Large MOD amalgam with recurrent mesial decay replaced with BAARD Overlay

This is the full case of the photo I posted a few weeks back.

Removal of large Amalgam revealed lingual cusps undermined by oblique fracture and large undercut present from amalgam at DB cusp

According to my own criteria the MB cusp probably could have been spared but I felt more confident doing an Overlay here

Dentin cracks & recurrent decay removed. Immediate Dentin Sealing with Resin Coating performed with Clearfil SE Protect & Majesty Flow

Deep amalgam left steep transitions to anatomic reduction. Following BAARD ceramic design rules & Biomimetic principles - stress reduced ceramic platform created with incremental placement of Clearfil AP-X composite. This serves multiple creates a prep design that minimizes both ceramic stresses and C-Factor stresses at delivery - aids in mimicking original biomechanics of natural tooth restoring dentin with composite of similar modulus & enamel with similar modulus glass ceramic

Buccal & lingual margins were beveled with large fine round diamond. E. Max MT A1 overlay delivered same day with Warm Clearfil AP-X composite

#biomimeticrestorativedentistry

#BAARD #overlay #onlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Biomimetic Restorative Dentistry - the best kind of addiction & this prep, IDS, & WARM Composite delivery are taught at The BAARD Institute online with the new BAARD Onlay & Advanced Adhesion Courses

Broken cusp/restoration removed & prepped for BAARD Onlay

Immediate Dentin Sealing performed with Gold Standard Clearfil SE Protect & Majesty Flow

e.Max A1 HT Delivered with Warm Clearfil AP-X & Clearfil SE Protect

#BiomimeticRestorativeDentistry

#BAARD #onlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Deceptively difficult Onlay case:

Fracturing DL cusp, sorry for the poor angle on the pre-op, there were stained fractures on distal marginal ridge & lingual groove...

Initial plan was to only cover DL cusp and preserve ML cusp, after removal of amalgam & recurrent Caries the decision was made to cover ML cusp.....

Difficult prep design due to the shape of the proximal box from existing amalgam and the aggressive lingual tilt of the molar....

Immediate dentin sealing performed with Clearfil SE Protect & Clearfil Majesty Flow

e. Max A1 MT luted with Warm Clearfil AP-X & Clearfil SE Protect

#BiomimeticRestorativeDentistry

#BAARD #onlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Haven’t used e. Max HT in awhile, very happy with the final

Tough case, lots of decal enamel, especially on the distal - I left some decal on distal buccal I had been chasing, did not extend into dentin, long term I do not think it should be an issue but I don’t love it

There was also a distal crack extending 1/4 into dentin, thankfully I dissected it out pretty quick for a change 😅

Immediate Dentin Sealing with CLEARFIL SE PROTECT & MAJESTY FLOW

Biobase constructed with CLEARFIL AP-X & MAJESTY FLOW

E. Max B1 HT bonded with WARM CLEARFIL AP-X & CLEARFIL SE PROTECT

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

I find deep lesions fascinating and one of my favorite things to treat. Tooth tested vital and normal. Despite the size of the lesion there was a good amount of Dentin thickness radiographically. While my goal is not complete removal - the goal is to maintain pulp vitality - based on the x-Ray it appeared this would be likely with good RDT (remaining dentin thickness)

Prep design was a challenge - due to buccal decal/arrested lesion (not the buccal “pit” - area around it)

Peripheral seal zone achieved and final Caries removal achieved with air abrasion. Immediate Dentin Sealing with Resin Coating performed with CLEARFIL SE PROTECT and MAJESTY FLOW. Ribbond placed over discolored dentin area. Biobase completed with CLEARFIL AP-X.

E. Max A1 HT bonded with CLEARFIL SE PROTECT & CLEARFIL AP-X Heated Restorative composite

On the final there was some slight excess composite to clean up on the mesial and a lot on the distal, thought I had removed it but all I did was burnish it 🤦🏻‍♂️ took awhile to remove, but we got it

#biomimeticrestorativedentistry

#BAARD #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

The restoration in composite of adjacent pre-molar contacts maybe one of the hardest restorative things we do IMHO. Deep margins & poor positioning can only amplify this.

Patient presented broken contact and recurrent decay on both pre-molars. Patient was having pain from food lodgement but the teeth tested vital and normal.

Spent a long time setting up the first dam only to significantly tear it in the first few seconds. I removed most the old composite and the replaced the dam.

As I got the first half of composite removed on the first pre-molar I realized how debonded it was and easily peeled the rest out with a scaler. Amazingly there wasn’t much Caries Dye staining under the deep resin on the first pre-molar. Caries End Points reached followed by air abrasion, bonding, and resin coating.

The safest way to approach restoring adjacent contacts is to do them one at a time. It is more time consuming but minimizes the chance of error. Additionally when restoring a direct that has a deep sub-gingival margin - its best to separate the steps into a margin elevation and then proximal contact restoration. This allows for better adaptation of the sub-gingival margin and better overall emergence profile in two planes.

There were a lot of steps to restoring this case, but isolating out each one allowed for more meticulous attention to detail. 1) Reel matrix placed for margin elevation with Teflon to aid in adaptation for 1st pre-molar 2) placement of Ribbond on 1st pre-molar 2) restoration of 2nd pre-molar 3) contouring of 2nd pre-molar contact 4) restoration of 1st pre-molar

The pre-molars were restored in the same way: proximal enamel shell created with Clearfil Majesty Universal, first dentin floor increment on EverX Flow, rest of dentin replaced with EverX Posterior, Final Enamel Replacement with Clearfil Majesty Universal

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife ...

Tough Deep Margin Elevation on extremely structurally compromised pre-molar - the whole bag of techniques was emptied out on this one.....

First, I literally tried talking the patient out of saving the tooth, not that I didn’t think it could be done, but wanted to make sure the patient had clear expectations of what we were about to take on....

I planned this out into two different appointments, 1st appointment would be to excavate Caries, determine restorability - this was based on amount of tooth structure remaking, I was actually amazed at how much coronal tooth structure was remaining AND if we could isolate for DME - I told the patient if I couldn’t reliably isolate for DME we should extract....

I removed gross decay, access the pulp, sealed off pulp with Teflon, sealed off deep excavation with Teflon packed between dam and tooth, completed Caries removal through use of Caries Detector Dye - Immediate Dentin Sealing performed and then utilized a copper band & matrix within matrix technique to complete DME...... with then placed Cavit and had patient come back for 2nd appointment.....

At second appointment - RCT completed (that is sealer puff at the apex) - two Ribbond fibers utilized, first one placed Mesial-Distal followed by a piece Buccal-Lingual.... EverX Flow was used incrementally to create the majority of the Biobase along with AP-X and top layer of Majesty Flow

Katana Avencia A3 composite block was utilized as opposed to a hard glass ceramic to better absorb and shield the underlying compromised sub-structure from stresses - in fact the entire Biobase and restoration were constructed to be a optimized stress shielding apparatus to protect the structurally compromised tooth

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

I utilize immediate dentin sealing for all ceramic restorations - especially crown preparations which are the least fracture resistant design for glass ceramics (Huang 2020)

We talk about a lot of the benefits of immediate dentin sealing but what is often not discussed is the increased fracture resistance it provides.

It is well known that bonding ceramic restorations increases their fracture resistance, so it should go without saying that higher bond strengths yield higher fracture resistance. In fact, this is well supported in the literature.

Dentin bonding can be tricky. Immediate dentin sealing allows us to bond dentin predictably & reliably. IDS provides durable dentin bond strengths that exceed enamel bond strengths.

It is no surprise then that multiple studies show higher ceramic fracture resistance when using IDS vs conventional resin cement bonding procedures - (Gresnigt 2016), (Yazigi 2017), (van den Breemer 2017), (Hosteegne 2020)

There are many reasons to implement IDS into your daily practice, this is just one of them.

This case is a case where I was replacing an existing crown - pretty much the only time I do crowns anymore

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Is mechanical retention over-rated? It depends on your philosophy

In Biomimetic Restorative Dentistry we try to emulate the Dentin-Enamel Complex as our model for bonding.A key feature of the DEC is that it is a SECURE BOND. Failures are directed away from the underlying dentin & pulp.Swipe left once.Having the hardest material & mechanical retention will aid in the longevity of the restoration, but what about the dentin and pulp underneath?

All studies of Immediate Dentin Sealing & Resin Coating show zero failures below the hybrid layer.In other words, failures do not breach the bond, just the DEC is designed to do (until we start cutting away tooth structure)

If the restoration is failing, personally I do not what it to stay on and mask the failure underneath.Swipe left twice & you will see a situation you will never see under a ceramic Onlay or Overlay - the tooth would never get to this point - the restoration would come out - we can’t rely on patient sensitivity - patients don’t always present with sensitivity on gross carious lesions & definitely not with RCT teeth.At the very least, staying above the BioRim puts potential microleakage further from the pulp.Numerous studies have reported the importance of Remaining Dentin Thickness between the restoration and the pulp.

The idea that overlays & onlays have lower long term success rates vs crowns is not well supported in the literature.In fact, most modern meta-analysis & retrospective analysis show similar if not higher success rates for these types of partial coverage restorations. (Morimoto 2018) is a good one.While clinical trials are nice, they are very difficult to achieve past 10 years, which is why few exist and after that point we mainly rely on clinical follow up studies.Of which for partial coverage Ceramics there are many with as good as or better comparative results to full coverage.While I appreciate the anecdotal evidence of 20-40 year old crowns, it is purely anecdotal and very difficult to compare realistic survival rate to other crowns placed 20-40 years ago.

IMHO retentive vs non-retentive is not a matter of right vs wrong, but your restorative philosophy.
#biomimeticdentistry #onlay ...

This case turned out to be a textbook BAARD Overlay Case

The initial treatment plan was an overlay based on the pre-treatment Caries and Structural Assessment

For borderline cases I will excavate to evaluate first, starting with reduction of the central fissure and obviously compromised cusps and marginal ridges...

When following the BAARD Prep Protocol for Non-retentive Overlays these cases go smooth, fast, & very stress free - for the operator and the bonding/ceramic

The enhanced visual access the overlay preparation design gives after cross reduction allows for more efficient Caries and crack diagnosis & removal

Caries removal end points utilized here

Air Abrasion followed for Immediate Dentin Sealing with Resin coating with CLEARFIL SE PROTECT & CLEARFIL MAJESTY FLOW

E. Max B1 HT bonded with WARM CLEARFIL AP-X & CLEARFIL SE PROTECT

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Photos can only tell part of the story..... (crown replacement case)

Sometimes things look like they are easy when they are done well, I assure you this was an extremely difficult case & isolation situation....

The key I have found with difficult isolation cases is that skill will only get you so far, the rest is determination & perseverance.....

Above all faith that you have the right plan in place and things WILL work out - this is very difficult in the beginning when trying new things and something I’ve noticed the “masters” have, the confidence that things will work BECAUSE they have worked in the past..... the more success I’ve have had the easier it has become to have a steady hand and hang in there when the going gets tough.....

For those trying new things whether it’s advanced adhesive dentistry, Biomimetics, and/or rubber dam isolation - hang in there, we all crawl before we walk and then sooner than later we are running..... don’t try to do too much, start with attainable victories and celebrate those victories, share them with us, and use them as the platform to keep climbing towards confidence and excellence

Stay bonded 🤞

#BAARD #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Still working on my anterior composite reconstructions....

Very old patient presented with broken distal filling with gross decay, the mesial filling was also chipped....

I did not want to chop down the remaining tooth structure for a crown so we opted for a Biomimetic reconstruction.....

Caries removal end points achieved (Alleman & Magne 2012) air particle abrasion followed by selective enamel etching, Clearfil SE Protect bonded followed by resin coating of the dentin. Ribbond placed over distal deep dentin......

I pre-op putty guide was taken and fabricated - essentially putty template made by copying lingual and incisal of existing and then a rough ideal lingual-incisal outline carved out of putty with a fine narrow shoulder diamond...... a thin layer of enamel replacing composite was placed on this putty and place on the tooth and bonded in place....

Next, a molar garrison matrix was used to construct the distal proximal enamel shell, this was then repeated on the mesial, the dentin was then replaced incrementally with Clearfil AP-X, enamel was replaced with Estelite Omega EA2 shade (in hindsight EA1 may have been a better choice, we’ll see when it rehydrates)

I am still working on my line angles and the mesial emergence was kind of tough, but overall I am pretty pleased with the overall result as was the patient. I hope you find some of these tips helpful.....

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Patience/Patients

I’ve always said you cannot do good work without good patients. I was fortunate to work on a very patient patient today.

The patient was easy going and wanted me to take all the time I needed to give her a great result. She was awesome and wanted to see each documented step in the camera view finder. I first showed her the size of the cavities after removal of old restorative and some decay - most of the decay was around the deep “bases”.... no one that is #BRD trained would be surprised by that though.....

I explained the larger the cavity the slower and longer it takes to do the filling right & without that these would need to be indirects. After letting the hybrid layer & resin coat mature I began placing the DEC mimicking Ribbond. I showed her the Ribbond before placing it and explained what it was.... next I took a photo of the Ribbond placed on the pulpal floor and Buccal/lingual axial walls......

Then the proximal enamel shells were constructed. After the Matrices and garrison ring removed we began the incremental reconstruction. The patient was interested so I showed her steps along the way.

When the procedure was over I apologized for it taking so long but she thanked me and was grateful I had the “patience” to do all that.......

With good isolation and a happy patient patient I was in heaven, I love what I do and got to come into work late as this was anything but that.....

#BAARD #Biomimetics #biomimeticdentistry #immediatedentinsealing #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

Tough margin elevation case......

Seemed pretty routine until root Caries in the distal concavity was discovered while prepping the distal margin........

Adapting a matrix band to a root concavity can be tricky, here a @garrison_dental reel matrix was used along with a cut sectional matrix...... Teflon was packed between the sectional matrix & the red matrix to adapt the sectional against the concavity.... the sectional was then flared back towards the distal and secured with flowable composite to the mesial marginal ridge of the adjacent tooth.....

Immediate Dentin Sealing & Resin Coat with Clearfil SE Protect & Clearfil Majesty Flow done 1st, before DME to allow decoupling with time while matrix within matrix was set up

Deep Margin Elevation performed with Clearfil Majesty Flow & Clearfil AP-X

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic #dentistry #photography ...

Overlay preparation

IDS Performed with Gold Standard Clearfil SE Protect & Majesty Flow

Entire case recorded on Microscope, will be uploaded to the Institute in the coming weeks with Narration...

E. Max A1 luted with Warm Clearfil AP-X & Clearfil SE Protect

TheBAARDInstitute.com - link in profile

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

This week has been a study in cracks....

Here is another tough crack case from this week that I am not in love with the long term prognosis as we weren’t able to achieve complete removal....

No biting pain, just some slight cold sensitivity that arose recently, normal pulp test results prior to treatment....

2nd molar was prepared for inlay - I actually prefer to do SRDC vs indirect for inlays but here I didn’t have the mental stamina for it so went with CEREC instead

Cracks were EVERYWHERE, photos do not do it justice, I started to get quite overwhelmed near the end, just doing one of these dissections is very concentration heavy - requiring lots of focus - the main cracks to remove were in the central fissure, lingual - disconnected and on the palatal axial wall, the mesial was unable to be completely removed, I went quite deep and halted before risking perforation

After AA & IDS, Deep Margin Elevation performed on mesial - thought about distal as well but it was quite visible and easily isolated, so I skipped it....

Dissections were filled incrementally with EverX Flow, larger defects were subsequently filled incrementally with Clearfil AP-X - I actually forgot to place Ribbond which I normally would have done here, it won’t make or break this case but I was quite upset I forgot - honestly this case was quite overwhelming and I was pretty mentally exhausted by the time I would normally place it....

Both teeth restored with Hybrid Composite Indirects - Cerasmart for the overlay & Avencia for the Inlay, the only reason I went with Cerasmart over Avencia on the Overlay was I had the shade in Cerasmart not Avencia....

The choice of Overlay material was multi-faceted - the MAIN reason was that lower modulus materials like composite absorb more stress and transfer less of it to the underlying substrate, the hope is to “nurse” the cracks along - side benefit is that this material is very easy to drill through for a future endo access and easily reparable....

Floss moved away from margin prior to seat

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcam ...

Tough case replacing failed composites

The distal composite just flicked out as I was prepping. Caries end point was achieved avoiding a pulp exposure on an asymptomatic and vital tooth. Air abrasion followed by bonding with Clearfil SE Protect and resin coating with Majesty Flow.

Doing two MOD premolars side by side can be tricky - the efficient and profitable thing would be to set up 2-3 rings and do as many proximally walls at once..... I find often that the more you try to do at once the more likely you are to kiss something and 1 or more of the proximal do not come out right......

I didn’t want to cut any corners and I wanted each proximal surface to come out just right so I did them one at a time. I did the distal most proximal enamel shell and worked my way mesial one at a time. Dentin was replaced with EverX Posterior and Enamel was replaced with Clearfil Majesty Universal.

I left a little composite on the lingual which was removed at the following visit when I did an MOD Resin on the 1st molar and an Onlay on the 2nd molar.

#biomimeticrestorativedentistry

#BAARD #overlay #Biomimetics #biomimeticdentistry #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic ...

“I’m really not a fan of crowns”, I said to the student shadowing me……..

This patient had presented with an open crown margin over a year ago, despite being open there was no decay on the X-Ray. I told the patient, as I do all patients with this scenario- that I find RCT teeth with crown’s with open margins particularly worrisome, especially zirconia or pfm - they are leaking into already heavily damaged and compromised teeth. A lot of the time the decay is not apparent at the margin and is obscured by the radio-opacity - therefore it continues to rot and by the time we get an indication - whether failed endo, decay finally large enough to be apparent, or crown breaks off - the prognosis becomes very poor……

In the patient’s defense there was a legit reason for putting off the treatment for a period of time….. the weekend before treatment date the patient developed throbbing pain. PA was inconclusive but CBCT revealed large lesion on distal root - retreat meant would be required….. but what is the best way to sequence this? We already a few hours reserved for the patient?

First, we called the endodontist to make sure the patient could be seen within 24 hours. I wanted to remove the crown and evaluate the situation first. The patient agreed. I cut off the zirconia crown quite easily with my Bien Air electric handpiece. I was very sad to see so much destruction underneath. There was not much too structure and the build up had quite a bit of leakage and decay. I was able to preserve most of the lingual axial wall and height but most everything else was down to the gum level.
(Caption Continued in pinned comment)

I will be discussing this case in detail tonight on BRD After Dark!

#biomimeticrestorativedentistry

#BAARD #Biomimetics #biomimeticdentistry #immediatedentinsealing #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry ...

Patient presented with poorly fitting stainless steel crown.

Unfortunately the “die is cast” regarding crown treatment by the earlier work. Stainless steel crown removed along with biofilm and caries.

IDS with resin coat performed with Clearfil SE Protect & Clearfil Majesty Flow.

Scanned & Designed with Cerec Primescan

e. Max A2 MT delivered with Panavia SA & Clearfil Quick Bond

Excess cement on distal cleaned after final x-ray & distal will be closed with future ortho

Esthetics were ok, could had used more “white” characterization

#BAARD #Biomimetics #immediatedentinsealing #compressiondome #preservethebiorim #cerec #cadcamdentistry #cadcamdentists #tooth #teeth #dentistry #digitaldentistry #kuraraynoritake #clearfilseprotect #dentalphotography #dentalhealth #dentistrymyworld #dentistlife #dentistrylove #dentalgram #dentistsofinstagram #dentallabor #labtechnician #dentalclinic #dentalteam #dentaltips ...