Dr Paul's Dental World

08/02/2023

Invisalign, whitening, white spot removal + 2x resin bonding

This patient was referred to me by my man .matthedge (if you're looking for an awesome dentist and legend person in GC area, he's your guy!). The patient wanted to improve the look of his front teeth and remove the white spots. We the discussed doing invisalign first, to achieve the following:
- Wider smile
- Correct angles of teeth
- Improve smile line (teeth edges should follow the lower lip)

Following that, we used resin ICON to remove white spots, and did resin bonding to his teo central teeth.

Overall we achieved an amazing result with relatively minimal treatment. Happy patient happy dentist!

Shout out to and with helping the invisalign process go smoothly!

If you have questions about this case or anything else, DM me 🙌

17/05/2022

This was a case that I loved from start to finish. Mary came in for her regular hygiene appointment, and expressed to the hygienist that she did not like her lower teeth. The hygienist told me this, and discussed that possibly levelling of the lower anteriors with a disc to make them even, might be all that is required.



When I did my examination, we discussed what she did not like about her bottom teeth. After asking a series of different questions, she ended up telling me that she didn’t like the unevenness, the shade, the worn edges. She wanted something more white, long lasting and permanent (ie not whitening. On a side note, she told me that she has asked to do whitening before, but was told no because she has fillings that would need to be changed over [note: don’t restrict a patient’s options because you think they don’t want to do something. She told me she gladly would’ve tried whitening, and changed the fillings, but was told no!]). We then discussed if there was anything she didn’t like about her upper teeth, and she was open to hear suggestions.



We ended up deciding that we would restore her lower teeth with ceramic, fabricate a new lower denture with precision attachments for stability, and place ceramic restorations on her upper 15-26 (because they were the ones in her smile).



We started the treatment with a mock-up to give us an idea that we were in the right direction, and once this was confirmed, we started with the lower teeth and finished with the upper teeth.



Lots of detail in the captions, so I hope enjoy it!

15/05/2022

Sandy was a patient at our practice who I had seen at a regular hygiene check-up. I had met her previously as I had done some small fillings for her.

At this particular check-up, I asked her if she liked her teeth. She said “the gaps” I said “yes”. She said “they’ve been like that since I was a teenager”. I said “Sandy, you didn’t really answer my question 😊” She said “Well, I wouldn’t mind fixing them, but I feel like it’s going to be expensive.” I said “when you save expensive, how much are you thinking?” She said “$10,000”. I said “What if I told you that I could close those spaces, and give you very nice looking teeth, for about $3,000?” (I was planning resin veneers). She said “tell me more”.

I then did a mock-up at home, and brought her back to see it. She loved it! After a discussion about material type, she then decided that she wanted something longer lasting, so she opted for porcelain veneers. We then discussed doing orthodontics beforehand to help the UL2 rotate, distribute spaces between upper anteriors better, and correct lower alignment…she agreed that Invisalign would be a good idea.

After about 7 months of Invisalign, we then prepped the teeth for 6 beautiful veneers by Talar at Prodenta, and now she has a smile that she loves! It’s cases like this that make me love my job.

20/04/2022

When a patient comes to your practice, needing an implant crown restored, knowing what type of implant they have is difficult.

I just found this awesome website (https://www.spotimplant.com/) that uses AI tech to help identify implants.

The difference between this company and others, is that this one uses computers to do the hard work scrolling through 1000s of different implants to find a match.

Let me know how you go - I'm looking forward to using it!

Spotimplant is the most comprehensive dental implant database, search engine, and identification tool.

31/10/2021

This patient came to us with worn teeth, that she had noticed is getting worse over time. It was affecting her confidence with smiling.

We discussed different options, including: (i) restore upper/lower canine-canine in current position without changing bite (ii) restore upper/lower canine-canine in current position, open the bite using Dahl technique (iii) restore all teeth and open bite (iv) ortho to expand around premolars and also to intrude lower anteriors, and then intrude. We decided on (ii) because she had no posterior wear, and she didn’t want to do ortho.

I restored the teeth in resin, as ceramic is too expensive at this stage, and I used the injection technique with flowable (G-aenial Universal Injectable) using alternate models and clear putty stents.

It took approx. 3mo for her bite to close posteriorly, at which point we made some night time retainers to help prevent future chipping.

Enjoy!

30/10/2021

I have taken over the books from a retired dentist who has a number of patients who prefer to do the bare minimum in terms of dental treatment, and try and treat their teeth using their health fund to dictate treatment.

This lady had two teeth that I knew would benefit from being fixed with emax, but she was hesitant. I find that taking my time with these patients is super important. One strategy that works well is to suggest treating the worst tooth first, and then using that as a gauge as to if we should do the other one or not.

In this case, we decided to do the 24 first, and then after she saw the state that it was in, she booked right back in to do the other side.

It is a nice case of my rationale of prep design, as well as the steps that I follow when doing my prep, and also a neat trick to use if the rubber dam tears.

Enjoy!

13/09/2021

Here is a video of an Emax onlay that I replaced a few months back. It was one of the most difficult procedures that I have been based on the access to the area, as well as proximity to the nerve of the tooth, and also trying to use the rubber dam in a difficult spot.

I'm using a camera mounted to my dental loupe glasses, and it was one of the first times I'd use it, so it is out of focus at times, but there are a few things that you will get out of it:
- Rubber dam placement and floss ties
- Tips to remove rubber dam
- Removing gingiva/haemostasis prior to impressions
- Rationale in deciding to remove tooth structure or not

This patient came in for an examination without any concerns. It wasn't until we took X-rays that we saw that his ceramic onlay was a problem waiting to happ...

12/09/2021

I wasn’t planning on uploading this case, hence the low quality intraoral photos.

This patient hadn’t been to the dentist for a number of years, and we had old fillings to replace, as well as calculus to clean.

I don’t often take X-rays after my treatment, unless I do lots of fillings (normally more than about 5), and this will be our new ‘baseline’ X-rays that we will compare to in future. I have also started to take X-rays following calculus removal, because otherwise it can be very difficult to know if it is all removed! And if it isn’t removed, we haven’t given the patient’s teeth and gums the best chance to be healthy. In this case, I had to re-clean the LHS after taking an X-ray, as there was some calculus still present after the first round of cleaning.

I am also becoming more pro-active in removing old fillings, because I am finding more and more that there is much more decay beneath them, compared to what I would expect.

Follow along through the pics. Descriptions in the captions.

Follow my journey on Insta and Youtube:
- www.instagram.com/drpaulsdentalworld
- www.youtube.com/drpaulsdentalworld

09/09/2021

This is a series of 4 onlays that I did in 2020/early 2021. They are in chronological order (1 – Jul 2020, 2 + 3 – Sep 2020, 4 – Mar 2021). I went to a CEREC course in Feb 2021 that changed how I do things slightly (I'll post other cases soon to see)

All were done with conservation of tooth structure in mind, and a reliance of good bonding for long-term success.

Detailed descriptions in the captions of each picture, explaining different tips/steps in the procedure.

Comments/questions welcomed.

Follow my journey on Insta and YouTube:
- www.instagram.com/drpaulsdentalworld
- www.youtube.com/drpaulsdentalworld

05/09/2021

This is a case of a failing amalgam filling, that we replaced with Emax using CEREC.

The patient has an existing upper night guard, so I didn't want to change the lower occlusion too much, so I did a biocopy of the tooth to guide me.

You will be able to see my workflow of scanning, to allow me to save time, as well as scan the prep with the rubber dam in place.

Descriptions in the captions.