Composite Addition Dentistry – Lecture by Dr. Brian Mills

In this video, Dr. Mills describes cosmetic addition dentistry, a procedure that improves the appearance of teeth that have been worn and damaged, while protecting the tooth’s enamel.

Video Transcription:

Dr. Mills: We’re going to be doing what’s called composite addition dentistry today, and what that is it’s a real conservative, noninvasive way to correct people’s either worn teeth or teeth that are not quite in the proper bite without removing any tooth structure. Zero invasiveness. All we’ll be doing today is polishing the teeth, just like when we polish teeth for a cleaning, and then putting some special bonding materials directly on the enamel surfaces and adding the composite a special way, with what we call matrixes. We’ll be discussing that later.

We’ll be treating our patient for about three to four hours. It’s very easy though for them, because we take breaks, there’s no anesthetic involved, so we can stop at any time, and a lot of that time they’re not just with their mouth open the entire time. I’m doing things outside of the mouth and they’re resting, usually they just put some headphones on and some sunglasses and relax and it’s done. It’s not a really hard procedure to go through.

Well there really is no downtime. You’re not numb, so you don’t have to wait for any surprises after the treatment; say, “Oh my goodness, am I going to have pain?” When our patient’s done her bite will feel great, she’ll be just finished and go home and we usually have them back in 24 to 48 hours just to do any final polishing or adjusting that’s needed. We’re going to be doing a treatment, it’s called the functional occlusal rehabilitation, is what it really is called.

That involves addressing all the teeth so they’ll all fit properly together, just like gears all fitting properly together. You can’t have one cog on the wheel out of sync or it disrupts the function of the entire gear or the cogs on the wheel. We usually start with lower teeth, and we’ll be demonstrating that later. What is involved is after we polish and prepare the teeth for bonding, we’ll have some clear matrixes and we’ll demonstrate how we add the composite material very accurately to each of the lower teeth to start balancing the bite. Then we’ll be starting the bonding on the upper teeth, the two central teeth are usually where we start.

After that, in this case the patient also needs what we call a negative coronoplasty. That essentially is there’s some teeth that have been worn slightly unevenly, we’re just round those worn edges so they fit better and then we’ll finish up bonding any areas on the back teeth. This is a good example of a moderate level three case. It’ll be incorporating some significant additions here, where we’re bonding the front area to establish our proper anterior guidance. We have cuspal additions on the posteriors here, here and here. If you look down, we’re going to be having some minor negative coronoplasty on some of the posterior teeth here, here and in these areas.

Here we can see on the maxillary arch we’re going to be doing some additions on the anterior teeth, some moderate coronoplasty on the posterior teeth in these areas, and these darker areas here, that have been marked, are going to be some fascia additions. They were previously waxed and then removed so we could make accurate matrixes. For the anterior areas, where you don’t have adequate vertical stops, you want to be using a very rigid matrix material.

There’s actually two kinds. This material is Durasoft, by Great Lakes. It’s great because it’s very rigid, like night guard material, but has a soft inner lining and it’s very thin, so you can actually see your work while you’re adding the composite. The disadvantage is if you have significant facial contours you’re adding on, you could possibly lock this in. For just incisal edge additions, this is a very nice matrix, but for what we’re doing there’s a good chance we would lock this in when we added our final contours.

This is an example … This patient will be having additions here. This is the untreated models. The matrix basically will go on and the nice thing is, if you see there’re voids in there, when I press there’s no distortion or deflection. This is our patient today, and if you notice, we have added on some heights of contour and some facial contours, so if you were to use that other matrix, the Durasoft, there’s a good chance you’d lock this on or have a very difficult time removing it.

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