Dr Paul's Dental World

Invisalign, whitening, white spot removal + 2x resin bonding

This patient was referred to me by my man .matthedge (if you're looking for an awesome dentist and legend person in GC area, he's your guy!). The patient wanted to improve the look of his front teeth and remove the white spots. We the discussed doing invisalign first, to achieve the following:
- Wider smile
- Correct angles of teeth
- Improve smile line (teeth edges should follow the lower lip)

Following that, we used resin ICON to remove white spots, and did resin bonding to his teo central teeth.

Overall we achieved an amazing result with relatively minimal treatment. Happy patient happy dentist!

Shout out to and with helping the invisalign process go smoothly!

If you have questions about this case or anything else, DM me 🙌

This was a case that I loved from start to finish. Mary came in for her regular hygiene appointment, and expressed to the hygienist that she did not like her lower teeth. The hygienist told me this, and discussed that possibly levelling of the lower anteriors with a disc to make them even, might be all that is required.



When I did my examination, we discussed what she did not like about her bottom teeth. After asking a series of different questions, she ended up telling me that she didn’t like the unevenness, the shade, the worn edges. She wanted something more white, long lasting and permanent (ie not whitening. On a side note, she told me that she has asked to do whitening before, but was told no because she has fillings that would need to be changed over [note: don’t restrict a patient’s options because you think they don’t want to do something. She told me she gladly would’ve tried whitening, and changed the fillings, but was told no!]). We then discussed if there was anything she didn’t like about her upper teeth, and she was open to hear suggestions.



We ended up deciding that we would restore her lower teeth with ceramic, fabricate a new lower denture with precision attachments for stability, and place ceramic restorations on her upper 15-26 (because they were the ones in her smile).



We started the treatment with a mock-up to give us an idea that we were in the right direction, and once this was confirmed, we started with the lower teeth and finished with the upper teeth.



Lots of detail in the captions, so I hope enjoy it!

Sandy was a patient at our practice who I had seen at a regular hygiene check-up. I had met her previously as I had done some small fillings for her.

At this particular check-up, I asked her if she liked her teeth. She said “the gaps” I said “yes”. She said “they’ve been like that since I was a teenager”. I said “Sandy, you didn’t really answer my question 😊” She said “Well, I wouldn’t mind fixing them, but I feel like it’s going to be expensive.” I said “when you save expensive, how much are you thinking?” She said “$10,000”. I said “What if I told you that I could close those spaces, and give you very nice looking teeth, for about $3,000?” (I was planning resin veneers). She said “tell me more”.

I then did a mock-up at home, and brought her back to see it. She loved it! After a discussion about material type, she then decided that she wanted something longer lasting, so she opted for porcelain veneers. We then discussed doing orthodontics beforehand to help the UL2 rotate, distribute spaces between upper anteriors better, and correct lower alignment…she agreed that Invisalign would be a good idea.

After about 7 months of Invisalign, we then prepped the teeth for 6 beautiful veneers by Talar at Prodenta, and now she has a smile that she loves! It’s cases like this that make me love my job.

When a patient comes to your practice, needing an implant crown restored, knowing what type of implant they have is difficult.

I just found this awesome website (https://www.spotimplant.com/) that uses AI tech to help identify implants.

The difference between this company and others, is that this one uses computers to do the hard work scrolling through 1000s of different implants to find a match.

Let me know how you go - I'm looking forward to using it!

Spotimplant | Dental Implant search engine and identification service Spotimplant is the most comprehensive dental implant database, search engine, and identification tool.

This patient came to us with worn teeth, that she had noticed is getting worse over time. It was affecting her confidence with smiling.

We discussed different options, including: (i) restore upper/lower canine-canine in current position without changing bite (ii) restore upper/lower canine-canine in current position, open the bite using Dahl technique (iii) restore all teeth and open bite (iv) ortho to expand around premolars and also to intrude lower anteriors, and then intrude. We decided on (ii) because she had no posterior wear, and she didn’t want to do ortho.

I restored the teeth in resin, as ceramic is too expensive at this stage, and I used the injection technique with flowable (G-aenial Universal Injectable) using alternate models and clear putty stents.

It took approx. 3mo for her bite to close posteriorly, at which point we made some night time retainers to help prevent future chipping.

Enjoy!

I have taken over the books from a retired dentist who has a number of patients who prefer to do the bare minimum in terms of dental treatment, and try and treat their teeth using their health fund to dictate treatment.

This lady had two teeth that I knew would benefit from being fixed with emax, but she was hesitant. I find that taking my time with these patients is super important. One strategy that works well is to suggest treating the worst tooth first, and then using that as a gauge as to if we should do the other one or not.

In this case, we decided to do the 24 first, and then after she saw the state that it was in, she booked right back in to do the other side.

It is a nice case of my rationale of prep design, as well as the steps that I follow when doing my prep, and also a neat trick to use if the rubber dam tears.

Enjoy!

Here is a video of an Emax onlay that I replaced a few months back. It was one of the most difficult procedures that I have been based on the access to the area, as well as proximity to the nerve of the tooth, and also trying to use the rubber dam in a difficult spot.

I'm using a camera mounted to my dental loupe glasses, and it was one of the first times I'd use it, so it is out of focus at times, but there are a few things that you will get out of it:
- Rubber dam placement and floss ties
- Tips to remove rubber dam
- Removing gingiva/haemostasis prior to impressions
- Rationale in deciding to remove tooth structure or not

https://youtu.be/Gg1fC-YnrrU

Extremely Difficult Ceramic Onlay Replacement With Emax Using CEREC This patient came in for an examination without any concerns. It wasn't until we took X-rays that we saw that his ceramic onlay was a problem waiting to happ...

I wasn’t planning on uploading this case, hence the low quality intraoral photos.

This patient hadn’t been to the dentist for a number of years, and we had old fillings to replace, as well as calculus to clean.

I don’t often take X-rays after my treatment, unless I do lots of fillings (normally more than about 5), and this will be our new ‘baseline’ X-rays that we will compare to in future. I have also started to take X-rays following calculus removal, because otherwise it can be very difficult to know if it is all removed! And if it isn’t removed, we haven’t given the patient’s teeth and gums the best chance to be healthy. In this case, I had to re-clean the LHS after taking an X-ray, as there was some calculus still present after the first round of cleaning.

I am also becoming more pro-active in removing old fillings, because I am finding more and more that there is much more decay beneath them, compared to what I would expect.

Follow along through the pics. Descriptions in the captions.

Follow my journey on Insta and Youtube:
- www.instagram.com/drpaulsdentalworld
- www.youtube.com/drpaulsdentalworld

This is a series of 4 onlays that I did in 2020/early 2021. They are in chronological order (1 – Jul 2020, 2 + 3 – Sep 2020, 4 – Mar 2021). I went to a CEREC course in Feb 2021 that changed how I do things slightly (I'll post other cases soon to see)

All were done with conservation of tooth structure in mind, and a reliance of good bonding for long-term success.

Detailed descriptions in the captions of each picture, explaining different tips/steps in the procedure.

Comments/questions welcomed.

Follow my journey on Insta and YouTube:
- www.instagram.com/drpaulsdentalworld
- www.youtube.com/drpaulsdentalworld

This is a case of a failing amalgam filling, that we replaced with Emax using CEREC.

The patient has an existing upper night guard, so I didn't want to change the lower occlusion too much, so I did a biocopy of the tooth to guide me.

You will be able to see my workflow of scanning, to allow me to save time, as well as scan the prep with the rubber dam in place.

Descriptions in the captions.

Before and after resin veneers. Swipe through the photos to see the journey.

This patient originally presented to me last year for a wisdom tooth removal.

After removing the tooth, we decided that a check-up and clean would be beneficial, because she is from the UK and needed a dentist in Sydney.

In the check-up we chatted about how she had ortho in the past, but never had a wire or wore her retainer long-term and has noticed that her teeth have moved. We took some photos for the big screen, and she didn’t like how her LHS was higher, and wanted to add some length to those teeth.

We discussed: i) do nothing and simply place a wire and night retainers to stop it getting worse – she wasn’t keen on this and wanted them changed ii) ortho – she said this was out of the question after doing braces when younger iii) resin additions – can make some length changes iv) veneers – either resin or porcelain, will get the best looking result.

Before deciding any more, I decided to do a free of charge wax-up myself of what is possible with veneers, to then do a mock-up. She can then choose what she wants to do.

In the end she chose the veneers, in resin because she did not like the idea of having some enamel removed.

I did it via the injection technique, of which I learnt a lot, and you might too.

🦊 𝐃𝐨𝐠 𝐨𝐫𝐚𝐥 𝐡𝐞𝐚𝐥𝐭𝐡! 🐕

Trying to teach our dog Caesar how to brush is like trying to charge your phone with a potato. It's not possible, but it's worth a shot!

If I was to teach him, the correct way would be:
- Soft brush
- Angling at 45° towards the gum
- 2mins
- 2x/day

This lady did not the look of her amalgam filling, and it also felt rough to her tongue. We discussed replacing with composite resin or ceramic, and she preferred the strength and longevity of ceramic.

The only issue was that this tooth was extremely important, as it is the last natural tooth that side, and her denture uses it to stay in place.

The success of replacing a tooth that is required for a denture, is based on how well we can replicate it.

There are a few more common options:
1) Placing a filling and shaping it as accurately as possible. This is difficult.
2) Placing a crown and using a laboratory, who makes the crown to fit the tooth and the denture. This takes about one week, and the patient is generally without their denture for this week.
3) Placing a crown using CEREC technology. This lets us scan the tooth before starting, and then we can make an exact replica when the final crown is made in the same appointment!

This was a case where we used CEREC to make a perfectly fitting crown in the one day.

Slide through the photos to see the progress and descriptions beneath each photo.

Feel free to comment or ask questions.

IG: instagram.com/drpaulsdentalworld
YouTube: youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

We can't always do the ideal treatment for everyone.⁣
⁣
Currently, Covid has put extra pressure on work and finances, and as a result this patient opted for an interim treatment for this tooth before he can be more financially comfortable to choose something stronger (ceramic or gold).
⁣
In cases like this, ensuring that the filling I do will last long enough until he is ready, is the most important thing for me.⁣

The worrying part about this tooth was that it had already broken once, and had a large crack inside of it.
⁣
Click through the photos to see more detailed shots, as well as descriptions in each caption.

Feel free to comment or ask questions.

IG: instagram.com/drpaulsdentalworld
YouTube: youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

This tooth is part of a bigger case. The patient presented with pain on his lower right molar, which we relieved at that visit by starting root canal therapy.

The patient then came back for a comprehensive examination, where we prioritised what needs to be done next to fix the issues he has.

When the case is finished I will post it in its entirety, but basically he has had some non-ideal work done in the UK, then lost trust in dentists and didn't go back to see one for 10yrs.

This was our second treatment visit, and this was a tooth that I selected to treat first due to the depth of the decay on the X-ray. I also did not want it to need root canal therapy like he just had.

The tooth tested positive to vitality, and shows no signs of infection on X-rays. The plan for this tooth is to place a core build-up, then re-test it in three months for vitality and with an X-ray, and if it is showing normal responses, we will place a ceramic onlay.

Slide through the photos to see the progression.

IG: instagram.com/drpaulsdentalworld
YouTube: youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

When we fill teeth, we try and shape them in a way to 𝐫𝐞𝐩𝐥𝐢𝐜𝐚𝐭𝐞 how they once were.

This helps:
✅ Stop food collecting with the next door tooth
✅ Be comfortable when biting
✅ Help masticate (chew) food
✅ Makes me feel good when I see it!

This patient had an existing filling that had dislodged, so we removed it, cleaned out the decay and replaced it with a new fresh filling.

Swipe across to see all the steps from start to finish (descriptions beneath photos). The blue spots in the last photo indicate where the patient's teeth are biting together - no 𝐚𝐝𝐣𝐮𝐬𝐭𝐦𝐞𝐧𝐭𝐬 𝐰𝐞𝐫𝐞 𝐧𝐞𝐞𝐝𝐞𝐝 𝐭𝐨 𝐛𝐞 𝐦𝐚𝐝𝐞 after the rubber dam was removed.

This is part of a bigger case. 36 is going to be CEREC'd in one of the future appointments.

IG: instagram.com/drpaulsdentalworld
YouTube: youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

Brush for me, brush for me, teach me oh, oh, oh....
I've never seen, anybody brush as good as you before!

Check the video to learn a few tips on looking after your teeth, and have a laugh at the same time.

IG: instagram.com/drpaulsdentalworld

Brush Monkey (Dental Dance Monkey Funny Music Video Parody) You know that feeling you get when you see someone with an amazingly white smile, and you want to know how they got it? Well, in this video we find out from ...

🖤 Black to White 🤍

Decay on the root surfaces of teeth is often a sign of 𝐢𝐧𝐜𝐨𝐫𝐫𝐞𝐜𝐭 𝐛𝐫𝐮𝐬𝐡𝐢𝐧𝐠 𝐭𝐞𝐜𝐡𝐧𝐢𝐪𝐮𝐞, combined with 𝐬𝐮𝐠𝐚𝐫 𝐢𝐧 𝐭𝐡𝐞 𝐝𝐢𝐞𝐭.

This patient was starting to get pain from these teeth, so we fixed them.

Often these fillings can be difficult because the gum is in the way, and when we start to clean the decay, it bleeds.

There are a few ways to deal with this situation, and this is one of them. After making the patient numb, I used an instrument (electrosurge) to remove the gum, and then placed the rubber dam to isolate the teeth from blood and saliva. The fillings were placed and then polished back.

The after shot is two weeks later, showing how nicely the 𝐠𝐮𝐦 𝐭𝐢𝐬𝐬𝐮𝐞 𝐡𝐚𝐬 𝐡𝐞𝐚𝐥𝐞𝐝.

Swipe across to see all the photos.

Details in the captions

IG: instagram.com/drpaulsdentalworld
YouTube: youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

A lot of our job consists of making teeth better. Often removing the active disease and bad tooth structure, and replacing it with something clean and better.

This is often in the form of new decay, or decay underneath an old filling.

In this case, these two teeth next to each other fit into both categories.

We removed the decay and the old existing dentistry, and replaced them with composite resin fillings.

The fillings were shaped to replicate their original shape, helping to restore function to this tooth.

Full descriptions in the captions.

IG: instagram.com/drpaulsdentalworld
YouTube: youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

I saw this young lady for a check-up and clean, as she had recently moved to the area.

After discussing her teeth, and asking "is there anything you would change about your smile?", she mentioned that she does not like the dark brown between her two front teeth.

She had asked her previous dentist to fix it, but they refused (I almost did too). I started to worry.

I examined the area she was talking about. At first I thought it may simply be staining, and I could remove it. After vigorous scraping with a scaler, I realised it was demineralisation (breakdown) of her enamel.

I sat the patient up and asked her how much she really wants me to fix it. I explained that although I think my hand skills are pretty good, and I love achieving my patient's goals, we have to consider the following:
1) The demineralisation is extremely superficial and I would have to remove some of her tooth structure and place fillings in those areas
2) These fillings may stain in the future
3) These fillings will need replacing at some stage in the future
4) It may be difficult for me to do a good job
5) I want to try and be conservative, which means that it may be very difficult for me to do a good job
Despite this, she decided that she wanted me to give it my best shot!

I placed the rubber dam on and removed the demineralised enamel with a very fine flame bur.

Using a Bioclear matrix, I then injected G-aenial Universal Flo, cured it, and crossed my fingers.

After I removed the matrix, I was blown away by the result that we had achieved!

As a final touch, I smoothed off the chipped incisal edges for that extra cherry on top.

Patient and I were extremely happy.

Descriptions beneath the photos

IG: instagram.com/drpaulsdentalworld
YouTube: https://www.youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

This patient presented for a comprehensive exam in March. Among other things, we had planned to replace the filling on her premolar with a crown, as it had root canal therapy and we wanted to protect it. On the tooth behind, she had a nice looking ceramic only.

Fast forward two months and the onlay had come off! Rather than re-cementing it, we decided that we would replace it with a new one, but re-design the preparation to improve retention, and replace the resin filling with a crown in the same appointment.

Both teeth were replaced with emax crowns that look great, but have increased the life that she will get out of these teeth.

With our CEREC technology, they were done together, in the same appointment on the same day.

Descriptions under each photo.

IG: instagram.com/drpaulsdentalworld
YouTube: https://www.youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw

To help a metal denture stay in place, specific teeth have to be utilised. This design works really well, unless this tooth ever gets a hole in it. If it does, in the process of removing the decay and placing a new filling, the shape of the tooth inevitably changes.

This leads to the arduous process of adjusting the filling to ensure that the denture fits how it should. Inevitably, the fit is never as good as when it was new.

This patient presented with a large hole on one of his premolar teeth, which just so happened to be the anchor tooth on that side, for his denture.

He was very concerned that if he lost this tooth, he will also be required to get a new denture.

Fortunately, his tooth responded positive to vitality testing, and the patient decided on placing a composite resin filling.

In the end, he was happy that he was able to keep his tooth and his denture, and I was happy that I did not have to make as many adjustments as I was expecting.

Descriptions are under each image.

If you enjoyed this post, feel free to like this page to see more.

I also post on Instagram (instagram.com/drpaulsdentalworld) and on Youtube (https://www.youtube.com/channel/UCDU7ngDBYzJssEO-1HLekJw).

Have you ever wondered what it would be like to see a dentist, who isn't normally a dentist?

In this episode, we find out what it would be like to have Dr Joe Exotic as your dentist!

PS: this video won't make much sense for those that have not seen Tiger King on Netflix.

WHAT IF JOE EXOTIC WAS A DENTIST - Released Early From Prison?! 🤷‍♂️ Let's Find Out! 👌 Joe Exotic - known for his wild personality, love of tigers, and his hate for Carole Baskin. It's easy to see him being a gay, gun-carrying, mullet wearing r...

This patient moved to Sydney four years ago and had been travelling back to her previous dentist for check-ups every 6 months.

This time, she decided to try another dentist in Sydney, to save her from taking a day off work during the week.

Her last check-up was one month ago, and she knew that she needed a filling on the right hand side. In a case like this, although I agreed with that filling, I wanted to do my own comprehensive exam.

After taking photos and looking at the X-rays, I found something else! There was some very suspicous looking shadowing on this molar. Although it did not look like anything on the X-ray, I felt it needed to be filled.

As you can see from the photos, I'm really glad that we did. It ended up being much deeper than expected, and there was decay on the central pit too!

There are descriptions in the photos outlining my rationale for each step.

As usual, any questions, comments or feedback, let me know!

www.drpaulshalhoub.com
www.instagram.com/drpaulsdentalworld

A few simple tips you and your family can use to stop getting holes in your teeth, or stop current holes from getting bigger.

Feel free to share with anyone who might benefit.

Keep on smiling!

HOW TO STOP TOOTH DECAY (11 Simple Tips To Stop Holes In Your Teeth, And Stop Current Holes Growing) 11 simple steps to stop cavities and holes forming in your teeth, as well as to stop the decay from getting worse if you already have it. 0:24 First Step 4:2...

This patient is a friend of a friend, and (with my permission) was given my phone number. She told me that she had a tooth that she was told needs extraction due to resorption and wanted to know if she could come in because it is now in pain.

History:
Pain started in 2018. Was told that it is resorption. Dentist tried to go in and assess how bad it is and then temporarily filled it which alleviated her pain. Dentist told patient to go to specialist to have tooth removed and have an implant. Patient went to the dental school and was never called back and had been out of pain until now.

Exam:
BW shows that the lesion on the distal (unsure if decay or resorption?) is very deep, a few mm past previous filling. CBCT (3D X-ray) shows equi-crestal in one area. CBCT also shows PARL on DB root and calcified canals. Link to see CBCT slices: https://bit.ly/3eFRSjS. Let me know if that doesn't work. Facebook won't let me upload videos into this album for some reason.

Discussion with patient:
- Can attempt to save tooth. Calcified canals may mean referral to specialist which will cost more $. Three appts required for endo and then crown is 1 or 2 appts. 10+yrs success if done well. Adv that I can remove lesion and assess if I can place a filling. Price quoted.
- Implant can be done. Slightly more $ than RCT+crown. More straightforward however keeping teeth is the ideal to do because the implant will likely fail eventually and need to be replaced by another implant. If RCT fails eventually, can place an implant then
--> Pt opted to try and save it if possible

I started on the distal and removed the existing filling, and then the lesion. Descriptions in the pictures about this. I'm still confused as to what it was!

Placed a filling and commenced extirpation. Patient will be going to an endodontist to complete the RCT.

Not sure to place an indirect restoration with deep marginal elevation or to go just beyond the margin. I'm leaning towards going past the margin, but will decide at the time.

Sometimes our patients bring their partners in. I love it when they ask questions, it means that they care! However this guy, he didn't let up! 😜

I've found out a way to put an end to that! Scott Morrison (ScoMo) with the original idea, cheers mate!

Dentist Finds New Way To Stop Patient's Partner Asking Too Many Questions!! (Funny Dental Video) At the dentist, sometimes a patient may bring a that family member or friend who won't stop asking too many questions - like in this case! Taking a leaf out ...

With dentists no longer being able to see non-emergency patients, it presents an interesteing question - what would it be like if we were able to work from home!?

I attempt to answer it here.

If Dentists Worked From Home With dentists no longer being able to see non-emergency patients, it presents an interesteing question - what would it be like if we were able to work from h...

👁️ Take a look through my eyes! 👁️

When fixing teeth, we're often fighting against a tongue, saliva contaminating our filling (and having to start again!), patients having difficulty opening, the cheeks..the list goes on!

Thankfully, we do have things to make this job easier.

This is one of them. It is called a 'Rubber Dam'. It is a sheet of rubber/latex that we punch small holes into. We then slide the teeth that we're working on, and a few either side, through these holes, and the metal clamps hold it in place. This gives us complete isolation from the rest of the mouth so we can work in the best environment possible, to do the best filling possible.

In this case, I did something a little different. Normally we work on one side of the mouth in one appointment, and do the other in another appointment. This patient wanted to get them done together, so I clamped both of his molars at once.

It saved me and the patient time, and effort, which is a win-win in our books!