Dr.Manoj Kumar.S BDS, MDS-Prosthodontics, FICOI, MICOI, Board Certified Dentist-Canada

Case 47: Occlusal stamp technique for direct composite restoration As the name indicates, a stamp is a preformed contour which impresses or creates a replica when placed on an object. With regards to dentistry, in the field of composite restorations any pit and fissure decay which requires a restoration and has not covitated the tooth structur externally is an ideal candidate for this occlusal stamp technique. Here in this case its a simple GV Blacks class 1 situation of dental caries on tooth no 2.7. Ther sequence of stemps involved are as follows: 1. After the initial diagnosis and confirmation with a radiograph, The fissures and the occlusal table is cleansed and a very thin coat of vaseline is optional, followed by application of flowable composite on the occlusal table creating a small mound. Before curing it place a small plastic applicator tip and then light cure it. Once done just tease the composite with a sharp tip of an explorer and it will easily pop out. Now the occlu...

Guest Speaker 3: Course on Direct Composites anterior and Posteriors 15th October 2017 SMAK academy was proud in conducting its second course on Direct composite restorations. I was a guest speaker and my talk was completely on "Finishing and Polishing of Composite restorations" This program was sponsored by Tokuyama and the entire program was done with their composites. However, the finishing and polishing protocols involved all the other various techniques in achieving the best esthetics. The program had lectures involving Material Sciences in Composites- by Dr.Shameem, Anterior Direct composite restorations by Dr.Mahadevan and Posterior direct composites by Dr.Kamakshi and concluded with Finishing and Polishing protocols for composites by me. Post lunch we did an extensive hands on on different layering techniques till the final finishing and polishing.

Case 46: Complete surgical phase: Maxillary arch 4 implants and Mandibular arch- Guided Bone regeneration with Titanium mesh and Autogenous bone graft and collagen membrane  Here is a case which is affected by generalised periodontitis in both maxillary and mandibular arch along with failed implants in the lower anteriors with severe bone defects. All the teeth were mobile and the plan was to go in for a total extraction followed by a wait period of 2-3 weeks before going ahead with implants in the maxillary arch ( 4 numbers) and a bar supported hybrid prosthesis with shortened arch. In the lower arch Guided bone regeneration at the lower anterior defect site extending from 4.3 to 3.4. Since the plan is to place implants in the sites of A to E (According to Misch) and a lower hybrid prosthesis with shortened arch over 5 implants. The first phase or the surgical phase was handed over to me to place the implants and the guided bone regeneration procedure. After a span...

Case 45: Cementation protocol for an emax- lithium disilicate crowns The chances for dislodgement of an all ceramic especially a glass ceramic is possible when isolation is not maintained during it cementation. Here is a case with a dislodged emax crown which was done somewhere else a year ago. Bonded restorations normally have an excellent durability and longevity if luted following proper cementation protocols. So what do we do to achieve that protocol? Step 1: Isolate the tooth or teeth using a Heavy rubber dam and use of either Brinker clamps or Tie floss can be done to expose the finish line margin. In this case the margini was supra-gingival and hence a tie-floss technique was employed. Step 2: Treating the cementing surface of the crown. Use of ultrasonics to remove any excess cement flecks attached to the crown is removed. Ideally if u have aluminium oxide air blast it can be used once. Later use 9% or 10% Hydro fluoric acid and etch the glass surface for 90 sec...

Case 44: All on 4 maxillary arch- System- Straumann implants As i have discussed the pros of an all on 4 implants with immediate loading in my previous cases, I am directly going ahead with a case discussion here. The patient had a history of single maxillary metal based complete denture opposing a natural dentition form 3.5 to 4.5 with an RPD for the posteriors. He did present with a root stump in 4.7 After CBCT analysis, we decided to go in for an all on 4 procedure as the patient was not satisfied with the removable maxillary denture. The system chosen was Straumann Roxolid SLA active. The entire procedure was carried out under local anesthesia. And the impression copings were splinted using pattern resin and a trayless impression was made with addition silicone. Further jigtrial and  jawrelation followed by try-in was carried out. Final prosthesis was torqued over the multi-unit abutments at 15 NCM as all the abutments were angulated to 15 degree for anteriors and 30 degre...