Dentistry by Dr Bez Shokouhi in Dee Why | Dentist & dental surgery

Dentistry by Dr Bez Shokouhi

Locality: Dee Why

Address: Coastal Smiles, 1/5 Dee Why Parade 2099 Dee Why, NSW, Australia

Website: http://www.coastalsmiles.com.au

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• Medical and health
• General dentist
• Dentist & dental surgery
• Cosmetic dentist

24.01.2022 Not a full protocol case, but a case to show how quite a decent result can be achieved by mixing and matching different materials by doing a bit of initial planning. Not every tooth has to receive the same type of restoration to make the treatment predictable or produce a satisfactory outcome. This patient has a combination of peg lateral incisors, mild microdontia and also hypodontia. Lots and lots planning and discussions were carried out at length, including the option of ...orthodontics. At this stage she chose not to pursue orthodontics, but with the option kept open and available for the future in case she changed her mind. She received a combination of composite veneers and crowns. She could, of course, have had porcelain veneers instead of composite. At this stage, a financial decision was made to have composite veneers, with the understanding that they can be changed to porcelain in the future if required. She has also had an implant placed at 26 and the implant crown has just been issued after these photos were taken. Apologies about the different lightings between the initial 3 set of photos and the final set of photos. The final set is taken using a new camera set up. There are more descriptions in the photos. If you enjoyed the content, please comment, like and share!

24.01.2022 A case of restoring worn lower anterior teeth using the Sausage Technique. Quite useful to gauge the incisal levels of all teeth from the get-go. Also quite time-saving compared to doing each tooth one at a time. This patient has already had Invisalign treatment and so had anterior restorative space planned and available. I’ve taken photos from both the front and from the occlusal surfaces.

23.01.2022 A page for sharing general dentistry cases, tips and tricks with other fellow dentists. If you enjoy the content, please comment, like and share! Tag any dental friends who may find the content useful.

23.01.2022 When it comes to indirect cuspal coverage restorations, I really only do two types of restorations: full coverage vertical preparation crowns, and bonded onlays (or crownlays as some would call them). I recently posted a case of a vertical preparation crown you can find the case here: Prior to doing vertical preparation crowns, for many years I was quite anti-crowns and pro-onlays. The reason is that I deemed onlays to be more conservative of tooth tissue compared to conven...tional crowns with horizontal margins. Conventional crowns, if prepared with heavy-handed reductions, can lead to various iatrogenic problems such as pulpitis, tooth weakening and catastrophic core fractures at gingival level. This is particularly true of smaller teeth such as premolars and small incisors. Onlays have been hugely successful in my practice with a very low rate of complications. I’m aware that there are those that still do not fully trust bonding to retain a non-retentive restoration, but in over 12 years of doing these restorations, I am aware of 2 debonds to the best of my knowledge. Those were attempts at bonding zirconia onlays, which I’m not hurrying to do again. However, I was also aware of the limitations of bonded onlays, such as the need for a mostly intact ring of good quality enamel to bond to, and also the extreme difficulty that could be encountered when trying to isolate certain teeth with deep subgingival margins prior to bonding. And that’s where I discovered and started doing vertical preparation crowns, which have been fantastic for those particular cases, and in my opinion overcome some of the problems of conventional crowns. When there is good enamel available, however, I will still do onlays. Currently I would say I am doing about 50:50 onlays and vertical preparation crowns. Here is a case of a typical e.max onlay procedure. This patient presented with a mildly symptomatic tooth 47 with a failing restoration and a distal marginal ridge crack line. The symptoms were consistent with cracked cusp syndrome. These cracks are dangerous and can lead to catastrophic vertical root fractures and pulpal symptoms, and so I am very pro-active in placing full-coverage restorations on them. My preference would have been for a cast gold onlay in this case, but the patient was vehemently opposed to the idea unfortunately.

21.01.2022 Another case of a fairly straightforward e.max onlay. This tooth has a good amount of circumferential enamel remaining and so bonding is very predictable. The only tricky aspect of the treatment was that on the mesiolingual aspect the margin was slightly subgingival, and so putting on the rubber dam to isolate the area at the time of bonding needed a small trick. You can see this in the photos. I’m aware of the caries in the 37 and the rough/ditched amalgam in the 35. I woul...d have preferred to restore all these teeth at the same time, but the patient has opted to restore 35 and 37 in a couple of months instead due to financial constraints. If you enjoyed this post, please like, comment and share!

20.01.2022 This patient presented with classic cracked cusp syndrome (CCS) on tooth 16 sharp sudden pain on pressure with hard foods, which disappeared as soon as the pressure was lifted. I often start such a procedure being fairly sure about whether I will be doing a bonded onlay restoration or a vertical preparation crown, depending on how much enamel is left, how good the quality of this enamel is, how much overall tooth structure is left and whether there are any deeply subgingiv...al areas. Sometime the initial plan has to change. In this case I was expecting to do a bonded e.max onlay, as I thought I would be having a good amount of enamel to bond to. After removing the existing restoration and having a good look, I found an unpleasant looking crack that went right through the mid-palatal and extended onto the cavity floor. I didn’t particularly want to chase this crack all the way subgingivally on the palatal side, but due to its aggressive appearance and the CCS symptoms I felt it may be safer to cover the crack as much as possible on the palatal aspect. Hence, I changed to the plan to a vertical preparation crown. Even though I don’t have the photo to show it, after the palatal preparation I could visualise the apical extent of the crack thankfully it stopped about 1-1.5mm subgingivally. The tooth was completely asymptomatic 2 weeks later at the issue appointment. The final photo is at 2 months review and the tooth is still asymptomatic. I’m sure there will be those who would have done an onlay in this situation and I would be interested to hear your opinions. Whenever a tooth has cracked cusp syndrome, it is essential to communicate to the patient that despite the treatment provided, there will always be some chance of future failure, such as the need for root canal therapy or extraction. In this case, the symptoms at presentation were mild, there was no pain on cold or heat, and no lingering pain, and so hopefully the risk of the above is quite low.

16.01.2022 Here is a case of a fairly straightforward class II restoration. One of my favourite things to use is PTFE tape which has so many uses in dentistry. This case demonstrates two simple but useful tricks that can be used every day. This patient presents with a failing composite restoration and secondary caries. The restoration is actually loose and moving. Amazingly the tooth is asymptomatic, and thankfully vital. Cold and electric pulp testing were done to confirm this.

15.01.2022 I’m presenting an interesting case here of a patient with a very thick biotype (apparently we should be saying phenotype now instead of biotype). Sometimes in patients with very thick tissues, a lot of the crown height of the posterior molars, especially second molars, is hidden under the gingivae. This could pose a dilemma if you’re trying to place a conventional crown on the tooth, because if you try to maintain a mostly equigingival crown margin, then the preparation heigh...t will be very short and have inadequate retention and resistance form. You could place the margin significantly subgingivally, but this creates its own problems as it can make preparation, impression taking and cementation very challenging. A vertical preparation crown allows for easier subgingival preparation and margin placement to achieve an adequate ferrule and prep height. Also, due to the smaller gap / geometry of vertical margins, these crowns tend to be very friendly to the gingivae and allow for excellent healing. In this patient, tooth 16 had deep caries which extended several mm subgingivally on the distal side. It was asymptomatic. Tooth 17 had mild cracked cusp syndrome symptoms, and hence the provision of an indirect cuspal coverage restoration. The reason that I opted not to do bonded emax onlays is that both teeth had very subgingival distal margins (on the 17 it was about 5mm subgingival), which would have been extremely challenging to properly isolate for bonding. Also, I had already seen the patient at another appointment a week earlier to remove the old 17 restoration and caries and place a composite core restoration. If you enjoyed this post, please comment, like and share!

12.01.2022 I don’t really like the term Vertiprep it seems to be a recent term coined quite randomly on Facebook. I personally prefer vertical preparation or even long bevel margin which apparently is the correct term as mentioned to me by a prosthodontist. Nevertheless I do say it out of habit and also because other people these days seem to understand what I mean. As most would also know, it’s nothing new and has been around for decades. It’s just had a bit of a resurgence and... renewed interest in the recent years. I’ve been doing them now for a few years, and have steadily become a big fan of them. For indirect cuspal coverage restorations, I basically either do onlays (emax or gold) when I have adequate enamel, and vertical preparation crowns (zirconia, gold, or occasionally PFM) when I don’t. There are several huge advantages of these types of crowns in my opinion: - The reduction in the peri-cervical dentine thickness (thickness of dentine at gingival level) is minimal. This is extremely significant for small teeth such as premolars and incisors, where traditional crown preparations can dangerously reduce the thickness at this area. How many times have you seen a premolar or lateral incisor crown fractured off with the core inside and the tooth unrestorable? - The vertical crown margin, if done well and accurately, is very friendly to periodontal health. This means that it is possible to have a vertical margin very subgingivally and attain excellent periodontal health. It is also much easier to do a vertical preparation subgingivally compared to a horizontal preparation. - This in turn means that for very damaged teeth, it can be remarkably easy to create a good amount of ferrule by doing deep subgingival preparations. There is quite a steep learning curve when doing vertical preparation crowns, but I think it is worth it. I have been amazed at how well you could use this technique to restore teeth that were otherwise pretty much unrestorable. Here is a typical case of a vertical preparation crown for a fractured tooth 25. More descriptions in the photos. If you enjoyed the content, please comment, like and share!

09.01.2022 In my recent post I mentioned the use of PTFE pellets. Here is a video of how to make them.

04.01.2022 Here is a routine case of side-by-side class II restorations in a quadrant. Even though cases like this are bread-and-butter dentistry, they require a lot of attention to detail and it is surprising how challenging they can be to achieve a satisfactory result. There are lots of ways to achieve a good result wedges, matrices, rings, etc. There are a few things that I believe are essential: good magnification and lighting, rubber dam, sandblasting, taking the time to ensure ...matrices and wedges are placed properly, and an immaculate bonding procedure with every step followed to the letter. All of this takes time and patience! More descriptions in the photos. If you enjoyed the content, please comment, like and share!

03.01.2022 As I’ve mentioned in some of my recent cases, when it comes to indirect restorations, I really just do either bonded lithium disilicate onlays or vertical preparation crowns (most of the time zirconia). It depends on the status of the tooth I’m working on, mainly on how much enamel is left, and whether there are deep subgingival regions. Here is a case where I have used both modalities on the same case. Tooth 35 was a definite vertical crown for me. For tooth 37 I briefly co...nsidered a vertical crown, but I went with an onlay in the end due to the abundance of good enamel all around. My photography is a little sub-par in this case sorry. The preparation was actually carried out under IV sedation due to a severe gag reflex, which was suppressed but not fully gone even with sedation. Hence, I had to work quite quickly with less time to wash teeth and to line up shots perfectly. As always, I would love to hear your comments. If you enjoy the case, please like, comment or share.