presents - edmonton and district dental society * less wear resistance than composites amalgam vs....

PRESENTS

FRED S. MARGOLIS, DDS, FICD, FACD, FADI

Esthetic Dentistry

for Tots & Teens

ESTHETIC DENTISTRY

FOR PRIMARY TEETH

Fred S. Margolis, D.D.S., F.I.C.D., F.A.C.D.

Early Childhood Caries

3 year old boy took a “Sippy Cup”

to bed and slept with the cup at

night for over 18 months.


“My teeth are dirty.” – Alex N.

“The other kids are saying his teeth

are dirty; ‘why are your teeth black?’;

‘you look like a monster!’ “For no

other reason, just get it done for

that.” Alex’s mother

CREATING SMILES

SEEMS LIKE MAGIC

AAPD Directory 2006

OPEN FACED

STAINLESS STEEL CROWNS

OPEN FACED

STAINLESS STEEL CROWN

Try-in of Stainless Steel CrownStep-by-Step Procedures:

Crown Try-in

Open Faced SSC

OPEN FACED


1) Try-in Stainless Steel Crown:

2) Open Face of Crown

3) Cement Crown to Tooth

OPEN FACED


Remove Facing of Crown

Note: Gingival Margin Intact

OPEN FACED STAINLESS STEEL CROWNS

Remove Facing

of Crown

Note: Gingival

Margin Intact

OPEN FACED STAINLESS

STEEL CROWNS

Remove

Facing of

Crown

Note: Gingival

Margin Intact

Abby J. Age 5

Tooth #’s K, L – SSC’s

SSC Cement

Courtesy Fred Margolis, DDS

OPEN FACED


Etching the Enamel and/or Dentin:

37% Phosphoric Acid for 15 seconds

Open Face SSC Technique

Bonding Agent Dentsply TPH3

Composite

OPEN FACED


Finish and Polish the Composite Facing

Sarah D. Age 10

Open-Face SSC

2 years post-op.

The PedoNatural CrownTM

Because Children Need To Smile!

Esthetic Full Coverage Restoration for the

Primary Dentition

The PedoNatural CrownTM

Because Children Need To Smile!

Esthetic Full Coverage Restoration for the

Primary Dentition www.PedoNaturalCrown.com


Case Study:

Peder H. Age at first visit 19 mos.

March 2002

Diagnosis: “Nursing Caries”

Nursing Caries: Labial View

Nursing Caries: Lingual View

Before

After

March 2002

• Initial Oral Examination revealed:

Facial and Lingual Caries #’s D,E,F,G

Tx: Preventive: Fluoride Varnish placed

by FSM

Rx: 1.1 % Sodium Fluoride Gel to be

brushed on once daily.

Recommendation: Stop Night-time

Nursing-At-Will

June 2002: Same tx as on

March 2002

Sept. 2002 : Age 2 y. 3 mos.

Patient had been weaned

off of nursing.

Same tx as above.

Feb. 2003: Exam, Oral

Px, Fluoride tx.,

Fluoride varnish

May 2003: Fluoride

Varnish

August 2003: Fluoride

Varnish

December 2003: Exam

to discuss tx plan:

Discussion included

conscious sedation.

January 2004

Age 3 ½ y.o.

• #D,E,F,G Acid-etch

composite with Celluloid

Strip Crowns

• Restorative Materials:

Fuji II and Prismafil L

• Patient sat on Mom’s lap

and NO Anesthetic used

to prepare teeth.

March 2004

• First post-op visit

• Oral exam,

Px,Fluoride Tx

Mother’s e-mail to office:

Peder is so happy with his new

smile. As soon as we left your

office the day he had his teeth

fixed he said, over and over, "I

LOVE my new teeth!" and "I look

GREAT!" We gave him a little

mirror to carry around the house

those first few days and he would

admire his teeth and comment on

how beautiful he looked. He

smiled and still smiles for friends

and strangers alike saying "Look

at my new teeth; don't I look

great?!" Thank you for helping

Peder so much and for treating

him with such gentle care and

respect. Janelle H.

Peder and Mother

CREATING SMILES with

Celluloid Strip Crowns and

Prismafil TPH Composite

Can we improve

this 4 year old girl’s

esthetics and self-image?

4 year old female


by Fred S. Margolis, D.D.S.

Jenna J. Early Childhood Caries

Waterlase MD for Caries

Removal and Laser Analgesia

Sandwich

Technique

• Caries

Removal

• GI or Resin-

modified GI

• Etch 37%

Phosph. Acid

15 secs.

• Bonding

Agent

Labial View

Lingual View

Jenna J.

Post- Strip Crowns

Jenna’s New Smile

Tooth

Brushing

Chart

Step-by-Step Technique

Try-in Crown Form Trim Crown Form

Holes for

venting

Composite into Crown Form

Etch Bonding Agent

Curing Light

Excess Composite

Removed

Strip Crown Removed

Finishing and Polishing

Before

After

Celluloid Strip Crowns

for Fractured Primary Teeth

Sammy D. Age 4

Class III caries # F, Class V caries # G

Tooth # F –ML; #G- L

Preparations with Waterlase MD

# F- Celluloid Strip Crown

with TPH Composite

# G- TPH composite

Benedict M. Age 3


Sandwich Technique

Fuji II LC

Sandwich Technique

What materials bond to dentin ?

Glass Ionomers

Resin Modified Glass Ionomers

Benedict M. Age 3


Waterlase MD

No Anesthetic

Resin

Modified

GI

Etch

Bonding

Agent

Bonding Agent

OptiBond® Solo Plus™ is a

single-component dental

adhesive designed for both

direct and indirect bonding

applications.

15 second application

Placement of Composite

Etching Enamel

37% Phosphoric Acid

15 Seconds

Light Curing the Composite

5 sec. cure

Demi Plus

Removing the Celluloid Strip

Benedict M. Age 3


3 year old – Class III caries

#E,F M-F caries

No Anesthetic

Erbium Laser Preparation

Completed Restorations

V.S. Age 6 Tooth #H-F

No Anesthetic Waterlase MD

Courtesy Fred Margolis, DDS November 2011

“Blue View” Cervical

Matrix


Composite Restoration


Class V Caries Removed

Etch Bonding

Agent

Placement of Composite

Contouring Composite

Cure - Thru Form

Finishing of Restoration

ET 8.5

# 8392-016

Polishing of Restoration

Finished Restoration

Akhil Age 4

#N-MF caries

Waterlase MD

No Anesthetic

Riley C. Age 3

Caries #P-DF; #Q-MF

Today’s Clinical Goals

A restorative material with:

• Proven Performance

• High polish (initial and lasting)

• Lifelike esthetics

• Strong physical properties

• Excellent handling for universal

applications

Herculite Ultra!

• Highest Esthetics

• Proven Clinical

Performance

• Superior Polish

• Optimum Handling

• Exact Vita Shade Match

• Increased Radiopacity

5 y.o. Male - Fractured

Primary Lateral Incisor

Celluloid Strip Crown

Maxillary Left/Lower Right

Try-in of Celluloid Strip Crown

Etch, Bonding Agent,

Strip Crown with Composite

Completed Restoration

Dentsply’s TPH-3 Shade X-L

Natalie S. Age 3

COMPOSITE VENEERS

Dark Primary Incisor

Acid-etch 37% phosphoric acid;

Opaquer; Bonding Agent; Prismafil TPH

Aprismatic or

Non-Prismatic Enamel

What is different about the

enamel in primary vs.

permanent teeth?

Gretchen C. Age 3

Composite Veneer #E

Waterlase MD used to remove

Aprismatic Enamel prior to bonding

Veneers for Dark Primary Incisors

Opaquer: White

Composite: Dentsply’s X-L TPH

Opaquers

Composite to Stainless Steel Crowns

Pre-fabricated

NuSmile Crowns

Available for ALL Primary Teeth

# E,F NuSmile Crowns

3 weeks after seating

3 year old- Early Childhood Caries

22 month old female

Nursing Caries

#’s E,F

Strip

Crowns

#D,G

NuSmile

Crowns

Jenna H. Age 3, CP

NuSmile Crowns 1 year post-seating

Jenna H. 4 yo female, CP

NuSmile Crowns

Seated 18 months ago

www.nusmilecrowns.com

Fischer R. Age 2yrs. 11mos.

Nursing Caries #’sD,E,F,G

Preparation for NuSmile

Crowns

NuSmile Crowns

Cemented

Milo C. Age 3

9 months after seating

NuSmile Crowns

Composite to Stainless Steel Crown

Nu-Smile- 5 months

WE TRY OUR BEST:

SOMETIMES IT’S NOT ENOUGH

NuSmile Crown Prep


Trimming off excess

composite Mesial & Distal

NuSmile Crown

Lower Left 2nd

Primary Molar

NuSmile Crown

30 months post-seating


The truth about

Chocolate

Chocolate is extracted from the beans of the cocoa plant.

Beans are a vegetable!

Sugar is extracted from sugar beat.

Sugar beat is a vegetable!

Therefore

Chocolate

is a vegetable !

Let´s spin the theory further...

Chocolate bars contain milk

Therefore

chocolate bars

are healthy!

Raisins, cherries, orange peel and strawberries in chocolate belong to the fruit family, so...

Eat as much as you like!

Chocolate is good for stress

Just think...

"STRESSED“ read backwards means:

"DESSERTS"

Amalgam vs. Compomer

COMPOMERS

ADVANTAGES

* Releases Fluoride

* Smooth Surface

* Excellent

Polishability

* Ease of Handling

* Highly Translucent

* Excellent Marginal

Adaptation

DISADVANTAGES Weaker than Composites *Less Wear Resistance than Composites

Amalgam vs. Compomer

• “…compomer appears to be a suitable

alternative to amalgam for proximal

restoration in primary molars of young

children for use in general dental practice.”

• Each restoration was evaluated…for 24

months The evaluation included wear,

surface texture, recurrent decay, marginal

integrity, and retention.

Duggal, MS, et al. Clinical Performance of a

Compomer and Amalgam for the

Interproximal Restoration of Primary

Molars: A 24-Month Evaluation. Br Dent J

2002; 193 (Sept.): 339-342

Preparation for Class II

Compomers in Primary Teeth

Dyract Compomer for

Class II Restorations

“Sandwich Technique”

for Posterior Primary Molars

Class II prep Compomer Composite

Completed Restoration

Cassandra Age 5

#S- DO Caries

Radiographic View Clinical View

Class II Preparation #S-DO

Proximal Slow Speed Compomer

Box HP + Restoration

Spoon Excavator

Tooth # J

Class II MO-DO

Tooth # A-MO; #B-DO

Note: Waterlase MD Turbo HP

Isolite – Pedo Size

Patient Age 5

Courtesy Fred Margolis, DDS

CLEARFILTM SE Protect

Provides Antibacterial & Fluoride releasing

functions for Minimally-Invasive direct restorations.

Kuraray Clearfil SE Protect

Kuraray releases SE

Protect in January 2010

that is exactly same

formula as Clearfil Protect

Bond. It is 2 step self etch,

antibacterial and Fluoride

releasing adhesive.

* SE Protect provides such

unique benefits with a

comparable price against

the gold standard self-etch

adhesive, Clearfil SE Bond


Antibacterial Primer can

eliminate process of cavity

cleanser

-The primer has

antibacterial effect more

than major antibacterial

cavity cleanser.

Reduce cost and process

than use of cavity cleanser

- No need to concern

compatibility of adhesive to

cavity cleanser


Virtually no post-operative sensitivity Superior Bond Strength and Durability - SE Protect has better long-term durability

than SE Bond that were recently demonstrated in-vivo and in-vitro studies. - Bonding agent of SE Protect contains a

special coated NaF to release Fluoride for a few months after the bonding. Fluoride

makes formation of an anti-acid layer just under the bonding layer. Researchers said it might make greater long-term durability, but not just only caries prevention.

Excellent handling properties

・Easy handling.

・Bottle or single-dose applicator.

・Wide indications, same as with SE Bond.

・Cures with any type of curing unit.

Features of CLEARFIL S3Bond

CL

EA

RF

IL S

3 B

ON

D

Similar benefits to a flowable

• Low viscosity material to fill line

angles

• A2 shade to esthetically blend in

restoration

Vitrebond™ Plus

Class II Primary 1st

Molar

Preparation Cavity Conditioner Equia

Tooth #S-DO

Equia – GI restorative

Tooth # K- MO

BeautiBond Beautifil Flow Plus Beautifil II

Fred Margolis, DDS

Tooth # K- MO

Beautifil

Flow Plus

BeautiBond

Beautifil II

Fred Margolis, DDS

One-step Etch and Bond

•Apply for 10 seconds •Air-dry •Light Cure

Fred S. Margolis, DDS

Flowable Composite

•Release and Recharges Fluoride •Resists Bacterial Colonization •Excellent Esthetics and Durability •High Radiopacity


Composite

•Release and Recharges Fluoride •Nano-Hybrid Composite •Excellent Esthetics and Durability •High Radiopacity


Composite


Features Benefits

High bond strength to

dentin & enamel with

incorporated bonding

agent

Simplified procedure

with no separate

bonding protocol

Reduces chance for

human error due to

bonding protocol

Easy handling & non-

slumping, rheological

property

Superb ease of use/ease

of placement

Excellent marginal

integrity

Long-lasting margins,

reduced voids, low

sensitivity

Excellent mechanical

properties

Long-lasting and durable

High radiopacity Easy X-ray detection

Apply 15 seconds

Cure 20 seconds

Vertise Flow procedure

55 seconds, 3 steps

Vertise Flow reduces the number of procedural steps compared to using a two-step bonding agent with a traditional flowable.

Dispense & Cure 20 seconds

Time Savings and Ease of Use For small class I caries:

Tooth #K- Occlusal Caries

Fred Margolis, DDS

Fred Margolis, DDS

Sean S. Age 4 #K-O

Billy W. Age 11

Tooth # I- Distal-Occlusal

Caries

Preparation and Direct

Pulp Cap

“Complete” Bonding

Agent

“Complete” is a light-cure primer/ unfilled resin

Completed Composite

Fred Margolis, DDS

New Pediatric Matrix Bands

GDS Corporation

CLASS II Preparation and

Restoration of Primary Molars

with Compomer (Dyract)

1-800 811 3949

www.triodent.com

•Removes Carious Dentin Only

•Not Sound Dentin


Wedjets Cord

Flexidam Flexible Frame

Coltene-Whaledent

ANKYLOSED

PRIMARY MOLARS

Ankylosed Tooth # L

Etch, Bonding Agent, Composite

37% Phosphoric Acid

Sullivan-Schein Bonding Agent

Prismafil TPH Shade L

Ankylosed Tooth # L

Etch & Bonding Agent

One Step or Not?

3M/ESPE PROMPT-POP

Bruxism Mouthguards

Severe Bruxism

Stainless Steel Crowns on Primary Molars

Severe Bruxism

PREVENTIVE DENTISTRY Occlusal Sealants

Triage Sealant -Pink

• Glass Ionomer

• Pink and White Colors

• Good for Partially Erupted Molars

Sealants on Primary Molars

“Clinpro” 3M-ESPE

Ultraseal

Primary Molar

Etch 15 seconds

Rinse and Dry

Drying Agent

Apply Sealant

Light Cure

Sealant Evaluation

• Full Coverage of Pits and

Fissures

• Sealant Bonded Strongly

to Tooth

• Mechanical, Thermal, and

Chemical Strength

• Quick and Easy

Placement

• Easily Visible

Extrinsic Brown Stain

Nina L. Age 9

Etiology Unknown:

Suspected Tea Stain—Cultural

Pumice and Bristle Brush

to Remove Extrinsic Stain

Extrinsic Stain Removed

THE END!

Bonding Agent

OptiBond® Solo Plus™ is a

single-component dental

adhesive designed for both

direct and indirect bonding

applications.

15 second application

presents - edmonton and district dental society * less wear resistance than composites amalgam vs....

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