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I'm really happy to be reunited with my mannequin Damiel again, we are going to make preclinic so much fun

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Lets talk about selective caries removal

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Lets talk about selective caries removal

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Research find here: https://link.springer.com/article/10.1007/s41894-020-00073-z

The aim of selective caries removal is to not to expose the pulp and ensure that the longevity of the pulp is promised after a restoration is commenced.

Before we were always taught to remove caries until hard dentine but according to current standards in order to decrease the risk of exposing the pulp it is said to remove caries until soft dentine.

this is because it is believed that the carious tissue that is left behind will have no intake of micronutrients after the cavity is sealed, so the progression of it will eventually stop and this gives enough time for the pulp to produce reactionary dentine which are atubular dentine that is layed down by odontoblast like cells.

while doing this it is important to remember that this procedure decrease the invasiveness, at the same time we need to:
- remove enough carious tissue to allow bonding of the material
- prevention of pulp exposure

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Selective removal of carious tissue in shallow, moderately deep and deep carious lesions in pediatric patients - Clinical Dentistry Reviewed

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The selective removal of carious tissue is a contemporary method of managing shallow, moderately deep, and deep carious lesions. The aim is to prevent pulp exposure while simultaneously restoring a tooth with no signs or symptoms of irreversible pulp pathology. The rationale behind selective removal…

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Distraction is key!
- Make a little story, when injecting LA, you can take about the tooth fairy trying to get rid of the tooth bugs by putting them to sleep, how their sprikle tastes like, how it will feel like sparkling water
- when extracting, must tell them to their toes, count numbers out loud, wiggle other bits, like their neyebrows, their hair, their finger, their nose their ears etc

POI
- Bite on the gauze, give parents an extra pack of sterile gauze, if the bleeding happens again just tell the child to bite on for around 30 min and check if bleeding has stopped.

- No eating or drinking until the numbing goes away.

- Ask if the child is going to school after wards, keep an eye on them because the LA increase chance of the child accidentally biting on their lip tongue or cheek. To the child and parents. No licking, No spitting, no poking can brush gently but no spitting letting the saliva drool out.

- No hard or chew food for 24 hours. After 24 hours can spit

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Excited to finally use my paeds model for some restoration！！

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The thinner beak it extracts more anterior teeth
The more curved it is the more posterior it will go

When grabbing the tooth, grab it from the furcation rather than the crown so it does not slip from the forceps and fall into patient's mouth
Beaks Hinge Handle

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Large anterior approximal lesions are performed that now involve the incisal edge. The context of this procedure would be due to an initial carious lesion or a restoration requiring replacement due to secondary caries or being unsatisfactory.

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Valentines day... I have a date with my mannequin.

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Valentines day... I have a date with my mannequin.

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a little heart i made with the ultrasonic

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a little heart i made with the ultrasonic

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As ultrasonic is a universal instrument with two endings it was really easy to adapt it to the surface and even make some doodles with it! (definitely not doing this in the patient's mouth with the calculus but it shows I have good technique with using it)

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This padlet records my growth within the simulation clinic.

In first year in 2021 I remember the massive cavity that I once created and was jokingly referred to as the grand canyon.

later on in perio classes I often start the scale and clean with the most serious attitude and (I thought) gentle stroke and realising I was scaling with the wrong end or instrument.

This padlet will display my progress since then in restorative and hygiene as a oral health therapist.

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I prefer using the winged clamp and putting on the dam and clamp together onto the tooth.

The rubber kept ripping and I have wasted many RD dam just on using the hole puncture, after I put it on there were leakage disto-buccal and mesio-lingually I couldn’t isolate it perfectly so the demonstrator helped me and showed me that while using the clamp forces to adjust.

DONT try to pull down with your fingers instead use the flat plastic.

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Multi tooth isolation 14-24, rubber dam then clamp and rubber dam and ligatures

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Multi tooth isolation 14-24, rubber dam then clamp and rubber dam and ligatures

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This is my very first time doing anterior isolation it took me a while to figure out how to put it on(my classmate told me to start from the 11 and 12 I flossed through the distal of both tooth and put a rubber wedge in the middle then slowly started flossing through each tooth. The result was good but a rip btw 11 n 12 occurred due to the wedge.

I realise there might be a better way of isolation by using a W3 clamp.

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-This one was much easier and quicker I did it under 2min I used the next table’s hole puncture I’m assuming the hole puncture are might be responsible for the ripping as well. I’ve also sprayed some water on the rd dam after placing to prevent ripping and then adjusted it

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under 3min use the flat plastic - forcep technique, good moisture control(also floss and then use forcep to slight adjust)

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I wanted to do another anterior isolation so i did 12 palatal comp. This was 1.5mm and width abt 3mm. there was a slight deficiency towards the distal

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Today was a really good day with the finish of the restoration but the process of making the cavity was horrendous due to time pressure and my own patience

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Single tooth isolation good moisture control obtained. was taught the trick of folding the rubber dam to prevent the water from leaking and uncovering the pt's face.

Caries removed from the dej cavity depth of 3mm

etch prime bond resin composite build up 2mm then 1mm

got carried away with the good morphology and set the composite before finishing the touch up, used highspeed football bur and sshp

alright morphology in the end, needs to have more patience and put attention to removing excess material before setting

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I'm really happy with how this one turned out the morphology looked great!

the cavity got deeper and bigger than expected about 4mm vertically

minimum caries left over on the floor, not really a selective caries removal

DEJ is clear

good moisture control

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good moisture control obtained on one try

Selective caries removal achieved, clear DEJ hard caries left behind on the floor.

excessive removal of interproximal hard tissue[ esp on the lingual side] CLEAR CONTACT POINT

suggestion, try to open the cavity really close to the interproximal next time and expand towards

excessive composite on the mesial lingual enamel and deficiency on the mesiobuccal cusp  due to usage of sickele probe

excessive composite has been polished off/flicked off

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too much caries removed

too deep

it is becoz i wasnt patient with drilling.

big strokes and movement

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a little bit of over hang at the end but good anatomy and no deficiency

used an interproxumal strip other things all to standard

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BPE score of
4*3 4*
3 3 3

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smooth finish 2mm width 2mm depth
i'm really happy with it

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16-17 rd dam was still a little hard to completely seal, but better than previous ones, the 17 Conseal flicked off due to the inefficient setting time, I was suppose to do 20 seconds but I only did 10

46 GIC finger pressed

Looked alright was a little overfilled in the middle try to remove with spoon excavator but flicked the whole thing off

47 GIC

Stick to the tooth well deficient in lingual excessive in the middle

12 P N/A

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Using the power instrument cleaning quad 2 3 (and eventually all quadrants)

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Using the power instrument cleaning quad 2 3 (and eventually all quadrants)

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I was able to move on to this really fast after last week's experience, my demonstrator was asking me if I have done this before in first year. It gave me a ego boost :)

I could only perform the Horizontal stroke  and it was hard for me to get under the gum and debride without pulling the gum away from the alveolar bone(very traumatic for the pt mentally and physically) and to get full access to the pt's interproximal areas.

this week we were also introduced to vertical stroke and lateral oblique strokes, as well as how we can orientate the EMS in many ways as it is a universal instrument (as long as we are not using the pointy tip to remove the tooth.)

I was able to easily gain access to the subgingival and interproximal access and debridement fully

improvement: extra-oral fulcruming needs more practice it's still a bit awkward for me right now.

Quadrant 2,3 OHT only sitting at 8am to 12pm position last week when we were first introduced to power instrument .

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I was giving Damiel a bit of a shower today with the ultrasonic.

a good DA who knows how to suction and a tissue is reallly important when it comes to using ultrasonic.

It is a universal instrument so it has two working ends. remember to angle the side of the tip tp the surface of the tooth instead of directly using the tip towards the tooth.

i applied feather like pressure, it really easy to remove the nail polish.  One way of knowing if you were using the correct end and pressure is to listen to the noise, if there is inconsistency with the noise and it creates a pitchy sound it means you have applied to much pressure.

I found it hard to do subgingival debridement, i think i need to adapt it to the correct angle.

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I studied a lot for osce to tell the difference between the instruments and that has really helped me in the clinic

I was able to pick up different instrument without looking at  the number and applying it to the right quadrant

I am still not very confident with my scaling skill, I still worry if i am doing the right strokes with my hand and needed the Demo's support to watch over me and reassure me

it is because when i do the stroke it feels awkward and un-natural, and generally speaking when i feel that way it usually means i am doing something very wrong.

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My first cervical restoration!
my goal is to: open a cavity that is no more than 3mm deep, and doing selective/complete caries removal depending on the depth of the caries
no defect on the final restoration
good morphology.

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​​​​​

I’m really happy with how this turned out a depth of 2mm complete caries removal smoothed the floor with size 4 ssrb.

I used a cotton roll for moisture control, it retracts the upper lip for me and it also absorbs moisture.

Needs to improve : speed this can be improved with practice. I used more than an hour for this resto

Initially there was under filled but the demo showed how to check where defect is with hand mirror and added composite on to it.

Used dark orange and yellow disc to smoothen the surface and give a shine to it.

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Spent 40 min on this restoration

Complete caries removal

smooth floor and wall

Needs to improve: overhang, underfill again

Should run probe across the surface and noticing any catch or bumpy surface. Can use flat plastic to run the surface vertically and when it produce sounds that could mean it has a big deficiency or big overhang.

As you can see the gum has been destroyed so the retraction cord choice could be better, i chose size 000 should go with 00 or 0 next time.

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please ignore the mesial, I installed a carious tooth so i thought i was suppose to remove the interproximal caries.

I expanded the cavity to the cervical region and only restored the cervical region as the demo has asked me to.

This time I have checked with my flat plastic on whether I can feel a little bump or not. And I added increments of composite and smoothing it off.

if we ignore the horrendous hold on the mesial it actually doesn't look so bad.

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’m really happy with how this turned out a depth of 2mm complete caries removal smoothed the floor with size 4 ssrb.

Needs to improve : speed this can be improved with practice.

Initially there was an a under fill but the demo showed how to check where defect is with hand mirror and added composite on to it.

The desk could be a little more organised.

Used dark orange and yellow disc to smoothen the surface and give a shine to it.

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Spent 40 min on this restoration

Complete caries removal

Needs to improve: overhang, underfill again

Should run probe across the surface and noticing any catch or bumpy surface.

Retraction cord choice could be better

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This time I have checked with me flat plastic on whether I can feel a little bump or not. And I added increments of composite and smoothing it off.

My head was on the wrong instruction with this one and opened a cavity inter-proximally

However Niamh saved me by showing me how to expand the cavity to the cervical.

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11MP Complete caries removal

I'm sad, the caries got completely removed as I was expanding the mesial wall

I used a round head to access both caries and it gave a faster and better result than the fissure bur I used last week

contact opened

floor and wall are both smooth.

11D as this is a composite it has fall off in chunk as I drilled in. So this was quickly removed

contact opened

floor and wall are both smooth.

But my time management went AMAZING for this operation, I only spent abt 15 minutes drilling birthday luck I guess.

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-a little deficiency at the contact area, but over all no excess and smooth finishing surface, I don't really like the matrix I still prefer mila strip.

-after polish it looks smooth and beautiful

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a little excess on the mesial

should be more patient and do repeated flattening technique with the flat plastic

after first polish there were still some excess, used yellow football bur  to adjust

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Hypomineralisation is a developmental defect in the ttoth, because there is insufficient mineral being deposited the enamel is prone to break down, we are not worried abt hypomin of the posterior teeth in terms of the colour, however we are worried that because the enamel is brittle once some part of enamel is broken off it would be easier for the child to develop caries(because of the prescence of the food trap)

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Hypomineralisation vs Hypoplasia vs ameloplastia

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Hypomineralisation vs Hypoplasia vs ameloplastia

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Hypomin and hypoplasia are both developmental defects.
However
Hypomin: Deficiency in mineral, something went wrong with the post secretory cells, enamel is not missing before eruption, post eruptive change is fast.
Hypoplasia : Deficiency in thickness. Something went wrong with the secretory cells, enamel is missing before eruption, post eruptive change is slow.

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the curved in surface goes in between the furcation, it helps increase the tooth's mobility

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11DP Cavity Preparation and Composite Resin Restoration

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11DP Cavity Preparation and Composite Resin Restoration

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Demonstrator feedback:
-Smooth surface finish.
-Set material free of voids or inclusions. ·
-Set material does not interfere with or compromise occlusion.
-Junction of material/ tooth surface interface (margins) detectable with explorer due to slight excess (flash) that can be corrected by polishing without compromising anatomy or ditching that can be corrected by further addition of material.
-Restoration morphology mostly resembles original anatomy/ tooth contours.
-Contact area correctly positioned.
-Minor damage to tooth or adjacent tooth/ teeth.

Caries removal
- Outline form based on extent and location of caries.
- DEJ caries free (hard dentine) and appropriate selective caries removal (to soft/ leathery/ firm dentine) or non-selective caries removal (to hard dentine) for depth and extent of caries.
- No unsupported enamel.

Rounded internal line angles.
- Minor correctable damage to adjacent tooth / teeth (eg. minor scratch that can be resolved with enamoplasty and remineralisation).
-  Axial depth based on extent and location of caries.

- No bevel or bevel only in aesthetic regions.

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Demonstrator feedback
- Junction of material/ tooth surface interface (margins) not detectable with explorer.
-  Minor surface roughness present that can be corrected by polishing without compromising anatomy.
- Minor voids or inclusions present in set material that can be corrected by polishing without compromising anatomy.
- Restoration morphology mostly resembles original anatomy/ tooth contours.
- Minor damage to tooth or adjacent tooth/
teeth.
-  Contact area correctly positioned.
- Set material does not interfere with or compromise occlusion.

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Sof-Lex™ Spiral Finishing and Polishing Wheels are a 2 grit system that finish and polish restorations to a life-like luster. The Spiral Wheels easily adapt to all tooth surfaces and are useful for both posterior and anterior teeth.

The flexible nature of the spiral adapts to all tooth surfaces—anterior and posterior, convex and concave and can be used from any angle.

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In our school we are taught to use dycal (irritate the pulp so the pulp horn will shrink) then apply vitrobond, then apply composite. However I had a discussion with one of my demonstrator, he states that we really want to increase bonding strength of the composite, and it has the highest bonding strength when it is directly bond to the tooth structure, so he would not recommend putting down a GIC layer base, and lining isn't something that is put in practice as well.

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Direct pulp capping is a restorative procedure which aims to maintain the vitality of a possibly infected dental pulp.

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My reflection about pulp capping is written under the video. this was a interproximal restoration, there is no base, polishing strip is usedyo smooth interproximal surface

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using a kidney shaped matrix it will create a better interproximal curve, create good morphology. I took a 45 degree angle approach with the bur so it will minimise the removal of healthy tooth structure.

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mirror mirror on the wall who is the fairest of them all :）I am very happy with how this one turned out. However while i was polishing have effected the morphology of the adjacent tooth. This did not create a detrimental morphological defect, or functional defect.

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Ensure proper isolation of the tooth, maintain a clean and dry environment.

Evaluate the extent of the lesion, make sure you do not remove excess tooth structure.

Select shade and translucency that match the natural tooth color for a seamless blend.

Remove carious tooth structure, creating a clean cavity preparation.

Etch the enamel wash, then primer on the dentin with an appropriate to create micromechanical retention.

Apply a bond.

Incrementally place and adapt the composite resin into the cavity, think about the colour of the dentin.

Shape and sculpt the restoration to mimic the natural tooth morphology.

light-cure

Check occlusion and adjust the restoration if necessary to achieve proper functional harmony with opposing teeth.

Perform polishing to achieve a smooth surface texture and shine, ensuring optimal esthetics.

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This is the second new topic for the year. Trauma is the aetiology of these fractures, the theory of which will be covered in the second half of the year. The palatal index technique will be introduced which can be used for reshaping teeth and both initially placing and replacing existing incisal edge restorations and anterior approximal restorations that extend onto the incisal edge.

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Prepare the lingual index: Create an accurate replica of the patient's teeth using a dental impression material, ensuring it captures the approximal surfaces that require restoration.

Select the appropriate shade and type of composite resin for the restorations, considering the patient's natural tooth color and the desired aesthetic outcome.

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Step By Step Direct Composite Restoration Central Incisor

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The lingual index should accurately reproduce the fine details of the lingual tooth surfaces, such as the embrasures, grooves, and cuspal inclines.

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before polishing

excess on the buccal and palatal aspect

excess on the mesial incisal edge

flashing

good colour matching, fairly good interproximal wall and contact area.

After polishing

smooth buccal and interproximal restoration

a little deficiency on the palatal

Need to spend more time on quality placement over fixing finishing and polishing, ensure get demo check points so can correct errors before progressing to end of restoration. Work on posture and indirect vision.

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initial restoration  had a rough labial surface

fix: polish multiple times just to create morphology and revove excess

To improve for next time: press on the surface with your thumb on a mila strip

-good morphology

-using the 2nd roughest disc helps control how much composite your are removing

Using the mylar strip and your thumb to create smoothness on the labial surface is a great idea, also not starting with the coarse disc as it may remove a bit more than needed. Great job with your morphology and layers.

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Layering the "dentin"

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Bcause I really wanted to give shine to the final resto so I gave it my all and I've discovered what's under the rubber polishing bur>:)
Warning: Should not be implemented in real life I could damage the patient's teeth.

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This looked different from my previous one with a more obvious mamelons developmental depression. I was really happy with the esthetic. There was also no damage to the adjacent tooth, it is so far the best anterior restoration I've placed

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starting from the mesial occlusal pit i am going to make a cavity outline.

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The width and depth of this cavity outline was well controlled! I have remove the hypomineralised tissue and drilled enough space for an intracoronal filling.
I used a wide cylinder bur starting from the mesial pit and slowly expand toward the this cavity outline only took me 3 minutes! It was good time management as well!
overall i think i was competent with this step!

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I think regarding this task i might still be developing because
- I have packed 2mm composite and there was a little void so without curing light I tried to add more and so the composite became quite rough afterwards. So then i had to use the yellow football bur to smooth it out(my demonstratir showed me the trick is to keep moving)
How to fix: Put according to the increment, light cure then proceed.

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I chose flowable because I still have my rubber dam on and f/s is known to be most durable towards wear in f/s material/ I had a little bit of excess on the mesial buccal cusp but that could be be removed with spoon excavator.

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for the 65 and 64

I was confused with the task and rather than looking at the radiograph i thought there were DO caries on the tooth.

My access point was once again pretty good however i expanding to mesially for the 64 as i was trying to find shadowing on the tooth.

then i just expanded my cavity vertically becoz according to the X-ray there were caries on the more cervical area. AND I FOUND THE CARIES!

this step took me quite a while so next time I will

- Understand the task before proceeding too fast

- remember to not go too occlusally and follow the caries, remove any unsupported enamel.

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After learning about SSC and pulpotomy we are finallly putting our hands to action and start DOING THE PROCEDURE

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Cavity outline + deroofed the peripheral pulp

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Cavity outline + deroofed the peripheral pulp

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I’ve prepared the correct tooth and identified the right type of moisture control

I was slightly over prepared however i still got access to the pulp chamber and removed all the coronal pulp.

The pulp chamber was intact and the radicular pulp was left behind

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WE CAN SEE DAH  RADICULAR PULP WOOP WOOP

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WE CAN SEE DAH  RADICULAR PULP WOOP WOOP

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We perform pulpotomy on deciduous teeth and needs to be preserved, and does not have internal or external root, absorption or pulp absorption and on immature permanent first molars as the root is still throwing in order to preserve the root and restore to tooth health, we will remove the coronal pulp only until we see the orifices to the root canal, and we need to make sure that we dont deroof the root canals or else a pulpectomy would be commenced.

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After rinsing, that, too, with haemostatic agent, such as ferric sulphate, cavit is placed, Cavit is a material that can seal off the Pulpal canal and allow temporary attachment to restoration materials. It mimics the tooth so the GIC would bond better.

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I rushed over this session as if i have somewhere to go afterwards

I did poorly with the preparation with the tooth i reduced all over the tooth and left some interproximal enamel which can potentially cause food packing and interproximal caries.

I used this session as a learning experience of how to properly prepare a ssc oath and i think i learnt many things in the end.

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Before I start today's padlet I should clarify a few things I have learnt about pulpotomy and SSC through the essential reading ,

Three type of vital pulp therapy
- Direct pulp capping
Commenced when the pulp is accidentally exposed during caries removal, very low success rate.
Procedure: Complete caries removal, remove a bit of the pulpal horn, fill in dycal vitrobond then restoration.
- Pulpotomy
Commence when the tooth has to be preserved(either for masicatory function or maintaining space)
Contradiction: internal / external root resorption, extensive pupal infection, apex radiolucency, exudates, abcess, irreversible pulpitis or necrotic pulp.
Procedure: Complete caries removal, removal of roof of the coronal pulp and the coronal pulp, leaving the radicular and the roof of the root canal.

- Pulpectomy
Commence when signs of irreversible pulpitis is present, space maintainence purpose and mascatory purpose.
Procedure: Complete pulpal removal
Contraindication: internal/external root resorption.

SSC
Creates optimum seal for the tooth for caries progression, it cuts of dietary resource and place the plaque in less cariogenic environment. Higher success rate than composite restoration.

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MO caries and the outline is horizontal shaped because there are three roots distal mesial and palatal. there was still a bit roof on the palatal coronal pulp.

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I have prepared the correct tooth prepared with appropriate outline form and deroofed the coronal pulp Appropriate internal form.

Coronal pulp removed in pulp chamber.

Radicular pulp in root canals.

Intact pulp chamber floor/ furcation..
Word count: 35 (Max 250)

TO BE COMPLETED BY THE SUPE

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Ready for SSC placement. I used fuji 2 because faster curing with the light cure.

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Tooth is very underprepared and has minor ledge with correctable scratch the adjacent teeth.

Next time I will adjust my bur angulation to correct my contact point removal mistake and check with my perio probe as to which cusp I need to remove more. Definitely trying on the crown before the procedure, you do not need the spring back technique for traditional crown.

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the tooth flicked off while i tried to remove the crown. (so i did a extraction)
This is my second crown placement and i went too careful with the crown preparation and could have remove more tooth structure.
I should try on the crown next time(completely sitting on the tooth), then seeing which cusp is too high reduce more then cement it.

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Hall crown has different steps.
It is easier than the traditional crown technique, there is no LA required, no additional shaving down of the tooth, just place some seperators in and call your pt back in 2-3 days. as long as you can see a clear band of pulp and the patient is not showing any clinical symptoms of irreversible pulpitis then hall crown technique is proven to be most affective to arrest carries .

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I was very efficient with time and had an appropriate outline form, pulp chamber deroofed , appropriate internal form , coronal pulp removal but i might have pressed to hard with my high speed and cause minimal exposure of the distal orifices . Correct tooth prepared.

Next time i will maintain the same speed but make sure i dont make this careless mistake. However the radicular could b removed just a little bit if the bleeding wont stop , after the little bit of radicular pulp is removed if the bleeding would not stop refer for pulpectomy or extraction.

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My clinical skills around posterior teeth is not up to the standard i want to be.

My restoration had a fairly smooth finish, the set material is free of voids. However. Think it interferes with the original occlusion and the morphology definitely needs some wOrk on.

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as it appears on the photograph I have shaved down the lingual cusp. Demo's comment is that: Morphology not as important in decid teeth as long as the margins are sealed well and not sitting high.

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I think it is easier to push through the seperators than flossing it through!

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I tried on some different crowns after this picture was taken. E4 fits perfectly, it has the spring back feeling.

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Strip crowns, it is done because it is a aesthetic looking restoration on children. Strip crowns facilitate the placement of composite on the anterior tooth, it is quick, it's a mold for the anterior teeth.'

It is not done on adults because we achieve a much better aesthetic look on permanent tooth with enamel and dentine shade.

When a child with ECC present we are suppose to give good OH and try to reminilarise everything while it is still possible, if parents is concerned with aesthetics I will suggest this.

80% success rates in follow up appointments.

CONS:
- Crown form is thicker than mila strips, might lead to tighter contact point.
- it might be difficult to remove the subgingival excess.

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I was time efficient with caries removal task, selectively removed the caries around the dej

No damages to adjacent surface

No unsupported enamel

Rounded internal line angles

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Things I have achieved this session

- No damage to adjacent tooth, contact area correctly positioned,

I have not

- got a smooth finishing surface

- set material was not free of voids

How I can improve

- I can alway overfill and reduce using polishing discs

- pack in The strip crown really well, push the composite down firm and hard so no voids (air bubbles) can be achieved,

Things I've learned

- to remove the strip crown rather than going subgingivally with a sickle probe and try to flick it off I could use a high speed cut out the strip crown then use flat plastic to flick the rest off.

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Only done on adult tooth, performed after a complicated crown fracture.
Cvek pulpotomy the vitality of the tooth after it has been performed on has to do with
- Trioxide mineral aggregate(MTA) high pH,has an excellent seal provided against bacterial migration.
risks: Ocular damage and irritation through respiratory passage.

- blood angulating agent is not recommended because you want to determine if the pulp has irreversible pulpitis. However MTA causes staining remember to warn parents about this.

Factors that would infoluence the succession of pulpotomy
- Degree of inflammation
- Time factor(ASAP)
- Outcome is not effected by the size as long as it is less than 4mm
- Better prognosis on tooth with open apices.

Pack with MTA/Non-setting calcium silicate
, vitrobond, then composite

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Drilled in about 1.5mm haemostasis reached

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I used a tweezer to bond the fragment but what i could have done was get a microbrush with a little bit of uncured composite on the tip of the brush.

FRAGMENT REBONDING (IF PRESENT OTHERWISE PROCEED TO COMPOSITE RESIN)

Remove fragment from medium and lightly dry.

Attach a small amount of uncured composite to the end of a microbrush, press into the incisal edge of the fragment to allow easy handling.

Try in fragment to evaluate fit (any medicaments and liners may slightly impede exact placement in some cases) and assess for missing pieces/ gaps.

If fit is not acceptable or there are missing pieces/ gaps reattach fragment with composite resin/ flowable composite resin or reshape the fitting surface of the fragment. The interface can be masked with a double bevel and addition of composite resin to the fracture line if required. Final steps would then include finishing and polishing and checking occlusion.

I should

- make sure tooth fragment is placed correctly(parallel to the incisal edge)

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I could have done a bevel which would have made the aesthetic so much better.

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demo's fix of composite on my incisal edge

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demo's fix of composite on my incisal edge

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she just put some more composite inbetween on the edge and buccal used mila strip to pull/press on the incisal edge and then used polishing to remove excess.

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My initial thought
- Splint is too long I need to decrease length and bond composite on 11 12 then lastly 21.

I had two opinions regarding this
Demo 1: Aesthtic not okay, wire too long, too much composite, splint unstable should remove splint cut it and reattach.

Demo 2: Add composite on the 12 and 11 as well to stabilise it, it's okay to keep going.