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hello welcome this video is going to discuss a case where a deciduous tooth a lower right e was grossly decayed and when we looked further into the case we realized that the tooth didn't have a
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permanent successor so it was really really important today that we made sure that the tooth and the old Decay was removed and it was restored properly and you know so it's just going to last a
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long time so if you look at the bite wing on the right hand side you can see clearly that the lower right four is present but the lower right five is missing there's a bit of a suspicion
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there to think to yourself well is there a permanent successor or not rightly or wrongly I took an OPG again people would say this is probably a little bit of an Overkill but I think um if I've got a suspicion there's a missing tooth there is also a suspicion
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that there are missing teeth elsewhere and if you look at the OPG here you can see that the lower five is missing and the tooth has got a significant Decay so as mentioned before we've got to make sure that whatever
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filling we put in here needs to be good solid and it's gonna last a long time I'll put a caveat to that because what I did say to mum and dad was that this person needs orthodontic treatment as
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well so what I will be doing is I will be writing a letter to the orthodontist just saying this tooth um is not in the best of shape but um you know is is it within the sort of
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plan of the orthodontic treatment to keep this tooth or to remove it and that's just a um a decision that they will make so um regardless I'm gonna put something in
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there just in case the tooth is required so to start off the case here what I'm doing here is I um isolating the tooth this is really really important to isolate and I've got
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one of these strange um clamps here and and off top of my head I couldn't tell you what this clamp is what I'll do is I'll put it underneath when it's cold and what it does is it um it clamps the tooth behind
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it but it also it extends anteriorly so you can um you can isolate multiple teeth in front of the one that you're doing this particular um clamp is really really good because
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the the mouth is very small so if you were just to clamp one tooth there wouldn't really be a lot of space for the suction and the uh the drill to get in there so it's nice to make a bit more
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space here I am just um looking at the tooth and I am very very very gingerly now just removing um a little bit of Tempe filling material that was there and just
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assessing how much Decay is in this tooth because the very very last thing that I want to do is I want to expose the pulp okay so when we are um drilling this tooth we're being very
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very very careful so with the with the fast hand piece I am just removing the undermined enamel um I don't want to take too much enamel away but but I want to take enough that if
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um if it is undermine it's not going to break away you see so we removed most the enamel that's going to be removed and now I'm going to use a a slow hand piece with a I think
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that's either a size six or a size eight Rose head Burr and my um the way I'm doing this is I am going around the edges of the cavity I don't
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want to put the rose head exactly where the port might be so I've just been being really really really careful and if needs be um I'm gonna check the base of the cavity for Decay and if I have to leave
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Decay above the ball I will do and again that's a conversation to have with the parents so here what I'm doing is I'm removing more Decay around the edge of the cavity being super super careful
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and it's hard for me to show you here but I'm having a little scratch and I'm and I'm thinking to myself I think there is Decay there still at the base of this cavity and I'm just going to be very very very careful with the rose head
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just to remove some of the more of the Decay okay this is easier with a microscope if you were doing this with a pair of Loops or indeed with the mark on eyeball
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you're really really risk exposing the pulp here so you've got to be super super careful and what you can't see here is I'm being very very gentle pushing down with the drill brilliant and I'm just expecting the
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cavity and actually in this case I managed to remove all of the Decay which was which was fantastic so what I'm now using is I'm using a bio ceramic I'm actually using biodentin
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although I've been known to use quite a few different um Liners in this case and the thing about by Dentin is it is really really nice for the pull and it also creates a
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um a fantastic chemical bond with the Dentin itself so it's a great lining material and it's less likely to leak than if you just put a just a normal restoration there
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the the thing about bio dancing it's it's really really technique sensitive and you've got to be super super careful and what I've mentioned a lot of my other videos is you want to put it in dampen it down a little bit maybe add a
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little bit more here but don't muck around with it too much because if you muck around with it too much the buy denting will just pull away from the cavity and it's super super annoying so you just put it in try and dampen it
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down a little bit don't muck around with it too much and just just walk away just walk away so here I'm just very very gently I couldn't obviously see the pulp
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um in this cavity but a lot of time you can see the pulp sort of shining through the denting and that's where you're gonna want to put the uh the the bio ceramic that's where you want to put the bite into so it's not obvious here what I'm doing
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is I'm actually blowing a little bit of water very very gently on into the cavity and actually buy a ceramic and the water makes it set quicker okay but you don't want to put it under water
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like it's a goldfish but you want to put make it a little bit moist and then essentially you just wait 15 minutes for it to set so I've sped it up here and I'm just waiting waiting and waiting for
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a good old 15 minutes and then when the 15 minutes is up you just check the cavity um you give it a very very gentle prod just to see if it's nice and set and
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then we are ready to put a GIC over the top here I'm using vitamin this is a g I like your GIC so I'm putting GIC over the bio ceramic and I'm going to set it
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and then I I'm gonna etch and bond the cavity and I'm using a selective etching technique here where I um Place The Edge just slightly around the cavity and then some people like to do some people don't I like to give it a good
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old brush into the cavity itself and then wash it away and then I'm using a bit of flow Bond of course first and then a little bit of flow and the bond I'm using here is something called eye bond
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and then a little bit of flow over the top so this filling's got quite a lot of layers um but you know rest assured this is this is taking time to make sure this tooth is um Gonna Last uh you know longer than
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say you should put a simple GI in there and finish result it's really really nice Dad was happy patient was happy and overall a really
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really nice result and listen if you really really like these videos I really really like making them and please like and more importantly subscribe to my channel and if you have any comments or any
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criticisms today you want to discuss anything put all your questions in the comments and I always comment back okay thanks for watching and have a nice day
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