Joseph Sarkissian DDS

In response to my story quiz, the results gravitate over the two correct answers. The reason why I would prioritize the vertical bite buildup, is because this is an orthopedic issue with far-reaching consequences such as childhood sleep apnea and an unfavorable growth pattern which will become more complicated after the child‘s rapid growth phase is over around age 13. This child was around 7 and the easiest intervention is to add a layer of composite on the baby molars to achieve an immediate orthopedic vertical gain of 2-3 mm. By age 10 baby molars become loose therefore this step will not be so efficient. The labial frenectomy is a dental/gingival issue and is absolutely correct and can be carried out anytime within a year or two.

Creating a new trend with brass separators on this sweet .

This condition afflicts between 0.1 - 1% of children. What is it and how would you treat it? 7 year old otherwise healthy boy.

A XT implant today at 18- month follow-up. Placed somewhat deeper than intended, I am showing here the favorable reaction of the marginal bone to this amazingly biocompatible and tissue friendly material. 1. Soft tissue response is outstanding, lacking any inflammation and pockets 2. There is vertical bone growth evident on the mesial of the implant (red arrows). 3. On the distal of the implant , despite the obvious violation of the biological space, the bone has settled into developing a thick cortical outline thanks to the forgiving nature of zirconia and the ability of fibroblasts to create attachments to it. 4. Osseointegration is rock-hard, with a Perio-test value of -6.1

Thank you to all those who participated in my quiz. The biggest issue that has to be immediately addressed is the buccal crossbite of the upper right premolar. This situation will never fix itself, on the contrary, the teeth will grow and lock more and perpetuate the situation. They will also cause a bite dysfunction which will deviate the lower jaw and cause permanent uneven mandibular growth. Upper arch development will aggravate this condition even more. Waiting is definitely not the answer since he is in his growth spurt, the best time to affect bone remodeling. Upper Premolar extraction will unfortunately be a death sentence since it will make the upper jaw constrict and camouflage the problem, causing future TMD, sleep apnea and a collapsed midface. The only way to intervene immediately right now is to develop the lower jaw at the same time opening the vertical with a flat plane to take the teeth out of occlusion and to allow the offending teeth to jump the bite. This boy is in mild class II tendency. The 6’s are in class I. It looks worse because of the flared upper incisors and the deep vertical bite relationship. in the next few photographs you will see the action I took. The upper segmental are intended to straighten the upper incisors, close the spaces, and later slightly retract them after I place a fixed TPA as anchor and a utility wire. Since he has most of his permanent already, it will be very hard for me to maintain him in this forward and open position unless I follow up with a rick-a-nator or an adult version of a twin blok. Today I also performed a which I will post separately.

I’m impressed that so many of my followers took the quiz, regardless of whether you chose the correct one or not. If you chose the incorrect options, I see the logic why you picked each one of them, therefore it is all good. My explanation: first of all, is (circa) half mercury and half powder, which is comprised of silver, tin, copper and zinc. The resulting “amalgam” is an unstable alloy with different combinations including Ag-Hg (gamma 1 phase) and Sn-Hg (gamma 2 phase). The latter is the most unstable and breaks down into tin oxide and mercury. Of course all other corrosion products include silver oxide, silver chloride, mercury chloride, tin oxide, zinc oxide etc are black or white. Sulphides are also possible. So let me comment on each answer: 1. MOLD is unlikely but technically there can be fungi in or around decaying matter. I would assume they would be more frequently found in root canaled teeth which are…DEAD. even then it’s even less likely to produce green colonies under amalgam. 2. Bacteria producing chlorophyll are Cyanobacteria and their like. Most of them are aerobic and most produce chlorophyll to be able to utilize energy from light. Unlikely to exist under amalgams or in dental decay. 3. Copper carbonate is the main product of copper corrosion and is frequently found in the corrosive layers of copper and its alloys. It is a beautiful green color, and the beautiful malachite is actually copper carbonate. Therefore this is the correct answer. 4. I see why most of you picked this answer because you know mercury is so abundant in amalgams. Mercury oxide is however red. Please take universal mercury-safe precautions while drilling out amalgams. Visit the website to find out more.

When there is always that one renegade tooth that looks you straight in the eye and challenges you by saying “how are you gonna deal with THIS, huh?”
This one had decided to rotate itself not 45 degrees, not 60, but 90 degrees exactly. Well I owe it to this sweet girl whose parents drive her 2 hours every time, that I will not be intimidated by it. I initiated rotation elastics. Newton’s rule says “for every action there’s an equal and opposite reaction”. Therefore some measures to counteract “reactive” movements were to wire tie the anterior canine to the lateral (otherwise the pull on it will make the canine rotate). The open coil between the 4 and 6 is to prevent the rotation and mesialization of the 6 due to the distal elastic. The composite button on the lingual of the 4 is simply to prevent the slippage of the elastic onto its occlusal aspect.

In cases where there is a history of involvement, we may notice drifting in all possible directions, settling in a position dictated by least resistance. Other factors influencing this type of drift is 1. unfavorable bone remodeling, 2. Myofunctional pressure from the positioning of the tongue, and last but not least, 3. premature anterior contacts. Basically the upper teeth, which are not as firm due to the loss of periodontal support , will undergo an “orthodontic” remodeling and take up new positions representing an equilibrium between all forces acting on them, essentially avoiding the bottom teeth hitting them, and the pressure of the tongue. Now would it be biologically logical to perform Invisalign or braces to close spaces and bring teeth together again? The only way we can really close spaces in the front is by pushing the teeth backwards. This will constrict the upper arch and violate the biological equilibrium, the same zone that the teeth were escaping from in the first place. A recipe for failure. Alternative? Lateral bonding to close the diastema following cosmetic principles such as my post-op photograph, and constructing a clear vacuum formed nighttime retainer to prevent further migration. Would you even know that something was done? In less than an hour her whole smile drastically changed.

There we go again. Looking at teeth on this skull still carrying his battle headcover. These villagers had created a makeshift army to protect their town Gotland from the invading Danish army and were all massacred and later thrown into mass graves, which in turn were discovered in our era and many samples ended up in the history museum of Stockholm. Just wondering how their teeth seem so relatively healthy and also how they survive longer than any other part of the decomposing bodies. I mean LOOK AT THEM. They haven’t even changed a bit!!

I have never seen so many skeletons and skulls in a museum as much as the Stockholm historical museum. Apparently most of the history around the Vikings are reconstructed based upon archaeological findings from graves, save some rare accounts recorded by missionaries which are fragmented, biased and unreliable. This particular skull was dug up in Birka, the first ever recorded Viking settlement, which we visited yesterday. This skeleton’s exhibit is realistically laid out as it was found, in the Stockholm history museum. Of course as dentists we are obsessed with and always look at teeth. Before I saw the description, I wondered about the age of the skull. The quiz I posted on my story was a fail. I think I know why many of you got it wrong. For one, Vikings were more robust and both teeth and skull are larger than most 6-year olds we usually see. Among the remaining teeth scattered around the grave was a permanent erupted molar with roots still not formed, as in the upper 6-year molar I have circled. The skull from our view has three teeth visible. If the cuspid is really a primary cuspid, then the teeth behind them can only be primary molars, since they have two roots each. The only way this child could be 10-12 is if the tooth labeled C were a permanent premolar (the 4) but that is unlikely.

https://karinbadt.medium.com/premolar-extractions-for-orthodontic-treatment-2190344bc7bf

Extracting Premolar Teeth for Orthodontic Treatment: The Risks Patients Report Health and Aesthetic Consequences