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Figure 4: This view of the mandibular arch shows the same type of
destruction evident in the maxillary arch. The patient said no dentist
had ever told him that he needed a nightguard, which surprised
me. (Keep in mind, I’ve found patients to be wrong more than they
are right when relaying clinical facts.) Again, the cast metal crown
on the lower right is the only tooth — natural or restored — that is
doing well in this oral environment.
Figure 5: Just for fun, I take out my VITA Easyshade ® Compact
(Vident; Brea, Calif.) and attempt to get a reading on the current
shade of the patient’s teeth. I have to admit that I half expected
smoke to come pouring out of the device as it attempted to match
this shade. The device is programmed to give the closest shade
as opposed to the exact shade, so it indicated a C4 as you might
have guessed.
Figure 6: When I place the C4 tab next to the teeth, it’s clear that
the hue and the chroma are more intense, and the value is much
lower. As the tetracycline staining is technically in the dentin, what
we are seeing is the stains showing through the enamel. You know
as well as I do that when we prep into the enamel, this discoloration
will only intensify.
Figure 7: A SeeMORE 4-way retractor (Discus Dental; Los Angeles,
Calif.) is placed. I used to use these retractors only when filming,
but then I realized they freed up a hand each for my assistant and
me. The company stopped making them for a while, but rumor has
it they are starting to again. Here I am placing PFG Light topical
anesthetic (Steven’s Pharmacy; Costa Mesa, Calif.) onto moist
mucosal tissue. (NOTE: Don’t dry the tissue beforehand.) We leave
it in place for 45–60 seconds before rinsing. I love this topical gel
because it is the only one I have found that keeps the patient from
feeling the needle insertion.
Another Use for Anterior BruxZir Solid Zirconia Restorations25