ANOTHER onlay? YES!

So this was my competency exam tooth, an gold onlay #19.
An onlay preparation is one of the hardest preparations you can do, as it takes lots of little specific angles and bevels and all sorts little ledges.  Well, for a competency, you have to do the whole thing, start to finish, without anyone's help in the least.
Here is what happened...which was great btw.

Here is what the tooth looks like all prepared.  We took an impression and then went to the lab to make some GOLD.

So now, we make sure it looks really nice, polished it up, try it in the mouth and then adjust the crown as necessary to make sure it fits how he bites and chews.  Then...CEMENT.

There we go, now that's how you polish a gold crown.  On a side note, I'm sure no one knows what this is, but I have a passion for secondary anatomy (don't take that the wrong way!)

How far I've come...

I just found a pic of my first onlay filling.  An onlay is kind of like a half crown, only covering a few of the spots that need to be covered and leaving the rest in tact.  This was almost two years ago...  What would I change now?  GEEZ JUSTIN, try polishing that gold a little more.  I'm embarassed... but i like everything else:)

High Noble Onlay #3

If I could do only gold for the rest of my life... I would be okay with that.

From broken to more broken to FIXED.

So it seems as though every enormous amalgam (silver filling) I take out, there appears to be a huge crack running down the middle of the tooth.  It's like the filling acts as a wedge or ax head and splits the tooth apart.
When that happens, sometimes they need a root canal, other times we can stick a crown on the tooth to hold it together and they end up being just fine... this tooth is one of those.

First I had to remove the silver filling, THEN I had to recreate the entire tooth out of amalgam so we would have a nice strong base to put a new shiny gold crown on.

Tooth rebuilt out of a silver filling

Then, we removed enough of the tooth so that we can put a cute little gold crown on top of it and then took an impression of that.

Tooth prepared for a gold crown

THEN the fun part...we make the gold crown down in the laboratory.

NOW, we can try it in the mouth, and if everything looks perfect, we end up cementing it in the mouth.

...and of course I can't find the picture of the cemented crown.  I will see him again soon, and have to take another final picture:)  WHOOPS.  

Teeth made new

This patient came to me with a nice big chip in both of his front teeth, but he also wanted whiter and brighter teeth at the same time.  Before we can re-shape his teeth permanently, we had to whiten the rest of his teeth. Temporarily, we put in a quick filling where his teeth were chipped and then gave him whitening trays.

After a little bleach and a nice cleaning, he came to the office to finish the restoration of his front teeth. This was him with his temporary fillings in the lower middles of his front top teeth (Class IV MI chips on #8 and 9)

The teeth cant upward towards the middle with the temporary fillings

Notice the shape of the teeth on the bottom before we fixed them

The teeth fixed in the middle, now looks more normal and follows the bottom
lip smile line.  The other discolored composites were also fixed, pictures to
come after my broken lens gets replaced.

Oh how cute, two little silver fillings

Mandibular 1st premolar with decay in the pits

 A lot of people have a lot of deep pits in their teeth that get lots of stain and are almost impossible to clean.  Eventually, these areas will trap enough stuff that bacteria will get in there and start eating away the tooth.  We did these as small as possible to keep the tooth strong as possible.

Tooth decay drilled out

Pits filled with amalgam and occlusion checked. So CUTE. 

Mock Board Exams

Every quarter we have to take a clinical exam that mimics the REAL exam we have to take in order to get a dental license.  You have to prove that you can do a hard filling, do a root canal treatment, and provide periodontal therapy to someone before you get licensed.  

Well, here is one of those exams I happened to have my camera out for:

Tooth to be restored, radiographic decay detected

This took sure looks great, wow.  You can't even tell it has a filling in it, BUT the radiograph (x-ray) sure could tell.  It was small, but we decided to re-do this one anyway.

Decay found under the filling after it is removed

The original tooth-colored filling was removed, and look at what is underneath: a BROWN SPOT.  That spot is actually where bacteria have gone underneath the filling and started to make acid and erode the tooth. Gross.

Decay removed and the tooth ready to fill

All of the decay has been removed, and the tooth has been shaped properly to hold in a silver filling in this particular tooth.

Tooth with the silver filling

The tooth was filled with the silver material. As it hardens, the filling is shaped to look like the original tooth and the bite is checked to make sure nothing changed from before they came in.

Case by Case

 A tooth can sure go through a lot of different treatments before a "FINAL" filling or crown is placed.
First, you have to start with a tooth that shows radiographic and clinical decay around an old filling:

We gave him an injection, and then started to remove the "old" filling.

         The old filling is removed  and LOOK, there is a huge crack down the middle of the pulp floor along with some decay.  This seems to happen more times than not lately, and in order to not SPLIT the crack more, we have to put in some sort of covering that won't the tooth break apart = gold crown.
And just so you know, a gold crown is THE LONGEST LASTING CROWN there is.  Seriously.  Nothing will be here longer in this guy's mouth than a gold crown.

Next, we have to fill the tooth with something so we have a nice strong base to put the crown onto.  One of the strongest we can use is another amalgam filling.
The tooth is filled up, shaped to look like a tooth, and then the patient is sent home.  We had to wait a couple of weeks to make sure the tooth did not flare up in pain because of the big crack and the fact that we were using a drill in the middle of his tooth.

 I shaped that tooth to fit a crown and then took an impression of the tooth.  Then, in the laboratory, I make a new crown out of wax on a stone model of the tooth.  The wax is turned into gold by a very long process, and then I cement that gold crown back into the patient's mouth.  Here is the crown on the model, and here is the crown in the mouth.

Gold crown in mouth after cementation