By Dr. Raymond Kimsey
The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence.
Daniel suffers from severe autism, the associated lack of speech, and a seizure disorder. Now 18 years old, his mother was hopeful that I would be able to sedate him and treat his needs.
Daniel had no ability to communicate with me and was completely uncooperative. I was able to get a brief look in his mouth, which revealed severe caries (Fig. 1).
The treatment plan would require completing the case in one visit using a material that would withstand stress and not contribute to rapid recurrent marginal caries. From my experience using strip crowns in primary dentition, I knew that they offered a fast, single appointment option that would both reduce cost and the risks of extensive anesthesia. Thinking ahead, I quickly made an upper anterior alginate impression.
I used a study model to prepare four strip crowns in advance. On treatment day, I placed an IV and sedated Daniel with midazolam. Working quickly, I removed the extensive caries (Fig. 2). Although deep, there were no exposures. I checked the strip crowns for fit (Fig. 3), treated the dentin with Pulpdent Desensitizer, placed a bonding agent, and filled the strip crowns with ACTIVA BioACTIVE-RESTORATIVE.
Why Activa? I have been using Activa for years and knew it would be the perfect solution. It is esthetic, durable, and its bioactive properties and marginal integrity are more resistant to recurrent caries than any other product. It is high strength, dual cure, and it flows nicely, so it is easy to fill and apply the strip crowns. The actual treatment time was remarkably fast for treating such severe disease.
Daniel returned the following week, and upon seeing me, he began to smile! Although he could not express it verbally, he knew how much I had helped him. With proper planning, this seemingly impossible case had a gratifying outcome for both the patient and his family, and for me as well (Fig. 4).
Dr. Kimsey is in private practice in Coral Gables, Florida. His specialties include implantology, anesthesia and IV sedation, and management of patients with mental and physical developmental defects.
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