Replacement of old amalgam on tooth #14 - Courtesy ROOTS
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From: Dr. Glenn A. van As
Sent: Tuesday, November 22, 2005 4:40 AM
Subject: [roots] You crack me up (not endo........yet)
Hi there, this is a patient who came into the office to replace an old
amalgam on tooth #14 (2-6 international system) and it was planned to be
done because of the shadow on the mesial which told me it had decay. I
also saw cracks in the tooth even though it was asymptomatic, because I
am using a scope at my hygiene appointments to screen for things like this.
I am trying to treat these cracks before they become symptomatic and
there is alot of stuff I have learned from David Clark on which cracks
he treats and which are just posterior craze lines (like cracks that
follow anatomic grooves).
Now remember, this tooth was asymptomatic but I chose to take out the
cracks in the tooth, use the erbium laser to be bactericidal to the
floor of the prep and fill it with a direct composite (Gradia over
No decay was visible radiographically, so I didnt take a radiograph of
the BW. I show this to tell you that so many amalgams I remove in the
molar regions have cracks like this and so many times they are or
shortly afterwards become symptomatic and its so nice to treat these
before they hurt and also before they catastrophically fail. In
addition, the Methylene Blue from Vista works awesome for the dental
plans to identify cracked teeth that require full cuspal coverage even
if they are restored minimally. Many of the teeth I have approved for
crowns are similar to this.
Hope that you enjoy it........in this case we are just going to wait and
see how the tooth is and if I create symptoms now with the restoration
or if it settles down - Glenn
Beautiful pictures, a great learning experience Glenn.
Your students are lucky to see this - Carlos Murgel
Thanks Carlos , I appreciate it. These were taken with the Nikon D2X which
is heavier than my D70 but it is a pretty good camera. The D70 is in the
shop right now because it just died one day last week. Its weird because of
all the Nikon Cameras I have owned this is the first time one has died.
Nice series, glenn, I have just one comment. If you are a disciple of
brother david's protocol, I believe he states we don't even begin to
evaluate cracks for categorization until we reach 16x - gary
Hi there Gary, a couple of things.
David has the old Global scopes with mags at 2.5, 4, 6.4, 10, 16 and 24
on the Protege Plus
The new G6 has 2.1, 3.2, 5, 8, 12, and 19.
Secondly it is more difficult to photograph cracks with any depth of
field or diameter of field at 19X mag.
It is easier to photograph at 12X mag for the lighting.
Davids protocol is fine for him (but it is a protocol!!)
Grin, ask him when he comes on, and he will disagree with me but that is ok!
Glenn do you think that the D2X is good for us? Don't you think it is too much
for the little that we need? - Carlos Murgel
Hi Carlos.......the Nikon D2X is my home camera, I take lots of photos of kids
activities, nature photos etc.
WHen my D70 died I had to put it on the scope (its too heavy in my opinion and
too much camera for the job) just so I could get photos.
I think the new Nikon D200 will be a good alternative but again the file sizes
are huge on these new cameras. I keep the files on Small right now and Fine just
so I get good quality but a smaller image and file size.
The color rendition is great though and Nikon has nailed the focussing......there
are so many options on the camera its frightening!
Thanks Carlos......I will post some more photos when I get time and again the D2X
is not my endo camera, the Nikon D70 is
(it does flash sync at 1/500th second which is cool)..... - Glenn
We've talked about it. My take is that if I see a crack at lower power it's
a crack. If I don't see it, turn the knob a level and look again. The
presence of a crack is definitive at any power; the lack of a crack at a
lower power does not mean one is not present, it simply means we do not have
evidence of it.
And don't pick on us guys that have the protégé plusses! - gary