Lee Ann Brady, DMD's Dental Blog

Are You Talking About Benefits or Benefits?

Mary Osborne — Tue, 14 May 2013 15:30:09 +0000

I’d like to suggest a formula for health, both the health of your patients, and the health of your practice: CSJ + PO + FF + MOP = Health

Direct Composite for Repairing Worn Incisal Edges

Lee Ann Brady — Thu, 09 May 2013 16:11:00 +0000

In most of these cases restoring the teeth becomes a combined procedure with an occlusal adjustment or equilibration. Altering the occlusion allows us to manage and minimize the forces placed on the teeth as well as alter surface area of contacts to distribute the forces. These two factors will increase the success of the restorations and increase the longevity of the teeth.

When is Appliance Therapy Complete

Lee Ann Brady — Wed, 08 May 2013 07:46:49 +0000

Based on the reason an appliance was recommended and fabricated we monitor increased stability and the disappearance or management of the signs and symptoms. One way to do this is through patient report, and it is very important to get feedback on how the patient is doing int he appliance and how their experience of any symptoms has resolved.

When Patient’s & Dentist’s Concerns Don’t Align

Lee Ann Brady — Wed, 01 May 2013 07:29:32 +0000

The challenge is that as dental professionals we become very comfortable with both dental disease and with common dental issues that are not problematic.

Are You Recommending Xylitol for Caries Control?

Lee Ann Brady — Mon, 29 Apr 2013 16:41:47 +0000

The recommended dose is 5g per day to prevent caries. I have found that the use of xyltiol gum and mints can be both a fabulous replacement product for our patients that already chew gum or use mints or hard candies, as well as being easily adopted as a new behavior to help reduce decay.

Are You Using Checklists?

Lee Ann Brady — Wed, 24 Apr 2013 07:10:27 +0000

Over the last few years more and more of the dentists I have spoken with have begun implementing checklists as a way to improve efficiency and successful execution of complex tasks in the dental office. Recently my friend Kirk Behrendt posted a video on the use of checklists which is worth a few minutes to watch.

Air Abrasion For Margin Repair

Lee Ann Brady — Wed, 17 Apr 2013 07:08:04 +0000

Without any anesthetic I used air abrasion with 50 micron aluminum oxide to just open up the margin, remove the stain and any decalcified tooth structure. The interface of the ceramic material was treated with a porcelain conditioner called Monobond Plus by Ivoclar Vivadent. The tooth is etched with phosphoric acid and then dentin adhesive is applied.

“Permanent” Restoration

Lee Ann Brady — Mon, 15 Apr 2013 07:32:34 +0000

So maybe we need to remove the word "permanent" from in front of many of the dental procedures we do. For that matter for many years I have tried to remove the word "temporary" as a descriptor in my office. At first I wondered about substituting a different adjective.

Improved Anterior Esthetics Using Microfill Composite

Lee Ann Brady — Thu, 11 Apr 2013 07:19:04 +0000

Understanding the properties of microfills, there perfect use is as the final surface layer in an anterior composite. So for anterior composite veneers, class four composite repairs or class three composites that come through to the facial using a.5mm facial enamel layer of a microfill may be the solution you are after.

Spot Etching & Cementing Provisionals

Lee Ann Brady — Tue, 09 Apr 2013 07:07:42 +0000

The first step is to air abrade the inside of the provisional. I place a substantial spot, 3mm diameter, of phosphoric acid etchant on the tooth. I etch int he middle of the labial surface on an anterior tooth and int he middle of the occlusal table on a posterior tooth.

Poly Wave LED Curing Lights

Lee Ann Brady — Mon, 08 Apr 2013 07:04:51 +0000

In addition to potentially upgrading to a sleeker and lighter unit, that has a superior charging technology there have been key improvements between LED and poly wave LED. One of the important factors driving this change has been the expansion of photo-initiators in our common resin based materials. Each photo-initiator has a specific band of light that optimizes it's polymerization.

Orthodontic Root Resorption: What Do We Need To Know?

Lee Ann Brady — Fri, 05 Apr 2013 07:29:51 +0000

After an initial episode of resorption, once the orthodontic forces are discontinued the roots heal by forming cellular cementum. This cellular cementum protects the roots from any additional rounds of root resorption.

Do Patients Para-Function in Centric Relation?

Lee Ann Brady — Wed, 03 Apr 2013 07:44:29 +0000

I have seen and restored multiple examples just like this. In my experience when the crown comes back from the lab we will be able to adjust it in without issue, but the patient will report it feels high, or it will become chronically sensitive. The solution will be to either adjust this crown in both intercuspal position and centric relation, or incorporate an equilibration with the restorative care.

What is Your Role in An Emergency?

Lee Ann Brady — Mon, 01 Apr 2013 07:29:06 +0000

One member of the team retrieves the AED, another calls 911, a third goes out front and stands to flag down the paramedics when they arrive and direct them to the correct office. The doctor and another team member worked together to preform CPR and use the AED, and a last team member was there as backup in case they needed anything or someone had to step away.

Using Expasyl for Hemostasis

Lee Ann Brady — Wed, 27 Mar 2013 07:21:56 +0000

My preference for creating the appropriate space is to utilize a two cord technique. The primary cord which stays behind helps to control crevicular fluid and the top cord leaves a space behind for the impression material after it is pulled. If you are using cords that have been impregnated with epinephrine or other hemostatic agents they can also control hemorrhage when the tissue damage or inflammation is minor.

Orthodontic Root Resorption & Occlusion

Lee Ann Brady — Wed, 20 Mar 2013 19:54:21 +0000

Over the years, I have treated numerous patients with "significant" root resorption and have always found managing the occlusal forces to be a critical factor. Mobility is one of the classic findings on incisors with significant resorption, and can be very concerning to the patient as well as the dental team. One of the first things I want to do when this situation presents is an occlusal analysis.

Adjusting An Appliance You Didn’t Make

Lee Ann Brady — Wed, 13 Mar 2013 07:38:41 +0000

Are you willing to make adjustments to an occlusal appliance that you did not make? Over the years I have met dentists who “never” adjust an appliance that was made by another dentist, and others who are willing to. In my experience either way it is a challenging situation and a challenging discussion with the [...]

Understanding DeBonded Restorations

Lee Ann Brady — Tue, 12 Mar 2013 07:25:35 +0000

When this happens there are several things to ask as a way to problem solve. First is to ask the question was the porcelain etched with hydrofluoric acid? If you are etching the restoration in your office make sure you are following the manufacturer recommendations for strength of the hydrofluoric and the time of the etch. If you are not etching yourself, have you verified with the technician that they are?

Doppler Joint Auscultation

Lee Ann Brady — Tue, 05 Mar 2013 12:59:21 +0000

Translation occurs when listening on the balancing side during an excursive or during the rest of the opening movement. Doppler is one of my favorite ways to listen to a joint as both the patient and I can hear the sounds.

Stacked(powder/liquid) Ceramic Restorations

Lee Ann Brady — Fri, 01 Mar 2013 12:33:10 +0000

Restorations can be made as thin as .3mm and therefore tooth preparation can be very conservative when utilizing this material. The material can be utilized for both full and partial coverage restorations. Due to the inherent physical properties of the ceramic and the creation process, restorations made this way have a relatively low flexural strength of 60-110mpa.

Anterior Veneer Prep for Closing Black Triangles

Lee Ann Brady — Tue, 26 Feb 2013 07:16:53 +0000

One of the greatest challenges of closing a black triangle, or gingival embrasure with a veneer is avoiding the creating of a ledge interproximally. This is similar to our experience with composite when we try to close a diastema.

Papilla Esthetics

Lee Ann Brady — Fri, 22 Feb 2013 15:09:58 +0000

The first is symmetry. Much like with gingival esthetics we want the papilla heights to be symmetric across the midline. Some patients will have papilla tips that when connected create a straight line, others the line will tip up toward the canines.

Learning The Color Properties of Your Composite

Lee Ann Brady — Mon, 18 Feb 2013 07:35:30 +0000

Earlier posts have discussed the difference in light and color properties between natural tooth structure (enamel & dentin) and their corresponding composite replacements. The difference in translucency, opacity and how the thickness of each layer impacts these properties and others like chroma and value become a challenge chairside when we try and replicate nature. One [...]

Making Sense of Types of Composite

Lee Ann Brady — Wed, 13 Feb 2013 07:05:37 +0000

All composite materials are a mix of organic resin matrix, filler particles and a coupling agent. The challenges we experience with composites like consistency and stickiness as well as characteristics like polymerization shrinkage, flexural strength and polishability are a result of the type and quantity of filler particles in relationship to the resin matrix. As [...]

Continuous Top Cord For Veneer Impressions

Lee Ann Brady — Mon, 11 Feb 2013 07:39:43 +0000

There are many ways to gain retraction today for final impressions. With all those options I still find that a two cord technique creates the most predictability in my hands. One of the challenges with a double cord technique is the removal of the top cord when there are multiple preps to impress at once. [...]