Dentaltown March 2020 - 29

Fig. 2

It may be useful even to divide this group
of patients into three subsets. There are some
patients limited by medical conditions. Their
mobility is compromised and so their office
visits become more complicated. Some need
transportation to and from the dental office,
and once there may need wheelchair lifts or
ramps and an office equipped to deal with
their physical limitations.
Those with cognitive difficulties may rely
on others to help with their oral home-care.
Extensive root caries can be a common
finding for this population. It may be
appropriate to modify treatment plans for
these patients. The use of glass ionomer
restorations may be appropriate, because they
are less technique-sensitive and inherently
release fluoride. I sometimes describe such
care as "rescue treatment."
A third subset, in my experience, are
baby boomers who show few signs of slowing
down. They are very active, traveling extensively, participating in sports and actively
socializing. To a degree, they are "older" only
as defined by the calendar. Their expectations
for their dental care are unchanged: They
seek high-quality, aesthetic restorations.
Sometimes, treatment of these teeth can
be made more complicated because of the
darkening of teeth as they age.
Most composite resin materials are keyed
to the Vita Classic shade guide, but many
times senior patients present with teeth
darker than A-4. Finding composite resins
in our usual inventory to match such teeth
can be an issue. Even when not excessively
dark, a tooth's shade may fall between several
near-miss shades, necessitating the mixing,
layering, trial-and-error approach to shade
matching. The following clinical cases show
a simplified method to successfully treat
several such teeth.

Case #1
An 86-year-old patient of long standing
had for some years been displeased by
the appearance of her upper right central
incisor. A surface crack running the inciso-
gingival length of the tooth had, over the
years, acquired a considerable amount
of stain. While not frankly decayed, the
tooth's appearance had become a concern
(Fig. 1).
Numerous times the patient had mentioned her concerns, but each time we
discussed treating the tooth, she would
hesitate to proceed because of uncertainty
about how the finished product would
look. As time passed, she also began to fear
that treating the tooth could result in the
tooth fracturing. I had taken to bypassing
the conversation at semiannual exams; I
did not want her to feel pressured by my
recommendations to address the tooth's
appearance. To my surprise, at her most
recent visit, the patient once again broached
the topic and this time decided that she
wished to treat the tooth.
To allay her fears of tooth fracture,
we began by taking a polyvinyl siloxane
impression of the teeth, which could be used
to fabricate a provisional crown should one
ever be needed. After administering local
anesthetic, I tried matching the tooth's
shade, which was close to D-3 on the Vita
Classic shade guide (Fig 2).

Fig. 3

Fig. 4

Fig. 5

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Dentaltown March 2020

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Dentaltown March 2020 - Cover2
Dentaltown March 2020 - 1
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