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TOWNIE CLINICAL: My Eight-Year-Old And SmartPrep By: Ian Shuman, DDS

I wound up treating my son for caries and yes, he has his dad’s teeth. No, I didn’t want to treat him and for three years I had referred him to a pediatric dentist–excellent practitioner, extremely competent. My little guy threw a fit in his office and was kicked back to me. Under threat of mommy, he sat in my chair and let me restore a few occlusals. Now, three years later, this Class II in #L becomes serious. Why didn’t I diagnose it sooner? Because the little guy has a wicked gag reflex and x-rays make him barf. Enough said.



Photo 1
Tooth #L. Yikes!


Photo 2
This entire procedure was performed without anesthesia. Unsupported enamel is removed using a Fissurotomy bur (SS White).


Photo 3
The lesion is grossly debrided using an RA6 SmartPrep (SS White) in a Rotary Master (J Morita) variable speed unit at 700rpm.


Photo 4
Caries dye (Danville) is used to ID any remaining infected dentin. (For details of this concept, refer to early works of Takao Fusayama.)


Photo 5
Remainder of infected dentin is removed with an RA4 SmartPrep.


Photo 6
The completed preparation. (Note that the mesial lesion of #K was restored prior to restoring #L).


Photo 7
The tooth is restored with a combination of a flowable base (Palfique flowable shade A2 medium flow) and Palfique Estelite Submicron-Filled paste composite (Shade A1). Anatomy is created in restoration prior to checking bite using a finishing bur from SS White.


Photo 8
Occlusion is adjusted with SS White finishing bur.


Photo 9
Composite is polished with OccluBrush (Kerr).


Photo 10
The completed case. Yea!

Dr. Ian Shuman maintains a full-time private practice outside Baltimore, Maryland emphasizing reconstructive and aesthetic dentistry. He is a Fellow in the Academy of General Dentistry, a Fellow of the Pierre Fauchard Academy and a member of the American Dental Association. Since 1989, Dr. Shuman has published over 50 dental research and clinical articles that have appeared in numerous dental journals. The cutting edge techniques and entertaining style of his seminars and hands-on courses have made him a hit in the dental world. Dr. Shuman has recently produced a complete Denture Educational System entitled “Creating the Denture Practice of Your Dreams” that includes an instructional DVD, workbook and CD-Rom. This educational system is an enjoyable, provocative, invaluable resource to your patients, and your practice. It may be ordered by calling 410-766-5104, online at www.ianshuman.com or by email at ishumandds@erols.com

Townie Comments

 artistdr 9/1/2003 11:27:34 AM 
Did you place a bit of Fuji 9 or Triage in that mesial (small now) lesion on K? Nice composite. I am afraid I take the easy route and place Fuji 9 in those large Class 2 pedos.
 ianshuman 9/1/2003 11:41:18 AM 
Alan, I used a simple low viscosity flowable for that second molar. As far as restoring these large lesions, the choice in materials depends on how long the tooth will be around. In this case, my eight-year-old, a very slow exfoliator will probably lose this tooth in about 4 years. So, I would prefer something that has more strength to it than RRGI alone.
 desert_rat 9/1/2003 12:16:46 PM  
I second the use of the Fuji 9 on these.
 artistdr 9/1/2003 2:09:26 PM  
Ian, Fuji 9 (or Triage) is not a RMGI. It is a pure restorative glass ionomer that likely will remain with the babytooth until it exfoliates. But you do the resins so nice that I think yours is a great choice.
 fmn1116 9/1/2003 4:09:13 PM  
Ian, are the SmartPreps showing to be dependable? (Are they consistent enough that you feel you could eliminate the dye step and be consistently safe?) I found when I started using dye a while ago, that my “use a dull carbon steel bur” technique I learned in dental school was pretty accurate. I have been contemplating the SmartPrep, just haven’t tried it.
 artistdr 9/1/2003 7:00:51 PM 
SmartPrep burs appear to this ignorant old dentist as another way to get more $$ from dentists. I see no use for them in my practice, but I might have a light touch. BUT then I did spend a bunch on lasers and a microscope. I guess my foolishness just costs more.
 ianshuman 9/2/2003 6:36:14 AM 
The SmartPrep is an excellent method for caries removal, especially in the absence of anesthesia. This concept is really the next step in Fusayama’s recommendation for removing infected, unremineralizable dentin only.

The use of caries indicator is really a must when first learning to use the SmartPrep.

As far as another way of taking money from dentists: Do what you do when you go through $40 worth of rotary endo files, incorporate it into your fee, the patient pays for it.

 

 
 mike_esposito_dds 9/2/2003 7:06:22 AM 
Nice case Ian...I’m sure you were as shocked as I was when I saw a Class II on my very own daughter’s deciduous tooth a few years back. I couldn’t believe it!! LOL, I guess dentists’ kids aren’t exempt from caries. FWIW, I’ve used Fuji II in cases like that with tremendous success so far.
 ianshuman 9/2/2003 9:43:56 AM 
I use Fuji II and IX on primary teeth with small lesions. I’ll use a very highly flowable resin in deeper narrow lesions like Palfique A1, and a combo of flowable and microfill in Class II and large lesions.
 nosilverdotcom 9/3/2003 7:46:17  
Greetings from a fellow ‘father of a restored kid’ dentist: my 3.5-year-old had an occlusal on #K. It just showed up one day. Those stinking ‘fruit snacks’ are single handedly creating a new decay epidemic. I see it at least 4 times a month. A kid 2-8 years old with massive–I mean massive decay. We’re talking 1958 Appalachian mountain decay. Always ask, “how many bags of fruit snacks does he/she get a day?” invariably–“oh 2 or 3.” Get the word out–THESE THINGS ARE CANDY!!
 showyourgrin 9/4/2003 12:27:55 PM 
Your little guy must have overcome his gag reflex in order to let you get the mirror and tools in for those pictures. Or is that an IO camera?
 ianshuman 9/5/2003 2:10:53 AM  
Actually, I only retracted his cheek with my mouth mirror. The photos were taken at quite a distance, no mirror, using a Nikon Coolpix 880. He still gags.

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