General
Periodontics
Prevention
Restorative
Oral Surgery
Oral Medicine
Prosthodontics
Medicine & Pharmacology
Radiology
Endodontics
Infection control
Pediatrics

 

General

1

What is a material, instrument or technique that makes practicing dentistry easier for you?

2

Is there any information or adverse effects with the use of ultrasonic scalers/hand pieces with persons whom have had a Sacral nerve stimulator implanted?

Periodontics

1

What clinical evidence is available for the efficacy of deep periodontal pocket disinfection with a soft tissue diode laser? What protocols are proven and recommended in terms of frequency of treatment?

2

1) Educate the general dentist and hygienist to recognize early signs of periodontal disease.

2) Train dentist and hygienist to present this information to patients in a kind, caring non-threatening but motivating way.

3) Have a section, in a concise manner, to evaluate new products. Do this in concise, readable articles, and not the lengthy, with lots of graphs and tables that are meant for researchers and academics.

Prevention

1

Is there any evidence of benefit for the routine use of an antibacterial mouth rinse( ie. chlorhexidine gluconate .12 %) prior to dental appointments. Would there be any contra-indications to this practise?

5

Is there a difference between the dental erosive capability of body temperature orange juice and similar temperature cola drinks? Why?

Surgery

1

I am interested in latest treatments, modalities and rationale for parasthesia arising from IAN slight damage.

2

The long half life of bisphosphonate drug retention makes taking the patient off the drug prior to dental extractions/surgery ineffective at reducing the negative effects of the drug on alveolar bone regeneration.

Some newer, daily- dose oral bisphosphonates seem to have half life retention of under 24 hrs, which would suggest that a “drug holiday” of eliminating the drug for weeks or months could allow for some reactivation of the bone metabolism allowing more normal recovery from surgical intervention.

Are these drugs only used for osteoporosis or are they used for cancer patients that have had radiation and chemotherapy? Why would a physician use the more long-term drugs over ones with the shorter half life?

As part of the discussion please review the debate over why these drugs are used and the evidence that supports their use to reduce fractures of long bones, spine, flat bones such as pevis, skull, and alveolus. A list of the commonly used drugs, their half life, and their preferred target use profile would be helpful.

With patients on long term bisphosphonates, discuss treatment options prior to the introduction of these drugs with ongoing strategies for maintaining them.

3

I am interested in the indications for socket grafting to preserve the alveolus for dental implants. Can we justify the fee structure for this?

4

In the case where there is an oro-antral commmuication. What is the solution?
I would like to ask you about the best flap in case of potential to oro-antral -communication in the upper teeth .

5

Based on scientific evidence, what is the best method of post-operative pain management following surgical extractions?

Restorative

1

Replacing a failing amalgam with composite. The existing amalgam restoration has a deep IRM base and is asymptomatic. Once the amalgam is removed and there is healthy tooth structure surrounding the IRM, I fear taking out the entire IRM when it is close to the pulp in case I introduce a pulpal problem that was not there previously.

As we know, IRM and composite are not compatible materials. Is there a liner or base material that is compatible with both IRM and composite that can be used in a sort of “sandwich technique” to put an interface between the two incompatible materials, and hence allow the clinician to leave a small portion of IRM in the tooth?

2

I was taught in dental school that we could successfully treat deep molar grooves with fissure sealants, and even early decay could be treated with “clean and seal” restorations. I guess my “burning question” is this: does anyone else share my opinion that first and second molars with deep grooves are not indicated for sealants or “clean and seal” restorations, and instead should be treated aggressively using proper anaesthesia and full composite (or amalgam!) restorations?

With digital imaging, we are picking up a lot of caries under sealants or small resin restorations on these teeth. Secondary question…is caries detection dye accurate?

3

What is the consensus on indirect pulp capping?
Just today I did partial excavation of decay on a first molar with symptoms of reversible pulpitis, left some semi hard decay and did a temporary restoration with IRM. I will go back in 6-7 months and try for a final composite filling and hope to avoid pulp exposure and RCT by doing so. I have done this several times over the years with mixed results, any pointers for case selection or materials?

4

What is the best material to do a direct pulp cap? Is it still Dycal but I heard Durelon.

I am not able to do a MOD with the Triodent matrix system (that I love), the two rings don’t fit at the same time. Any inputs? The rep tells me I can.

5

My burning question- who should do the post-endodontic restoration, endodontist or restorative dentist?

6

I think, with all due respect to Black’s Principles, that the preparation can be whatever the decay dictates.
It’s the matrixing and contact that are the challenge for most dentists. Also, the finishing & polishing can be a chore, if you don’t have the right tools.

I would really appreciate an update on “2012” matrix types, and also the top tested finishing burs and polishers.
Most of us tend to depend on the sales reps (not always reliable)

7

Any detrimental effects of tooth whitening agents on enamel? Some have shown increased microfracture in the enamel seen only under SEM however is it clinically relevant?

8

What are evidence based guidelines in decision making when treatment planning prosthetic restoration of molars as far as the choice between resin bonded onlay restorations (ceramic or ceramic reinforced resins) vs full coverage ceramics, and the different luting agents or cements.

9

Is there any solid evidence that the coating recommended for Resin Based Glass Ionomer Restorations impedes the release or uptake of Fluoride?

10

Is the disinfection of cavity preparations taught in dental schools? I am referring to a CRA, Clinicians report that showed viable gram positive and negative organisms in 100% of all prepared teeth. See CRA Nov. 2009, Vol. 2, Issue 11. “Disinfection of Tooth Preparations-Why and How?” It’s easy.

My peers won’t disagree. Their objection is the 2 minutes it would take. If it isn’t taught it’s not likely that many will follow this practice. We waste a lot of time in our work anyway. If bugs are the enemy then this becomes significant especially under sealants. Similarly, is the use of caries detect taught or is the objection the same? It’s one more step. “It would slow me down.”

11

I am presently doing my own research into effective hemostatic agents. Presently many of the bonding and impression techniques we use are highly sensitive to moisture (crevicular fluid), saliva, blood etc. As we do more and more cosmetic dentistry new problems arise with bonding techniques and long term aesthetics in the esthetic zone.

By far the best drying, hemostatic agents I have found to date, ferric sulfate and superoxyl have inherent problems with long term black line staining or greying under the restoration or in the case of superoxyl, weakening bond strengths leading to future marginal discolouration. All other products and techniques I have tried to date are less than adequate, aluminum chloride (viscostat,detail, expasyl paste), epinephrine, laser curettage. Any suggestions on techniques or other products? The best of these would be expasyl paste, but clean up is not the best and I am not sure if residual amounts may affect our bonding techniques?

12

I was wondering what the pros and cons of self adhesive resin cements (ie: RelyX, Unicem 2) and resin modified glass ionomers (ie: FujiCEM 2) in regards to crown and bridge cementation. Are they essentially equally reliable?

13

What is the “Ideal Treatment of Choice” for the following clinical situation:

A patient presents with a Max. central incisor broken off to the gingival crest. Let’s assume the tooth already has an adequate endo, and has sufficient clinical crown (suprabony, ie. no need for perio surg. / crown lengthening) What is the best way to restore this tooth , way back when I was in dental school we were taught to place a cast post and core, and then restore with a full coverage crown. Is this still the best solution… or is it more recommended to place a “resin fibre post with a resin core build up” ??? Then follow up with full crown coverage.

Is there any evidence out there which supports either decision?

14

Regarding direct composite restorations: Is it time to retire GV Black preparations and incremental filling and start utilizing the likes of David Clark (saucer shaped preps/ injection mould filling with through and through curing)?

15

Consider the clinical situation of a successfully endodontically treated tooth which suffers trauma or restoration failure such that the coronal structure is highly debilitated. For simplicity, assume that the periodontal condition is WNL and the adjacent teeth are healthy with no restorative history. What clinical condition must exist such that restoration with a post/core/crown still has a better prognosis than removal and replacement with an implant supported crown?

16

I always worry that the cavosurface margins of class II preps are not fully filled when using composite resin. Is there a difference in the long term margin integrity using the following 3 methods? 1) pack composite resin into the proximal box using an amalgam condenser 2) place flowable resin along all cavosurface margins of the proximal box and cure it prior to packing composite. 3) place flowable resin on the cavosurface margins and then insert composite on top of the uncured flowable.

17

Does warming composite prior to placing in preparation result in better depth of curing?

18

Are there updated criteria to use when deciding if a crack/craze line on an a symptomatic tooth should be attempted to be removed, either with restoration or crown?

19

Best pulp therapy treatment options for deep decay extending into the pulp of 1st molars of a young patient? With and without closed apices?

20

What are the main differences between “posterior composites” and universal composites?

21

What kind of a restoration is best recomended for root caries, especially where isolation is a problem? Sandwich technique with GI? Is a full GI cement resto recomended over amalgam in non esthetic areas? Which is the recomended GI cement for such a resto?

22

Since composite fillings eventually leak…..and many times by the time the patient comes to us the secondary caries has spread a lot under the restoration to cause an even bigger filling(if not RC), what is the best solution to prevent this from happening? Would putting a liner with fluoride release like GI, GI Compomers (ionosit, vitreobond) etc recomended? Do they help in some way prevent or reduce the spread of sec decay?

23

As a practising dentist I am often asked whether it is recommended to change old amalgam fillings to the latest white composites. I often reply with information such as Amalgam fillings are unbonded but the gap fills with corrosion products and seal better as they age(is this true for the newer non-corrosion alloys?). Composite fillings look better but need more maintainence..they last about 5 years(?) They are not recommended in patients with poor oral hygeine, dry mouth etc as plaque and acids acting on them tend to break the bonds down sooner. Please correct me(if I a wrong) and add to my information. What else should I be informing patientsd in order for them to make a well informed decision?

24 (AZ)

Bonding systems and techniques: So many options available and so many different clinical situations, that this question is daily:
Examples:

• One step etch/prime systems – When and where. Enamel or no/minimal enamel.
• Veneers bonding – which step, when, what goes on the veneer and what goes on the tooth? When is the adhesive cured, when is it not? Can i mix bonding systems?

25 (AZ)

Cement – Which system to bond and/or cement is best in different situations –

– Maryland bridge cementing or recementing

– all porcelain crowns – pressable or not

26. (AZ)

Temporization – What is the best material for veneer temps? Techniques?

27

Post-op sensitivity after Cl. II composite restoration: I have found that a few of my patients sometimes have post-op sensitivity after a C. II restoration that occurs only when flossing and more specifically when flossing through the contact (at the point of resistance). I have attributed this to “too strong” of a contact or a slight overhang of the restoration, and corrected most cases by easing the contact or overhang with a finishing strip, but it has not worked in all cases. Is there any other methods to avoid this type of post-op sensitivity or to correct it once the restoration is in place?

28

Has anyone seen ‘preeruption caries’? I have several cases where there appeared radiographically to be caries on the occlusal surfaces of unerupted teeth. On eruption, I observed them for a while. After the first one increased in size over time, i went in and restored all of them. All seemed to be carious.

29

Some clinicians advocate bulk fill for composite placement, using either flowable (alone or covered with one layer of solid composite- as a second light increment) or solid composite resin alone in one increment.
Given known limitations of bulk fill such as shrinkage and limited curing at certain depths of the restoration, what advantages are there for this technique other than reduced operation time?
The question refers to using this technique for large one-surface restorations (> 2×2 mm) or restorations involving 2 or more surfaces of the tooth. Are there materials that are preferred over others with this technique? Is there peer-reviewed research supporting this technique?

30

My patient came in the clinic with a crown of tooth 24 in her hand complaining about having this crown fallen off for the 4th time ( the crown was made by another dentist). Then,about 10 months ago,I made a new PFM crown on this tooth. Now, the patient came back with grade 2 mobility on this tooth and a very deep pocket on lingual side. In x-ray examination, bone level in mesial and distal is normal. Surprisingly, there are loose contact on mesial and distal although I am sure that in time of insertion the crown had good proximal contacts. I checked occlusion and actually took it out of occlusion. I, also, deep cleaned lingual side. The patient is a very heavy grinder and after all this happened, she accepted to have night guard. None of these treatment helped to reduce mobility. I don’t know what happened to this tooth and what will be the next step. I would appreciate if you could kindly help me with this situation.
( I can’t imagine that we can provide advice for this sort of problem – probable response – refer to a periodontist?)

31

What are the advantages and disadvantages of full-contour zirconia vs cast gold for a full crown on a second molar?

32

I would like to know how your readers would restore a case of severe bulimia. I would send a picture if possible.

33

Patient comes with a full porcelain crown such as Lava which has come off. Tooth is sound, and resin cement inside the crown. What is the safest way to clean up inside the crown?

Oral Medicine

1

What are the causes of burning tongue?

Prosthodontics

1

Maybe the experts could discuss crown to root ratio in regards to implants and the latest research. Does C/R matter or not with an integrated implant and then more importantly- what do you do in your practice?

2

What does the literature say about crown- root ratio for implants with regard to short implants and crowns that are long or longer than the 50/50 guide for natural teeth?

3

I have always been intrigued by the use of implants and natural teeth as part of a fixed retained prosthesis. The conventional thinking has been that you will get intrusion of the natural abutment when you use a combined case involving mixing the two. I suspect that there are many other factors that would alter this outcome and that avoiding this combination should not be a hard and fast rule. There is little in the literature that would be an “evidence based” study that has outlined guidelines for this combination.

Discuss scenarios whereby you might consider ….or completely avoid this combination

4

I have a patient with missing upper canine. She previously had implant surgery but it failed, has deep bite, short clinical crown in the upper first premolar and small upper lateral which has elevated risk of pulp exposure if i try to make full ceramic preparation. I thought I could make full coverage on the premolar and class III preparation on the lateral but i am afraid about the impact of heavy occlusal forces. What can I do?

5

What’s the current consensus on the best cement for Implant crowns?

6

When is it appropriate to link prosthesis to both implants and natural teeth? (repeat?)

7

Has anyone had any experience with allergic reactions to casted frameworks for implant supported bridges containing alladium (75%), silver, indium, gallium and gold?

8

Is there any study relating to problem with space opening between a crown on the most distal tooth and the rest of dentition (distalization of crowned 7 for example after crown insert) cause, treatment and prevention.

Medicine & Pharmacology

1

I have a patient on long-term prednisone (20-30 mg), type 1 diabetes, myasthenia gravis, who has seizures, who needs a few routine restorative procedures done as well as a cleaning. Last time he had local he said he had a seizure on the way home. I spoke to his family dr about doubling his prednisone dose the morning before his appt to prevent an adrenal crisis. His MD said he is not familiar with doing that, but he doesn’t see a problem with it. His dr also recommended antibiotics prophylaxis. When I spoke to my patient he said he would rather not take extra prednisone as it makes him feel unwell.

How would you handle this situation?

Is it still common practice to double the prednisone dose if they are on it long-term?

2

Is it safe to use vasoconstrictors in patients with sickle-cell disease? Which one is the best choice? Could I perform a painless dental extraction without vasoconstrictors in these cases?

3

Is it safe to use single tooth anaesthesia for primary teeth without causing any harm to the developing permanent teeth? Is it safe also to use 2% lidocaine with 1:80,000 epinephrine for single tooth anaesthesia delivery system? Why is there increase in heart rate following single tooth anaesthesia delivery system?

4

I am searching for advice and recommendations on minimizing narcotic prescriptions and advice on prescribing analgesics for irreversible pulpitis and for wisdom tooth surgery.

5

The current CDA position on antibiotic prophylaxis regarding joint replacement calls for antibiotics for 2 years post insertion of the total joint prothesis.

The American Academy of Orthopaedic Surgeons now advocate antibiotic coverage for the lifetime of the total joint prothesis.
Can you please clarify this apparent conflict? (Euan has provided an answer and copied me)

6

I have a patient who had recently been diagnosed with Lyme disease. The specialist has highly recommended to the patient to have all of the endodontically treated teeth extracted because they are contributing to the sequalae and persistence of the spirochetes and/or toxins. I had the patient get a letter from the specialist detailing the reason for extracting these teeth and the evidence for doing so. In the meantime, I have searched medline, asked several oral surgeons and an endodontist regarding this matter and there seems to no information to support or refute the claim made by the Lyme disease expert. I am waiting to hear back from Lyme disease specialist. How should this case be handled and is there a specialist in medicine or dentistry that the patient should consult with?

Need to find someone who has experience treating periodontal issues with scleroderma. A patient has the typical limited opening due to tightening of the lips. It seems the vestibule is tight as well. It is as if the entire vestibular tissue is one big frenum pull, resulting in advanced recession and stripping of attached gingiva from the roots. My question is, will grafting or vestibular deepening help? More immediately, will a surgical approach prove successful? Will surgical trauma cause more scarring and tightening of tissue, make the problem worse?
Surprising, few of my colleagues have experience with this. I am trying to find info to help guide treatment planning. I can send photos and radiographs. Feel free to contact me directly by email, drpbelzycki@rogers.com or by phone 416-995-0875.
I hate typing, love talking. I am 59 and a first time blogger.

7

Are there recommended guidelines for reducing the incidence of shingles in a patient that has a history of developing shingles after dental care?

8

I would value your opinion regarding a patient scenario, where by the patients medical practitioner has requested extraction of the patient’s teeth, some are healthy and some are not, prior to Knee surgery.

I have requested this in writing from the medical practitioner and i feel ideally it should ideally be from the orthopaedic surgeon.

I have yet to carry out an assessment of the patient’s dental needs and my initial thoughts are, to save the healthy teeth i.e. those which can be restore without any apical pathology and those which do not require endodontic treatment. those not grossly periodontally involved.

Are there any guidelines that have been issued, i would appreciate any further advice.

9

While I was away for vacation, one of my patients came to the clinic and complaint of a strong table salt taste in his mouth. It last for several days causing a major discomfort. I saw him today, and although the taste seems to be dying down, he claims it is still present. The oral exam didn’t show anything on the tissue or else. Would you know about any systemic disease that could cause this situation?

10

Do I need to go for prophylactic antibiotic coverage before performing oral prophylaxis in patient who has undergone bypass surgery 1 year ago.

Radiology

1

I have seem an exponential growth in CBCT at the marketing level (shouldn’t we ALL have one?), and have seen an emerging trend in dentists using them to reverse engineer pans etc. Most recently, an advert came across my desk where bitewings engineered from a pan are the answer. What is the impact of emerging radiographic technologies on cumulative patient ionizing radiation exposure?

Endodontics

1

What are the pros and cones of using the twisted file system for RCT?

2

Regarding the size and shape of root canals…..the trend seems to be shifting from large tapers(0.8.0.6) occlusally, plus large size files(30, 35) in order to facilicate access of irrigants and flushing into the depths back to keeping the canals narrow in order to preserve tooth structure and prevent fractures etc. Do please advise.

3

Which rotary endodontic and obturation system is the best?

Infection control

1

Should the transmission (gears) inside prophy heads and slow speed hand pieces be sterilized between patients?

I find to my surprise that assistants and hygienists leave these on the angle nose cones.

Pediatrics

1

What are the current standards for treatment of permanent teeth who have had trauma and require apexification?