Michael Miller, DDS
I am currently using a Polaroid camera to show before-and-after cosmetic treatment. After surveying approximately 40 patients, 32 patients felt that the intraoral camera would not have influenced their acceptance of dental treatment. They felt a mirror with good lighting would be just as helpful. I was wondering if purchasing an intraoral camera justifies its cost. Are we just hearing a lot of hype from ad agencies?
From your message, it is not clear whether you actually used an intraoral camera on 40 patients or merely asked them if they would be influenced by its use if you had one. If you merely asked them without actually showing them their teeth on an intraoral camera, then it is not a fair question.
This really is a case of "seeing is believing." A mirror with good lighting is not even in the same league as a good intraoral camera. Our focus groups were overwhelmingly in favor of the cameras; it is difficult even to imagine practicing without one. An intraoral camera is one piece of high tech equipment that really does live up to its hype.
We recommend reading the section on intraoral cameras in the 1999 annual edition of Reality and choosing the one that has the features for which you are looking. Then ask for at least a one-week trial. Although Vipercam was the top choice, others, such as Telicam Elite, scored well.
In addition, when you attach a camera to a computer and add dedicated software, you have so many more options compared to the noncomputerized ones. You can store an unlimited number of images and recall them at any time; you can zoom in and out; and you can rotate the image. Even though the computerized versions are more expensive, those who use them would never go back to the noncomputerized variety. In the final analysis, however, any intraoral camera is better than none at all. Forget the mirror - buy a camera!
Can using Clearfil Liner Bond 2V (CLB2V) primers and bond for an anterior restoration cause some discoloration of the final restoration? Is using this combination contraindicated for anterior restorations? I had a color problem with a composite I did, and I`m wondering if it was the CLB2V.
CLB2V will not cause discoloration by itself, but the self-etching primer does not etch enamel, especially unprepared enamel, as well as phosphoric acid. Assuming you did not etch the enamel with phosphoric acid, that may be the source of your problem due to microleakage. Otherwise, undercuring the composite also could cause premature discoloration. When using CLB2V, we always recommend etching at least the enamel with phosphoric acid before applying the adhesive.
Nevertheless, CLB2V has been very effective in minimizing or eliminating postoperative sensitivity. Please see our reports in the February and March issues of Reality NOW for more information on this unique adhesive.
Best as I can tell, microabrasion is a way to remove thin layers of pigment, useful mainly for large fluorosed areas. I have used Ultradent`s system. It is a 10 percent (I think) HCl acid in a coarse, abrasive paste, and it comes with a handy bristle brush in a cup applicator. It helped some, but it doesn`t promise much to patients. In severe cases, use a bur as much as you dare and then smooth and polish with the paste and cup.
Opalustre from Ultradent is 6.6 percent HCl in a silicon carbide paste. It is currently under evaluation, but we expect it to perform similar to Prema from Premier. If you use a bur, you may need to replace the lost tooth structure with a translucent composite, especially if the stains are concentrated in one area of the teeth. Microabrasion for fluorosis can be effective, but it is difficult to say beforehand on which teeth it will work.
Dr. Miller is the editor-in-chief of REALITY and REALITY NOW, the information source for esthetic dentistry. He is an international lecturer and a Fellow of the American Academy of Cosmetic Dentistry, as well as a founding member. He maintains a private practice in Houston, Tex. For more information on REALITY and to receive a complimentary issue of his monthly update, REALITY NOW, call (800) 544-4999 or visit www.realityesthetics.com.