Fractured Cusp/Onlay - Laser Dentistry Forum

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June 7, 2003 at 3:02 am #10704 Reply

Robert Gregg
Participant

Jeff–

Very nice appearance of tissue, tooth and restoration!

What sort of camera did you use?

Bob

June 7, 2003 at 3:08 am #10708 Reply

Swpmn
Spectator

Jeff:

Nice case!!!! Nd:YAG troughing looks great with no charring. Was your “goom” sore the next day?

Did Dr. Leigh use the Opus Er:YAG to remove that old composite?

Speaking of sitting on the other side of the chair, guess who this is?

Al 😉

June 7, 2003 at 1:38 pm #10702 Reply

Glenn van As
Spectator

Jeff: thanks for sharing a nice conservative technique for us to see……..

I dont like doing these kinds of preps because in my hands inevitably an unsupported cusp fractures off (MB for instance) but you have done it well. I dont believe the bonding strengthens the tooth so much.

ANother question, why Panavia F which is so opaque for such a case. I think an alterantive would be a resin cement such as Variolink or Calibra or something translucent which would have made your margins less noticeable because they do stand out.

Again in closing , thanks for sharing the case, and dont think I am being too picky ( I didnt talk about biologic width yet did I )

Grin

and thanks

Glenn

June 7, 2003 at 2:44 pm #10699 Reply

Benchwmer
Spectator

Glenn,
The new Panavia Light cement is a resin cement dual cured with a dual cured dentin bonding agent. Self-etching, all in one prime and bond. Acceptable color for posterior onlays. Never any post-sensitivity. This was bonded w/o using any local. Great stuff.
Dr. Leigh wanted to do a crown on #30, (Ivy Leaguer).
I’ve been doing indirect composite onlays now for 12 years, never shoeing cusps, you have to believe in bonding. Of the thousand onlays, maybe a dozen fractured cusps over these years. Those you can repair w/ Air abrasion and more bonding. This is the third one Dr. Leigh has done for me in the last 4 years. All wonderful. No post-op discomfort at all after being lased.
Bob,
The photos are using a 20-year old, 35mm Nikon 6000, w/ Lester Dine ring light, Fugi slide film, scanned w/ HP Photo-Smart S20. These were taken using a mirror.
Thanks.
Jeff

June 7, 2003 at 2:52 pm #10706 Reply

Robert Gregg DDS
Spectator

Hi Jeff,

I end up in your camp about bonding these sorts of restorations.

I started bonding with DICORs in 1985, and after figuring out it was the poor occlusion that caused my problems, I now have complete confidence in my posterior inlays like this.

But I have EVERY crown, inlay whatever patient back for a one week post-op check to look at their bite on the new restoration. AMAZING what shows up ay 1 week that didn’t at the seat appt.

Bob

June 7, 2003 at 4:03 pm #10700 Reply

Benchwmer
Spectator

Bob,
Using LA and acid etch I used to need frequent follow-up occlussal adjustments. Now that I can seat most of these onlays without using LA and acid-etching, I see better occlussal results and almost no sensitivity.
Jeff

June 7, 2003 at 4:19 pm #10703 Reply

Glenn van As
Spectator

Hi Jeff: thanks for the update……I will maintain that I dont like the opaque color for posterior white onlays or inlays………for gold ok but that is your choice.

As for the bonding , I am glad you are getting those kind of results , I dont. My experiences with bonded indirect resins hasnt been very good. Same kind of results as with Targis Vectris which sucked in my hands.

I applaud your efforts and photography.

Thanks

Glenn

June 10, 2003 at 12:23 am #10705 Reply

Robert Gregg
Participant

Hi Glenn and Jeff,

Since we are on the subject of ceramics in posterior teeth, I thought you might want to look at one on an upper left first molar “DO”. Place in 1992, this is an 11 year old “DICOR” that I photographed today on exam.

[img]https://www.laserdentistryforum.com/attachments/upload/VickiDICOR1.JPG[/img]

I can polish or abrade that margin down and/or remove the stain/decay and reseal if I want to. I didn’t.

[img]https://www.laserdentistryforum.com/attachments/upload/VickiDICOR3.JPG[/img]

Was this, is this a good service? Not very opaque, as I barely noticed the inlay under 20:20 view

Did this restoration hold up? Did it “restore” the tooth? Did it “protect” the tooth from secondary fractures? Is it easier to see stain or decay here than with a gold margin? Did it not fracture itself? I answered YES to all those questions.

Bob

June 10, 2003 at 1:17 am #10701 Reply

Benchwmer
Spectator

Glenn,
Panavia F Light is not the old Panavia used for Maryland bridges, it’s a new formulation, dual cured, tooth colored, about a (A3), comes w/ ED self prime and bond system.
Bob,
Still looks good. I only used Dicor for full crowns, always composite for onlays, like the way it adjusts, polishes, doesn’t wear opossing teeth.
Here is a case from 1994:

Both done at same time one gold, one Herculite Lab XRV
Now:

I’m happy with both 10 year old onlays.
Jeff

June 10, 2003 at 3:21 pm #10707 Reply

Robert Gregg DDS
Spectator

Jeff,

DICOR only wore opposing teeth of you put feldspathic porcelain externally for shade.

I always used unshaded and unglazed DICOR and the abrasiveness was nearly identical to enamel.

Take a look at the pictures above. It’s the ceramic that is wearing!

I obtained my coloration from the resin cements I used. Ray Bertoloti once told me that I was the first he had heard doing that. I told him I learned it from him. He said he’d never heard of it. That was 1987…..

Bob
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