Case Photos

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A silicone polishing point is used to further smooth and polish the restoration. The smoother the restorative surface, the less plaque will adhere to it. And we all know that plaque is the enemy! Plaque is nothing more than millions of bacteria stuck together which release acids and toxins which can not only demineralize tooth structure (decay), but also cause gum disease which can slowly (or in some cases, rapidly) deteriorate the jaw bone which help hold our teeth firmly in place.Marginal recurring decay was confirmed through tactile exploration.13A closer look through microscopic examination reveals that there is more than just marginal staining going on here.13From a distance, it is sometimes difficult to distinguish staining from recurring decay around the margin of an existing composite restoration.13

Regular dental check-ups are key in diagnosing problems early. This tooth, for instance, could have needed a root canal and possibly a crown in a year or so if decay was not detected and treated early, and cost of treatment would have been significantly greater. Decay which has not yet progressed to the pulp or nerve of a tooth typically does not cause any pain symptoms. So see your dentist and hygienist regularly!

In addition to resolving the acute inflammatory condition, tooth mobility was also significantly reduced.This photo was taken a year post-operatively. While it could be argued from a cosmetic standpoint that an extraction and implant could have produced a more cosmetically pleasing result, this patient was more concerned in not losing her own front tooth. Every patient is different, and for some, losing a front tooth can be psychologically traumatizing.4Pre-operative close-up view. Note the exudate of puss (suppuration) from the gingival margin.4Various treatment options were discussed, including extraction and implant since the prognosis in saving the acutely infected tooth was guarded due to advanced bone destruction and excessive mobility. Patient chose the Laser treatment option first since the remaining teeth needed to be treated for the chronic condition anyway in order to prevent further destruction of bone and subsequent loss of other teeth.4

An acute periodontal abscess typically occurs in patients with untreated chronic periodontitis (gum disease) and in association with moderate-to-deep periodontal pockets. Periodontal abscesses often arise as an acute exacerbation of a preexisting pocket. This case was effectively managed with Laser Therapy. Lasers come in various wavelengths. Dr. Donato Napoletano is trained and certified in utilizing 3 laser wavelengths: Diode, Erbium (Er:YAG) & Neodymium (Nd:YAG). A PerioLase Nd:YAG laser was used in treating this patient’s acute and chronic periodontal condition with a procedure known as LANAP (Laser Assisted New Attachment Procedure).

View of new CEREC crown from other side.  Thanks for watching!Amalgam overhang being smoothed which will help make flossing easier for this patient.21The adjacent tooth with the silver filling has a ledge (overhang) of filling material below the gum line. Overhangs accumulate plaque and makes it difficult for patients to floss without getting the floss hung-up. While I am in there working, I will address issues like this whenever I have access. Removing the old crown therefore provided access and an opportunity to smooth things up!21Step 1: old (leaking) crown removed from subject tooth21

Core Build-Up & Cerec Porcelain Crown

One of the great things about using Dental Operating Microscopes (with digital cameras attached to them), is that my trigger-happy assistant can snap away while I’m working! Showing patients what I see (before, during and after treatment) is a big plus over trying to explain what I saw and did through words alone.