Local anesthesia is used to make our patients feel as comfortable as possible when performing large dental procedures. Each one of our teeth is able to experience different sensations due to the unique innervation provided to the teeth in our mouth. This is why our teeth experience a shocking sensation when drinking something too cold & a painful sensation when biting on something too hard. Accordingly we want our patients as numb as can be when removing a cavity. But that’s where the problem lies. The numbing medication must be delivered through a needle apparatus and a lot of people have a fear of dental injections! I hear plenty of stories where the patient had a bad experience in the past & are consequently anxious to get any dental work done. And there is some truth to those stories. Injections are not the most comfortable process in the world. I mean we are poking you with a needle. But the dental community is constantly evolving and there are now a variety of techniques that make the dental injection more comfortable then ever before.So what can your dentist do to make the experience more comfortable!

Well the first tip would have to be the use of a topical anesthetic, a cream that is placed on the gums prior to receiving the shot. This cream has a medication that can numb the first couple mm of the injection site. So it makes that initial pinch from the injection way more comfortable. Injection speed is the next most important step to receive a comfortable shot. The evidence based research has proven that a slower injection with minimum pressure leads to a more comfortable anesthesia experience. *Close up* i have definitely experienced the pain that came from a fast injection at an oral surgeons office when I was younger & it resulted in me fainting in the office (pause) but that’s a story for another time! Lastly, i would say that the temperature of the anesthetic can contribute to the pain. It is better to inject anesthetic close to your body temperature. These carpules can be warmed through a warming device or through the doctors hands!  A lot of other things can be mentioned with regards to receiving a more comfortable injection but I believe this gives you a nice introduction to anesthesia. If y’all have any questions about the above steps make sure to leave a comment down below! 

Close up. Now, it’s time to give myself a shot

*make some jokes* 

Aight so I’m going to be performing a maxillary infiltration which is basically an injection isolated to an individual tooth in the mouth. & i think I’m gunna stick with my upper left premolar because it’ll be the easiest to do. So first I’m going to place the topical anesthetic and I want to cover it with 2*2 so the cream doesn’t flow to the back of the mouth & ummm I’m gunna put a lot on! Lol I don’t know why I do this. Whatever…. aight here goes nothing

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(Show the Lingual Stent) / (Clips of me Repairing the Teeth) / (Clips of me Talking)

Restoring broken teeth with composite resin is by far one of my favorite procedure to perform in office but can also be one of the most technically challenging to do right. (Photos of before/after images).  Last year, I made a video giving a visual of this procedure but failed to describe the reason behind the technique. In this video, I want to go into more detail about the sequence of repairing anterior teeth & share a few tips/tricks I use to achieve an awesome result.

So let’s break it down!

The first concept we need to talk about involves bonding. Bond strength of composite resin to the patients natural teeth is critical for the long – lasting prognosis of these teeth. Unfortunately, fractured teeth doesn’t give the the dentist much retentive features to lock the filling in place. So we need to do everything in our power to increase the bond strength with our physical & chemical preparation design. 

To start off, I roughen the enamel surface of the tooth up with a medium grit diamond bur in a star shaped pattern. This 2-3 mm patterned bevel microscopically increases surface area of the tooth which allows for greater adhesion. I gradually fade out the preparation to the periphery because it helps establish a seamless transition from natural tooth to the filling. If this bevel is too short or doesn’t fade out appropriately then you will be able to distinguish where the filling begins and ends.  

Next, we need to chemically prepare the tooth. A 35% phosphoric acid etchant helps with adhesion by creating a porous retentive surface on the tooth. I extend the etchant beyond the margins to once again facilitate the seamless transition from tooth to composite resin. The white teflon tape protects the adjacent teeth from this potent chemical. If you don’t have a teflon tape or mylar strip to protect the adjacent tooth, this chemical can extend to the surface and create post operative sensitivity. After a firm wash & dry, you will notice that the etched enamel appears frosty. This is a good way to tell if the surface was etched for a long enough time. 

Next, I paint on my bonding agent with a brush. I apply multiple layers to ensure that the porous enamel saturated with bond. However, it is important to thin this agent out because it can interfere with the adhesion of the composite resin to the tooth. After curing the bonding agent we can move on to the artistry of composite layering. 

I begin every class IV restoration with the formation of a palatal shelf.  In this case, I have a prefabricated putty to help form the lingual shelf. & I know many of you are probably thinking how would you have the available if the patient came in with a fracture. Well, it simply involves a semi rigid putty matrix and using a bur to cut back to the desired incised length.  & I will def make a video showing how to create a lingual index if anyone is interested. in fact, leave a comment down below if thats something you would want to see.  

So this lingual stent is incredibly useful at it allows me to predictably build up the back shell of the filling with ease. Once formed, I can start layering composite, using dentin shade for the body of the tooth & enamel shade for the outermost surface of the tooth. Your decision in layering & characterization ultimately stems from evaluation of the contralateral tooth to establish symmetry. Some teeth are polychromatic, some teeth have unique translucency properties in the incisal edge and others have unique color schemes.  Taking some time to notice these characterizations make a huge difference in the final results of the composite filling. In this video, I layer the tooth as if were monochromatic . I always leave a little room for the final composite layer in order to extend that layer over the entire restoration. One continuous layer makes for a smooth surface that can be polished quite easily. In this video, I use a wheel to blend out the restoration, but today, I would use a medium stiffness brush as it works better in my hands 

Now its time for our refinements. The natural contours of our teeth have an impact on how light reflects off the tooth which can truly transform a filling. This is why it is so important to fine tune the contours. Using a pencil to lightly mark the mesio-facial contours on this tooth helps me see where I need refine the restoration. I always start with a fine diamond for bulk cut back while small refinements are completed with a course red disc. I work this red disc till I have the contours exactly where I need them to be  in this video I use jiffy cups but today I would complete the polish with series of fine discs. To finalize the polish,  I use a series of polishing discs with aluminum oxide for a final glaze. In this video I use 

I hope this gives y’all an idea of what goes on in my head when sequencing anterior fillings. Eventually, I will get to a live video tutorial to show this process in real time. 

If you have any questions please feel free to leave them down in the comment section below. Thanks for your time!

The post How I use a LINGUAL STENT for Anterior Composites appeared first on Smile Influencers.