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Dental Specialties

What type of palliative care can I provide for persistent generalized dentin hypersensitivity?

This question was submitted to us by a practising dentist: “I had a patient present today with ongoing generalized sensitivity. No clinical evidence of recession; no bruxism or clenching that she is aware of; and no dietary changes. I would like to make trays to better deliver some palliative relief (she is currently using desensitizing toothpaste). What is the best product for the trays? Would Fluoride or relief gel or some other product that I am unaware of be best?” Dr. Hardy Limeback, former head of preventive dentistry at the University of Toronto provided this initial response: Persistent generalized dentin ...

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All-ceramic dental crowns VS. metal-ceramic dental crowns: what is the clinical and cost effectiveness?

This Rapid Response is produced by the Canadian Agency for Drugs and Technologies in Health (www.cadth.ca) Report in Brief (PDF)                                         Full Report (PDF) Key Findings The short term (< 5 years) survival of all-ceramic crowns when used for anterior teeth is comparable to porcelain fused to metal crowns. Summary of Findings Dental Crown Survival Posterior all-ceramic crowns fabricated from alumina, reinforced glass-ceramic, zirconia, or lithium disilicate had comparable survival rates to posterior PFM crowns (< 5 years analysis). InCeram and glass-ceramic, ...

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How would you manage and restore this severely worn dentition?

This question was submitted by Dr. Stephen Abrams from Cliffcrest Dental. Dr. Abrams is seeking colleagues’ opinions about the best approach to the video case that is presented below. Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.  

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What are the advantages and disadvantages of self-adhesive resin cements for crown & bridge cementation?

This question was submitted to us by a practising dentist: What are the pros and cons of self-adhesive resin cements (i.e.: RelyX, Unicem 2) and resin modified glass ionomers (i.e.: FujiCEM 2) in crown and bridge cementation? Are they equally reliable? Dr. Omar El-Mowafy, Head of Restorative Dentistry at the University of Toronto provided this initial response: Advantages of self-adhesive resin cements 1. Eliminate the need for etching tooth structure or application of primer/bonding agent; and as a result, dramatically reduce the potential for post-operative sensitivity . 2. Dual-cured: excess cement can be briefly light-cured for ease of use. When used with a ...

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How do I manage vital, irreversibly inflamed teeth with unstoppable bleeding?

This urgent care scenario is presented by the JCDAOasis Team in consultation with Dr. Brian Jafine. Peer-reviewed content that appeared in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca  Presentation Population Patients with recent dental restorations (amalgams, resins, crowns) or trauma Medically-compromised patients Signs Large/deep restorations and crowns (broken down, leaking, open margins) Continuous bleeding after several attempts to dry, close, or fill the root canal spaces Symptoms Pain severity: the patient may experience some pain Investigation Thoroughly assess the patient’s medical history: inquire about diabetes mellitus, bleeding disorders, hypertension, history of radiation therapy, etc. Perform an oral examination: ...

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Recurrent Herpes Simplex: What Are the Possible Interventions?

This short consult is presented by Dr. Eric Stoopler, DMD; Dr. Arthur Kuperstein, DDS; and Dr. Thomas Sollecito, DMD Peer-reviewed content that appeared in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca and in the sixth edition of the print JCDA. Primary and recurrent infection with herpes simplex virus (HSV-1 and HSV-2) can cause oral and/or genital lesions, although the majority of oral infections are caused by HSV-1. Symptomatic vesicles/ulcers of the oral mucosal tissues generally follow the onset of systemic symptoms and are often accompanied by significant erythema of the gingival tissues (i.e., “primary herpetic gingivostomatitis”). Treatment of primary HSV infections ...

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How can I promote esthetic papilla formation between adjacent implant-supported restorations on upper anterior teeth?

The following verbatim question was submitted by a practising dentist: My patient had implants to replace 11 and 21. I have placed contoured healing abutments and temporary crowns with the contact 4-5 mm above the bone (2 mm gingiva and 2 mm space). These have been in place 4 months and although the papilla has filled in between the laterals, the tissues are still flat between the 11 and 21 despite the fact that a periodontist placed the implants doing a graft to “bulk up”   the tissue. The patient is not overly concerned; however, you can see the area when he smiles, so ...

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Case Follow-up: To Implant or Not To Implant: What Role Does Imaging Play?

This case is presented by the University of Toronto, Department of Oral Radiology Residents: Edwin Chang, Sherif El Saraj, Catherine Nolet-Levesque, Daniel Turgeon, Niloufar Amintavakoli, and Trish Lukat.  Pre-operative images provided courtesy of Dr. Milan Madhavji of Canaray | Specialists in Oral Radiology. You can view the original case here. Case Follow-Up Four implants were placed in the anterior mandible. Following implant surgery, the patient experienced persistent pain in the implant area and two of the implants failed in the immediate post-operative period. Over the course of the following year, the pain progressively worsened in the anterior mandible and the patient was subsequently ...

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