Minimally invasive adhesive dentistry.

I want to share a short case with everyone to show the possibilities in restorative dentistry today, and why it is so important to have trust in the care, skill, and judgment of your restorative dentist.

Much of the dentistry being performed continues to lag behind the current possibilities and technologies that are available today, and this almost always proves to result in a detriment to the patient. Granted, procedures of minimally invasive adhesive dentistry require intense planning and certain technical ability, but success can be predictably achieved in numerous clinical applications. Each case must be individualized and personalized based on someone's unique needs, circumstances, and objectives.

I have a great patient who came to me with the chief complaint of missing a tooth on her lower left side. The tooth had a history of needing root canal treatment and a full coverage crown, and eventually the tooth fractured. The dentist decided to remove the tooth without any consideration or discussion as to how he would replace it in the future.

Well, a few years later, this patient wanted her tooth back (understandably so). She is a young, attractive woman who will need many more years of using her teeth. However, things were now much more complex because of decisions that had been made (or not made) up to this point in time.

When the tooth was extracted, the dentist simply allowed the area to heal without anticipating the future replacement tooth. Subsequently, we lost plenty of healthy bone and soft tissue that could have been extremely helpful to make placing and restoring this area with a dental implant simple and predictable.

But, this was not the case. After obtaining a C.T. scan and consulting with our surgical colleagues, we determined that the ability to place a bone graft and implant would have an unpredictable outcome due to certain anatomical restrictions. Additionally, the time-frame to complete (not a factor in my decision-making) was significantly longer. 

Long story short, this particular patient was not interested in waiting. She had made up her mind that she did not want to go the route of a dental implant, and I had to respect that choice. She was fully informed of the pros and cons of both potential treatment options.

After adamantly telling me she was not going to have a dental implant placed, I had to figure out other viable options for her that I was comfortable with. The traditional option of a "bridge" (fixed partial denture) requires removing excessive amounts of healthy tooth structure from two teeth that were, for all intents and purposes in this case, perfect. This was the last thing I wanted to do. In fact, it is always a goal to do the most minimum amount of dentistry we can to achieve exceptional and predictable results.

So, we made a decision to fabricate an extremely thin glass-oxide ceramic restoration that would adhesively bond to this patient's healthy enamel. Thus, I was able to do very little dentistry on her adjacent teeth, and still create a restoration that is functional (chew whatever you want on it), and beautiful.

All of us were extremely happy with the result, and I could not be happier to have preserved the maximum amount of this patient's healthy tooth structure as possible instead of doing a traditional "bridge."

This was a fun and gratifying case to wrap up before the weekend. It continues to excite and amaze me what we can achieve when things are done in a meticulous and well-planned manner.

I have attached case documentation photographs below. I hope you agree that the result is pretty exceptional!

Note: Please understand that anything and everything I post to my blog or my website is entirely my restorative dental work and my digital dental photography that is done on my incredible patients. I thank them for their trust and their willingness to allow me to share their stories and experiences with others.