yellow spot and place a white filling.</p>
</div>
<h4>What is the cost to fix a yellow spot?</h4>
<p>Well if there is just one and it is small then a white filling will take care of it. The costs range from a few hundred to maybe 5 or 6 hundred, depending on the size of the area. Very large areas, often back teeth, may need a crown. Crowns cost significantly more and can run up to around $2,000. Many people will unfortunately have at least 4 teeth that have stains if the stain is from hypomineralization.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/08/yellow-spot-on-tooth.html/">Yellow spot on tooth</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1133955623211056490.post-23417562353993367442019-08-15T00:16:00.001-07:002019-08-15T00:16:21.418-07:00Root resection and hemisection<p style="float: right; margin: 0 0 10px 15px; width:240px; height: auto;"><img src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/root-resection-crown-prep.jpg?fit=493%2C592&ssl=1" width="240" style="max-width: 100%; height: auto;" /></p>
<h1 style="text-align: center;">What is a root resection and a hemisection?</h1>
<p>Root resection and hemisection are often found online together because the procedure itself is similar. however, the reason for using either treatment is very different.</p>
<h2>What’s a root resection?</h2>
<p>A root resection is the surgical removal of one root of a tooth, leaving the healthy root of the tooth behind. This is most often done with upper molars when the MB2 is not found and a <a href="https://www.bauersmiles.com/wheaton-root-canal/" target="_blank" rel="noopener noreferrer">root canal</a> fails. Often an <a href="https://www.bauersmiles.com/2012/06/apicoectomy.html/" target="_blank" rel="noopener noreferrer">apicoectomy</a> was unsuccessful and this is a resection of the root is the last chance to save the tooth.</p>
<p>A tooth that has a root resection will need a new crown and the design can be tricky. There will be a deep indentation in the area.</p>
<div id="attachment_14101" style="width: 503px" class="wp-caption aligncenter"><a href="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/root-resection-crown-prep.jpg?ssl=1"><img aria-describedby="caption-attachment-14101" class="wp-image-14101 size-full" title="root resection crown prep" src="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/root-resection-crown-prep.jpg?resize=493%2C592&ssl=1" alt="Crown prep of tooth with a root resection." width="493" height="592" srcset="https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/root-resection-crown-prep.jpg?w=493&ssl=1 493w, https://i1.wp.com/www.bauersmiles.com/wp-content/uploads/2019/08/root-resection-crown-prep.jpg?resize=250%2C300&ssl=1 250w" sizes="(max-width: 493px) 100vw, 493px" data-recalc-dims="1" /></a>
<p id="caption-attachment-14101" class="wp-caption-text">Images of a tooth with a root resection and the crown prep and crown for the tooth.</p>
</div>
<h2>What’s a hemisection of a tooth?</h2>
<p>A hemisection is when we surgically cut a two into individual roots. This may result in the removal of a tooth root, which is then a resection. We do this most often on lower molars with periodontal disease. By creating two teeth we can often make the area more cleansable for a patient. When the patient can clean the teeth better, we extend the life of a tooth. This procedure has become so out of date that I am fairly certain I have not seen one in 15 years of practice. Pre-dental implant that would not have been the case.</p>
<h3>When do we do a hemisection or a root resection?</h3>
<p>The answer to this is in each what is section above. However, with the advent of <a href="https://www.bauersmiles.com/dental-implants/" target="_blank" rel="noopener noreferrer">dental implants</a> and their gain in popularity both of these procedures are far less common. Going <a href="https://www.ncbi.nlm.nih.gov/pubmed/9638002" target="_blank" rel="noopener noreferrer">back to 1998</a>, there was already literature review showing a dental implant is better. It is difficult today to say that there are very many instances where doing these procedures still makes a lot of sense. There exist two instances where we think they are still useful. First of all is for very old patients that need 10 years or less from a tooth. Secondly would be for patients that really want to maintain their own teeth. Dental implants are simply far more predictable today and likely less expensive in the long run.</p>
<p>The post <a rel="nofollow" href="https://www.bauersmiles.com/2019/08/root-resection-hemisection.html/">Root resection and hemisection</a> appeared first on <a rel="nofollow" href="https://www.bauersmiles.com">Wheaton Orthodontist, Dentist, Pediatric Dentist</a>.</p>
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