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This is #9 and #10. It is a phased case. The patient will ended up with perio sx, 6×11 in fixed with a RPD . For now $ is tight so we are doing diercts and keeping him in a holding pattern. #9 will need endo. He has just had 3 RCTS and another would push him over the edge .
So these are two facial composites. Both needed to recontour the gingival as the caries was sub and the tissue was fibrous and thick. #9 was deep and slight caries was left over the pulp.
Setting Gingival recontouring was 1.75 W /11%a /7%w
Enamel was 3.5W/65%a/55%w
Dentin was 2.5W/65%a/55%w
Questions/ observations
1. Recountouring the tissue was a little difficult for me. The Horizontal was rather easy. Using the silk fibers as you guys suggested was a great aid. Still need to work on smoothing the area. The thinning was the hard park. I sort of got what I wanted. It seems like doing as Ron did with contouring with a diamond then going back and painting with the laser would be easier. Bleeding looks like a problem in the pictures but really was not until air was blown on the tissue. The low water setting on my unit are a pain. There is a delay in the water that seems like forever. You have to defouse wait til the water starts and then work. Tough to do in the posteriors. Biolase says they have a hardware/software fix coming out to take care of the problem.
2. Enamel , #9 I thought went well preping the enamel, #10 tended to be rougher and more frosting. Same settings and about the same distance enamel to tip.
3. Dentin seemed fine . Caries removal is something else. This was leathery caries. Just had to get in with the spoon after the bulk was removed. #9 pulp is staring at me. There is some caries left but did not want to risk an exposure. Stll may blowup. I did the enamel setings at defoused for 90 sec just in hopes of helping. Sort of like crossing my fingers.
4. After photo. Well the restorations look good from across the room. Magnification don’t lie. Looks like some recontouring at the next visit and play with the shade some more. These were A5.
5. Tissue response. The way cool part is how the tissue looks post sx. I am used to electro sx and the tissue would look like hell. This tissue looks good for just post op!
David(Edited by dkimmel at 6:42 pm on April 14, 2003)