991219

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Chapter 1 At the reception desk () 1. Making an appointment ()

Check-up Fully booked Cancel an appointment
1.Making an appointment
Miss Suzuki()Hello, this is Dr. Sato() and Dr. Richards Dental Clinic. How can I help you ? Mr. AbeGood morning. I am ringing (calling or phoning) to ask if I could make an appointment for a check-up ? Miss SuzukiUnfortunately Dr. Sato() and Dr. Richard are both busy all this week. Is next Monday OK ? We have some spaces in the morning. Mr. AbeNext Monday morning is fine for me. Could it be early in the morning ?
1.Making an appointment
Miss SuzukiThe first available space is 8:30. Is 8:30 am alright for you ? Mr. Abe8:30 am is perfect, thank you. Miss SuzukiCould I have your name again, please ? Mr. AbeYes of course. My name is Kenji Abe( ).
Chapter 1 At the reception desk () 2. Cancelling an appointment ( )
2.Cancelling an appointment
Miss SuzukiGood afternoon, Dr. Sato and Dr. Richards Dental Clinic. Can I help you ? Mr. OtakeHello this is Kenichi Otake(). I would like to cancel an appointment if possible. Miss SuzukiCould you tell me when is your appoint Mr. Otake ? Mr. OtakeIts this Friday at 4 pm. Miss SuzukiThats no problem. I will cancel it for you. Would you like to make another one ?
2.Cancelling an appointment
Mr. OtakeYes please. Dr. Richard was going to do a filling so I need to come again. Could I come in next week ? Miss SuzukiI am sorry. Dr. Richard is fully booked (; no more spaces were available) next week. Because you need a filling, a longer appointment is necessary. The next time Dr. Richard can see you will be a week on Tuesday. Will that be alright ? Mr. OtakeYes, thats fine thank you.
Chapter 1 At the reception desk () 3 .Changing an appointment ( )
3.Changing an appointment
Miss Suzuki : Dr. Sato and Dr. Richards Dental
Clinic, how can I help you? Mrs. Sayama : My name is Mrs. Sayama() and I have an appointment this afternoon with Dr. Sato but I have to change it because I dont feel well. Miss Suzuki: Oh dear Im sorry to hear that you are not feeling well. Would you like to make another appointment?
3.Changing an appointment
Mrs. Sayama : Can I call you back because
Im going away for a few days? Miss Suzuki: Thats fine. We look forward to seeing you again, Mrs. Sayama.
Chapter 2 Emergency () 1. Broken tooth ()

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Composite filling, composite resin: , Metal crown: White crown: Ceramic matertals: Zirconia: Prepare the tooth: ; Emergency: Chew:
1.Broken tooth
Dr. Sato: Youre back again, Mr. Ishida. Is it the
same tooth? Mr. Ishida: Im not sure. I bit (past tense of bite) on a yakitori( : ()) last night then I heard a crack and felt something sharp in my mouth. I think it is either the tooth you worked on or the one next to it. I cant say.
1.Broken tooth
Dr. Sato: Well, luckily the tooth I rebuilt last time
is OK. It is the tooth behind. You also had a composite filling in that tooth but now the remaining bit of enamel has broken off. Mr. Ishida: Is it serious? Dr. Sato: Yes and no. (used to show that there is not one clear answer to a question )
1.Broken tooth
Mr. Ishida: What do you mean? Dr. Sato: Well , yes in the sense that if we do what we did last time and repair the broken enamel with composite resin all your tooth will consist of composite. Mr. Ishida: That is good, isnt it?
1.Broken tooth
Dr.Sato : Not really. If all of the tooth consists of composite resin, it can easily break again and all the filling may break off. We will need to place a crown on the tooth. Mr.Ishida : I dont want a metal crown. Some of my friends have metal crowns and they dont look very nice. Can I have a white crown?
1.Broken tooth
Dr. Sato: Yes, thats no problem. There are some new ceramic materials available, which can be used to make the crown. Because you have a tendency to break your teeth we will need to use a strong ceramic. Something like a Procera high strength alumina coping or one made of zirconia.
1.Broken tooth
What well do today is put some composite resin on as a temporary measure and give you another appointment. Mr. Ishida: Cant you prepare the tooth today? Dr. Sato: Unfortunately you were seen as an emergency and I have another patient waiting. Sorry.
1.Broken tooth
Mr. Ishida: Its just that I have to go Italy for a business trip. Ill be out of the country fir a mouth. So Im worried that the composite resin wont last. Dr. Sato: If you are careful not to eat anything very hard on those teeth you should be fine.
1.Broken tooth
Mr. Ishida: Ill make sure I chew on the other side. Thanks for what you have done today .Im sorry for all the trouble I have caused you. Dr. Sato: Its my pleasure Mr. Ishida().
Chapter 2 Emergency () 2.A denture tooth has broken off ()
She has broken a tooth off her upper. denture: . What can I do for you?: ? A front tooth has broken off my upper denture.: .
2.A denture tooth has broken off
Miss Suzuki: Sorry to trouble you Dr. Richard, a lady called Mrs. Kawajima( ) has come in and would like to know if someone could see her. She is very distressed. She says she has broken a tooth off her upper denture. Dr. Richard: Could you see if Dr. Sato is free?
Miss Suzuki: Yes certainly. Dr. Richard: I have just finished so I can see Mrs. Kawajima. Could you call her in please Miss Kato()? Miss KatoWould you like to come through please Mrs. Kawajima()
Dr. SatoWhat can I do for you Mrs. Kawajima Mrs. KawajimaA front tooth has broken off my upper denture and now I cant smile. Its terrible. I must give a presentation this afternoon in front of 200 people. If this tooth cant be fixed everyone will laugh at me
Dr. SatoLet me have a look. Ah no problem. The tooth just needs to be stuck back on. It will take me just a few minutes. Mrs. KawajimaThank you so much.
Chapter 2 Emergency ()
3. Pericoronitis ()
Patients file Wisdom tooth ; Bite Gum Lower third molar Swollen / Swell Crown Pericoronitis Flap of gum Infection Erupt Radiograph Impacted tooth
Mesially Refer Oral surgeon Second opinion Extract Sterile water Antibiotics Allergic to Penicillin White spot Have a sweet tooth Hygienist
3. Pericoronitis
Miss SuzukiYour first patient has just cancelled so you have a bit more time. However, there is an emergency patient on the way. I will call you when I have made the patients file. Miss Tanaka()Dr. Richard, we will be working in Dr. Satos surgery today. We are lucky. He is not in today.
3. Pericoronitis
Dr. Richard Thats good. Has someone been called to come and check the autoclave( )? Miss Tanaka Yes. Your first patient Cancelled. But there is an emergency patient on the way. Miss Suzuki The emergency patient has come. The patients name is Miss Komata (). Here is her file. Miss Tanaka Dr. Richard, are you ready for the emergency patient? Her name is Miss Komata. Dr. Richard Yes. Can you call her in please?
3. Pericoronitis
Miss Tanaka Good morning Miss Komata( ). Could you come this way please. Dr. Richard Good morning Miss Komata, please come in and have a seat. What can we do for you? Miss Komata Thank you for seeing me at such short notice. I think its wisdom tooth. The back of my mouth hurts when I try to bite together. The pain has been getting worse and I couldnt sleep last night. I am also having difficulty opening my mouth.
3. Pericoronitis
Dr. Richard Ok. Lets have a look. Yes, the gum around your lower third molar is swollen. Part of the crown is visible. You have pericoronitis. Miss Komata Pericoronitis Whats that Dr. Richard There is a flap of gum overlying the wisdom tooth. Food has got stuck underneath and an infection has started. It looks like your third molar is having trouble erupting. We need to take a radiograph to check its position.
3. Pericoronitis
Dr. Richard :Your tooth is impacted mesially. Let me show you. Miss Komata: Will it come through later on? Dr. Richard :I dont think so.It is tilted against the molar in front. I will refer you to an oral surgeon for a second opinion. He may recommend you have it extracted. I will wash under the gum with sterile water and give you some antibiotics. They will reduce the infection. Are you allergic to Penicillin?
3. Pericoronitis
Miss Komata : No. I have had Penicillin before. Dr. Richard :I have noticed a couple of other things. You have several white spots on your teeth and there is some calculus behind your lower incisors. Do you like to eat a lot of sweet thing. Miss Komata : Yes I do. My friends have told me I have a sweet tooth. Dr. Richard: I will give you another appointment so we can talk about your diet and give you some advice and also I will book() you in with our hygienist. Miss Komata : Thanks very much.
Chapter 2 Emergency ()
4 . An allergic reaction ( )
Allergic reaction Wisdom tooth Swelling Rash Go and see a doctor Alternative antibiotics oral surgeon Have ones wisdom tooth removed Indication
4 . An allergic reaction
Miss Suzuki: Miss Tanaka, do you think Dr. Richard can see an emergency patient? Miss Tanaka: Yes Im sure he can. Whats the problem? Miss Suzuki: Mrs. Komata has returned. She thinks that shes had an allergic reaction to the antibiotics Dr. Richard gave her for her wisdom tooth trouble Miss Tanaka: I remember Mrs. Komata. She came in yesterday as an emergency. Ill let Dr. Richard know that shes in the waiting room. .
Miss Tanaka: Dr. Richard. We have an emergency patient. You remember Mrs. Komata who came in yesterday with the wisdom tooth swelling? Well she thinks shes had an allergic reaction to the antibiotics you gave her. Dr. Richard: that doesnt sound good. We had better bring her in the straight away. Miss Tanaka: Please come this way, Mrs. Komata. Dr. Richard: I hear things arent going well for you, Mrs. Komata.
Mrs. Komata: Unfortunately no they arent. I have developed a rash on my arm and I think its an allergic reaction to the antibiotics you gave me. Dr. Richard: yes I can see the rash. I gave you penicillin. When I asked you if you had any allergies you said you hadnt. Mrs. Komata: Thats right I dont. Dr. Richard: Have you had penicillin before? Mrs. Komata: No I havent.
Dr. Richard: well it looks like you have had an allergic reaction. You must go and see your Medical Doctor for further tests. In the meantime, please stop the penicillin and I will give you an alternative antibiotic. You have a review (follow-up) appointment next week dont you? Mrs. Komata : Yes I do. Dr. Richard: I will see you then and decide if we need o refer you to the oral surgeon to have your wisdom tooth removed. If you have an infection that requires antibiotics then that is an indication to have the tooth removed.
Mrs. Komata: Thanks for seeing me so quickly. Ill go straight to my Doctor. Dr. Richard: Before you leave, I will write a letter for you to give to your Doctor explaining what has happened. Please take a seat in the waiting room for a few minutes.
Chapter 2 Emergency () 5. An avulsed tooth ()
Upper central incisor Come through () Surgery (British dental clinical or) Splint the tooth () Periodontal membrane
5. An avulsed tooth
Miss Suzuki : Miss Kato, could you see if Dr. Sato can come to the phone please? Mrs. Ogata() would like to speak to Dr. Sato urgently. Apparently her front teeth was knocked out. Miss Kato : Ill get him at once. Miss Suzuki : Dr. Sato, Mrs. Ogatas daughter has had an accident at school and has had her front tooth knocked out and she wants to know what to do. Dr. Sato : Hello Mrs. Ogata. This is Dr. Sato speaking. I hear your daughter has had an accident.
5. An avulsed tooth
Mrs. Ogata : Yes. I remember you telling me her upper central incisors have come through. It is one of those. Dr. Sato : the best thing to do is to put the tooth back if you can. Is there some milk anywhere? If so put the tooth in milk and gently move it around. Try not to touch or clean the root. Mrs. Ogata : Ok. Yes there is some milk and I shall do that now. Dr. Sato : Good.
5. An avulsed tooth
Dr. Sato : Now the next part is the hard bit(part). You need to put the tooth back in the socket. But please be careful to put the tooth back the right way around. The flat part faces to the front. Push the tooth in as quickly as you can then ask her to bite gently on something soft like a piece of cotton. Dr. Sato : Then bring her straight to the surgery(British dental clinical) and I shall have a look at her when she is here. Ill splint the tooth for a few days just to keep it in position while hopefully a new periodontal membrane will grow.
5. An avulsed tooth
Mrs. Ogata: I have cleaned her face and wiped the blood away so I am ready to try to put the tooth back. Once I have done that Ill bring her straight to you. Thank you so much for your advice.
Chapter 3 Treatment () 1. Composite filling ( )
Premolar Palatal cusp Light-cured composite resin Glass particle Polymerize Restoration () Set Adhesion Indirect onlay Metal-ceramic crown - Calculus
1. Composite filling
Miss Kato: Good morning Dr. Sato. Ready for this morning Dr. Sato : Absolutely. How many patients do we have Miss Kato: Five this morning. The first patient is Mr. Ishida. He has broken a tooth. Are you ready Dr. Sato :Yes. Can you call him in Mr. Ishida: Thanks for seeing me Dr. Sato. I was eating some Yakitori when I heard a crack and then noticed a piece of tooth in my mouth. I think it is one of my premolars.
Dr. Sato :Ill have a look. Ah yes, you have broken the palatal cusp of your second premolar. We can rebuild it with light-cured composite resin. Mr. Ishida: What is light-cured composite resin Will it last for a long time Dr. Sato : Light-cured composite resin is a resin, which contains glass particles of different sizes. We use a blue light to polymerize() it. The material has a long working time to give it the correct shape. When we are happy with the shape of the restoration then we set it with the light. It relies on adhesion to stay in place.
Dr. Sato : How long will it last Dr. Sato : Well that is difficult to say. It depends on many things. If it breaks again then we could either place an indirect onlay or prepare the tooth for a metal-ceramic crown. These are more expensive and time-consuming long-term options. I noticed that you also have some calculus on your teeth. I will arrange for you to see your Dental Hygienist, Miss Yoshida().
Chapter 3 Treatment () 2. A painful tooth, endodontic treatment (, )
Amalgam filling Pulp Radiograph X Endodontic treatment Secondary caries Bacteria Toxins Drop out Inflamed Non-vital Dental abscess ()
Pulp extirpation Local anesthetic Numb Clamp Rubber dam Root canal(s) Antibiotic paste Temporary filling Topical anesthetic
2. A painful tooth, endodontic treatment

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Miss Yoshida: Good morning Mr. Santana, how are you today Mr. Santana: Not too good actually. Miss Yoshida: Why Whats happening Mr. Santana: Well one of the teeth, which you were going to clean, is hurting me. Its the first upper big tooth on the left. Miss Yoshida: Oh dear. How long has it been hurting you

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Mr. Santana: Since last week. Now its starting to keep me awake at night. I also cant chew on it. Something broke last week. I think it was the filling. Miss Yoshida: Ill have a look. Yes, you have broken an amalgam filling in the upper first molar. I will call Dr. Sato in to have a look

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Dr. Sato: Miss Yoshida is right. The amalgam filling has broken. The reason is that the tooth became soft underneath and could not support the filling. It looks like the soft tooth has reached the pulp and now the pulp is dying, which is why you have pain. We need to take a radiograph to see how deep the soft tooth is.

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Dr. Sato: Unfortunately the soft tooth has affected the pulp and the tooth needs endodontic treatment. Mr. Santana: Sorry could you explain that again Dr. Sato: Yes certainly. Ill go slowly and show you some pictures. Sometimes fillings can become decayed. This is called secondary caries because it is the second time the tooth has become decayed. Dental caries is caused by bacteria releasing toxins, which dissolve the mineral part of the tooth. Then the tooth becomes soft.

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Dr. Sato: This can cause the filling to drop out because it has no firm support. The bacterial toxins eventually reach the pulp, which is in the middle of the tooth. The pulp becomes inflamed, which is why you feel pain. Unfortunately in your case it is impossible to keep your pulp alive. We need to remove the inflamed pulp to stop your pain.

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Dr. Sato: If we dont do it, the infection will go further and all the pulp will die. In other words it will become non-vital. This will give rise to infection in the bone around the tooth. This is called a dental abscess. Mr. Santana: Can you get rid of the pain Dr. Sato: Yes, we can carry out endodontic treatment. In other words we can remove the pulp and clean out the inside of the tooth so there is nothing left to cause pain. This procedure is called pulp extirpation.

. Mr. Santana: Is it painful when you clean out the tooth Dr. Sato: No, I will give you a local anesthetic, which will numb the tooth. Dr. Sato: It will be numb for a few hours so you must be careful with hot drinks and eating. You may bite your lip or burn yourself if you are not careful.
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Mr. Santana : How do you clean out the tooth? Dr. Sato : After your tooth has gone numb we clamp a piece of rubber over the tooth. This is called a rubber dam. It stops you swallowing anything. We then remove all of the old filling and decayed tooth. The upper first molar has 3 roots and at least 3 root canals, which are channels inside the roots. Dr. Sato: We use small, very narrow files to remove the contents of the root canals. After we have cleaned the root canals we put in some antibiotic paste and a temporary filling. You will need to come back so we can continue with the treatment.

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Mr. Santana : Sorry for asking so many questions. I feel less nervous now that I know what is going to happen. Dr. Sato: First, Ill put some cream on the gum to numb the surface. Can I have the topical anesthetic please Miss Kato
Chapter 3 Treatment 3. porcelain laminate veneer ( ): (1) preliminary discussion with the dental technician
Surgery Appointment Wax-up Porcelain laminate veneer Prepare Upper incisor Silicone index Transparent acrylic template
3. porcelain veneer: (1) preliminary discussion with the dental technician

Dr. Richard : Good morning Miss Suzuki. How are you? Miss Suzuki : Im fine thanks. Kaz Yoshida of HiCeramics asked you to call him. Dr. Richard : I will call him right way. Have you seen Dr. Sato? Miss Suzuki : Yes, he is in his surgery. By the way, your first patient Mr. Jones rang to say that unfortunately he has been called to an urgent meeting and cannot come this morning. He apologized and asked if he could make another appointment.
3. porcelain veneer: (1) preliminary discussion with the dental technician

Dr. Richard: Ill call Kaz and see what he wantsIs that Mr. Yoshida? Kaz Yoshida : Hi Dr. Richard. Thanks for calling back. I rang regarding the Wax-up for Miss Ito(). You plan to make her four Porcelain Laminate Veneers. Dr. Richard : Thats right. We are going to prepare the upper incisors for Porcelain Laminate Veneers. I will show Miss Ito the Wax-up on Wednesday. Then if she is happy with it, I will ask you to make a silicone index and transparent acrylic template. Could you come in on Wednesday to talk to Miss Ito? Kaz Yoshida : Wednesday is fine. See you then.
Cheap 3 Treatment 3. porcelain laminate veneer: (2) Wax-up
Porcelain veneers: Dental Technician: Labial surface: Enamel: Anterior teeth: Treatment: Wear:
Mold: Silicone putty: Set: Trim: Clear acrylic mask: Prepare the teeth:
3. porcelain veneer: (2) Wax-up

Dr. Richard: did you have any trouble with the trains this morning, Miss Tanaka? Miss. Tanaka: No. but I heard there were delays on the Yamanote line(). Your first patient Miss Ito is here. Dr. Richard: Ah yes. We are going to show her the wax-up for her new porcelain veneers. Could you have a look to see if Kaz has also come? I asked him to come when Miss Ito was due in.
3. porcelain veneer: (2) Wax-up Miss Tanaka: I'll go and have a look...Yes, he is here. He is talking to Miss Suzuki at the reception desk. Dr. Richard: Good. I'll ask him in...How's it going Kaz? Kaz Yoshida: Very well thanks. Dr. Richard : Could you ask Miss Ito to come please, Miss Tanaka? Miss Tanaka: Please have a seat, Miss Ito. Dr. Richard: Good morning, Miss Ito. I have asked our Dental Technician, Kazuo Yoshida() to join us to discuss the wax-up of your teeth.

Miss Ito() : Nice to meet you. Dr. Richard: Well this is the wax-up. Because you have lost some of your enamel, we have been able to build out the teeth a little. This will make them more like they were before you began losing the surface enamel. Miss Ito: Yes, unfortunately too many soft drinks and fruit juices. Well I have followed your advice and stopped drinking soft drinks and cut down on the fruit juice.

The teeth look a little bigger now and also slightly longer. But they seem to look more like how they used to look. Kaz Yoshida: I looked at the photograph, which you gave me of your teeth a few years ago and compared it with the photo, which Dr. Richard took last time. I have added wax where you have lost some of the enamel and also lengthened the teeth slightly so that you show a little more tooth when you smile. Miss Ito: Yes, they look much nicer now.

Dr. Richer: Do you want us to proceed with the treatment? The next stage would be for you to wear a clear acrylic mask, which will be lightly stuck to your teeth. You will then wear the mask for a couple of weeks to get used to your new smile. After that, if you are happy with your new smile then we can go head and prepare the teeth. If you do not like your new appearance, then we will not proceed with the preparations.

Miss Ito :What is an acrylic mask? Dr. Richard :What we do is we copy the wax up in dental stone. We then make a mold of the labial surfaces of the anterior teeth using silicone putty. When you come back we fill this silicone putty mold with clear acrylic and hold it against the teeth while it sets. It does not stick to the teeth. It is carefully trimmed so that it clips onto the teeth. It allows you to check your new smile at home. Of course, the color will not be perfect but it will allow you to check what the final shape of the teeth will be
3.Porcelain Veneer: Tooth preparation

Dr. Richard: What do you think of the acrylic mask? Miss Ito: It looked a bit strange at first but I have got used to it. I like the new shape of the teeth. Dr. Richard: Are you happy for me to prepare your teeth for porcelain veneers on your upper central incisors? Miss Ito: Do you have to remove much enamel? Dr. Richard: No. Your teeth incline inwards and you have composite fillings in both teeth so we only have to remove a few fractions of a millimeter. My technician, Kaz, has made me a putty matrix.
Cheap 3 Treatment 3. porcelain veneer: Tooth preparation( )
Porcelain veneer: Matrix: Acrylic mask: Cast the impression in plaster: Prepare: Central incisor: Adhesive resin cement:

Miss Ito: Sorry, why do you need a putty matrix? Dr. Richard: The putty matrix is very useful. It will make sure I do not remove too much enamel. Kaz made an impression of the wax-up of your central incisors. He then cast the impression in plaster. This gave him a model of how you wish your teeth to look. A putty matrix was made on this model. As we adjust the surfaces of your central incisors we place the putty matrix against the preparations. We can then see how much space there is for the porcelain veneers. We need about 0.3-0.5mm of space.

Miss Ito: It all sounds very complicated. Im not sure I understand but you seem to be taking great care. Dr. Richard: Yes, I am. But this way we can ensure that the veneers will look like the acrylic mask but a better color. Miss Ito: Will they fail off the teeth? Dr. Richard: We use a special adhesive resin cement so it is unlikely they will fall off. We shall give you an appointment in a weeks time. Will that be alright for you? Miss Ito: That will be great thank you.
Cheap 3 Treatment 4.Making a new denture: (1)Complaints about old dentures
Denture: False teeth: Set: Appearance: Preliminary impression: Cast (up): Model : Laboratory: Technician:() Special tray( custom or individual tray): Fitting:
4.Making a new denture: (1)Complaints about old dentures

Miss Kato: Dr. Sato, Mrs. Kawajima is here. Dr. Sato: Oh, no, dont tell me the tooth on her denture has fallen off again. Miss Kato: No, she wants you to make her a new denture. Shall I call her in? Dr. Sato: Yes please. Mrs. Kawajima: Thanks for seeing me Dr. Sato. Dr. Sato: How can I help you? Mrs. Kawajima: its my false teeth. They are getting quite loose and the top one keeps dropping down.

Dr. Sato: How long have you had them? Mrs. Kawajima: Oh, its so long ago I cant remember. Over 20 years I think. Dr. Sato : Would you like me to make you a new set? Mrs. Kawajima: Yes please. Dr. Sato : Are you happy with the appearance of the teeth of your current set? Mrs. Kawajima: Not really. I think the teeth are a little small. Also, I would like whiter teeth. Will it take long to make me a set of new teeth.

Mrs. Kawajima: Can you make a start today? Dr. Sato: Yes, we can make the preliminary impressions today. After taking the impressions, we will cast them up and then send the models to the laboratory. The technician will then make some special trays. Mrs. Kawajima: May I ask why you need to make special trays? Dr. Sato: Special trays are custom-fitted to your mouth. They will enable me to take some accurate impressions of your mouth. Accurate impressions will help in making better fitting denture.
Cheap 3 Treatment 4.Making a new denture: Making an impression
Special tray( individual or custom tray ) : Treatment : Impression material : Zinc oxide-eugenol impression paste : Vinyl polysiloxane (addition silicone) ()( ) Acrylic : Alveolar ridge () Denture flange : () Peripheral seal : Insert :
4.Making a new denture: Making an impression

Dr. Sato: Have Mrs. Kawajimas special trays come bake? Miss Suzuki: Yes, they have. Mrs. Kawajima: Good morning Miss Suzuki, good morning Dr. Sato. I think Im a little early. Dr. Sato: Ive already finished my previous treatment so it wont be too long. My asistant, Miss Kato will call you in a few minutes.

Miss Kato: which impression material will you be using? Dr. Sato: I will use Exadenture. Miss Kato: Dont you usually use zinc oxide-eugenol impression paste? Dr. Sato: I do but I will try this new vinyl polysiloxane impression material, today. I will use Exadenture Border type first, the Exadenture paste.

Miss Kato : Shall I call her in? Dr. Sato : Yes please. Mrs. Kawajima: Im really happy you can see me again so soon. Could you tell me what are you going to do today? Dr. Sato: We are going to make the final impressions. We have made upper and lower acrylic special trays in which we will place the impression material. We make each impression in two stages.

Mrs. Kawajima: May I ask why two stages are necessary? Dr. Sato : We must first record the shape of the tissues surrounding the alveolar ridges. If the denture flanges accurately reproduce the shape of the surrounding tissues a good peripheral seal will be obtained when the denture is inserted. This means it will stay in better.

Mrs. Kawajima : That makes sense ( ). I was just asking because my previous dentist just took one impression. Dr Sato: First I will check the fit of the trays then make any necessary adjustments.
Cheap 3 Treatment 4.Making a new denture: Jaw registration( )
Jaw registration (bite registration): Foxs occlusal plane guide: Wax rim: Instrument:, Imaginary line: Pupil: Inter-pupillary line:
Alar of the nose: Tragus of the ear: Ala-tragus line: Freeway space (Interocclusal space) Measurement:,
4.Making a new denture: Jaw registration

Dr. Sato : Are you ready for Mrs. Kawajima? Miss Kato : Is it the jaw registration stage, isnt it? Dr. Sato : Yes, I will need the Foxs occlusal plane guide and Willis bite gauge. Miss Kato : Would you like to come through, Mrs. Kawajima? Dr. Sato : Good afternoon Mrs. Kawajima, how are you today? Mrs. Kawajima : Im fine thanks.

Dr. Sato : Today, we are going to measure up two wax rims, which we will be placing in your mouth. First we will put the upper wax rim inside your mouth to determine how much tooth you will show and then trim the wax rim so that teeth do not appear to be sloping to one side. Mrs. Kawajima : How do you do that? Dr. Sato : We use this plastic instrument, which is called the Foxs occlusal plane guide. We place it against the wax rim and line it up with two imaginary lines.

Dr. Sato : An imaginary line between the pupils called the inter-pupillary line and a line between the ala of the nose and the tragus of the ear called the ala-tragus line. We then trim the wax rim so that the Foxs occlusal plane guide is parallel to these lines. Mrs. Kawajima : That sounds difficult. Dr. Sato : I also must trim the lower wax rim so that I can determine the free way space.

Mrs. Kawajima : Could I ask what the freeway is? Dr. Sato : We must make sure that there is a small gap of a couple of millimeters between the teeth when you are not eating, otherwise you will get pain beneath the dentures. Next time you come we will make another measurement. Mrs. Kawajima : You certainly seem to be taking a great deal of care.
Chapter 3 4.Making a new denture:

retruded contact position
Mandible: Retruded contact position: Measurement: Gothic arch tracer: Wax rim: Mold: , Artificial teeth:
clicking sound: (), bite: high quality acrylic teeth: realistic: set up: processing ( , )
4.Making a new denture: retruded contact position

Mrs. Kawajima: Whats happening today, Dr Sato? Dr. Sato: We are going to record the relationship of the mandible to the maxilla. It is called the retruded contact position.

Mrs. Kawajima: Didnt you do that last time? Dr. Sato: No. We made some different measurements at your last appointment. Today, I am going to use a device called a Gothic arch tracer(), which has been fitted to the upper and lower wax rims. I will put the wax rims in your mouth and then ask you to move your mandible forwards and backwards and side to side. Also, we need to select the correct mold and shade of artificial teeth.

Mrs. Kawajima: I would like white teeth. My existing teeth are starting to look yellow. Also, is it possible to have porcelain teeth? Dr. Sato: You can definitely have whiter teeth, however, I wouldnt recommend porcelain teeth. They are difficult to adjust and can make a clicking sound when you bite together. I suggest high quality acrylic teeth. They look quite realistic.

Mrs. Kawajima: That sounds fine. Dr. Sato: Next time you come the teeth will have been set up in wax. While the teeth are in wax, it is possible to change them if you are not happy. Once you are happy with them we will process the wax trial dentures into acrylic.

Mrs. Kawajima: How long do I have to wait until my next appointment? Dr. Sato: We can have the wax trial dentures ready in one week. However, they may need some adjustments so they may not be ready for processing next time. Mrs. Kawajima: I appreciate all the trouble you are going to. Thank you.
Chapter 3 4.Making a new denture: Try-in
set-up: prominent: process: ,
acrylic:
4.Making a new denture: Try-in

Dr. Sato: How do you like the set-up of your new teeth? Mrs. Kawajima: I like the color and shape of the teeth. Its just the two front teeth they look a little prominent. Dr. Sato: Yes, I agree. I will alter the positions of the upper incisors. Mrs. Kawajima: Do you think they will be ready next time?
4.Making a new denture: Try-in

Dr. Sato: Yes. The technician has done a good job. The bite is correct and you are happy with the shape and color of your teeth. So if you are happy with the position of the teeth once I have altered them, I can request them to be processed into acrylic.
Chapter 3 4.Making a new denture: Insertion
Laboratory () Set Insert Hurt Gum Fitting surface Pressure indicating paste( ) Follow-up appointment Wear Ulcer
4.Making a new denture: Insertion

Dr.Sato: Good news Mrs. Kawajima, your new dentures have come back from the laboratory Mrs. Kawajima: I hope they fit better than my current set. They have been giving me a lot of trouble recently. Dr. Sato: I will insert the upper denture first and make sure it doesnt hurt you before I insert the lower denture. Do you feel any pain when I press on the top denture ? Mrs. Kawajima: No, it feels fine.

Dr. Sato: Ok. I will insert the lower denture and then you can tell me if it hurts. Mrs. Kawajima: It feels as if its digging in the gum on the right-hand side. Drs. Sato: Before I adjust the denture I am going to paint a white paste on the fitting surface of the denture. Mrs. Kawajima: Whats the white paste for? Dr. Sato : Its called Pressure Indicating Paste and can help identify which area of the denture is causing the pain. Then, I can carefully adjust the denture, Otherwise I might cut away too much.

Dr. Sato : How do they feel now? Mrs. Kawajima: Much better. The dentures are not rubbing now. Dr. Sato : This hand mirror will let you see how the dentures look. Mrs. Kawajima: They look nice. I like their color and appearance. Thank you.

Dr. Sato: I am pleased that you like them. There are some instructions, which you need to obey for the next few days. You may find eating difficult at first. Please cut your food into small pieces and eat soft things first. If you start getting any pain, please take them out. I will give you a follow-up appointment in a few days. If keep wearing them when they are hurting, you may get an ulcer. Mrs. Kawajima: I understand. Thank you.
Chapter 3 4.Making a new denture: Denture adjustment
hurt dig post-dam (posterior palatal seal) () seal Ridge Acrylic posterior border soft-tissue hard and soft palate plaster model reduce
4.Making a new denture: Denture adjustment

Dr. Sato: So, how have your dentures been? Mrs. Kawajima: Quite good. All my friends have said how much younger I look, which is very nice. I am slowly beginning to eat better with them. However, you did say to take care eating because it might be a little difficult at first. Dr. Sato: Do they hurt anywhere? Mrs. Kawajima: Its just the top one. It seems to be digging in a little at the back.
Dr. Sato : Ill have a look. Ah yes. Its the post-dam we made. Its a little deep. Mrs. Kawajima: Sorry did you say post-dam? Dr. Sato: Yes. In order to get a good seal at the back, we added a thin ridge of acrylic to the back of the denture. The back of the upper denture is called the posterior border. A couple of visits previously, I took some soft-tissue measurements at the junction of your hard and soft palates. These measurements told me how deep to make the ridge of acrylic. I then altered the plaster model according to the measurements.

Mrs. Kawajima: Ah, I think I understand. Dr. Sato: It appears the ridge is a little too deep so I will reduce it very slightly. Mrs. Kawajima: Thank you.
Chapter 3 5. Metal-ceramic crown replacement: Black margin
Certainly How can we help you? Cap(crown) Front teeth Whats wrong with them? Metal-ceramic crown Ceramic Metal Ceramic material Porcelain Fracture
Fitted Prepare the teeth Margins of preparation Gum margins Cemented Gingivae Recede Collar of metal Replace Periapical radiographX
5.Metal-ceramic crown replacement: Black margin

Dr. Richard: Who is our next patient Miss Tanaka? Miss Tanaka: Its Mrs. Shioda() Dr. Richard: Could you ask her in please? Miss Tanaka: Certainly. Dr. Richard: How can we help you, Mrs. Shioda? Mrs. Shioda: Its my caps on my two front teeth? Dr. Richard: Whats wrong with them? Mrs. Shioda: I think they are going bad. They are going black around the edges. Do you know whats happening with them?

Dr. Richard: Your caps are what we called metalceramic crowns. They have an outer covering of ceramic on top of a thin layer of metal. Mrs. Shioda: May I ask why it is necessary to use metal in the crown? Dr. Richard: The outer ceramic material is porcelain, which is brittle and can easily fracture. The metal strengthens the porcelain so that it doesnt fracture easily. The black line, which you can see is metal.
Mrs. Shioda: Why is the metal showing? I couldnt see it when the crowns were first fitted. Dr. Richard: We prepare the teeth so that the margins of the preparation lie just below the gum margins so when the crowns are cemented you cant see their margins. However, over a period of years the gums or gingivae may recede slightly. If the gingivae recede then the crown margins will be exposed. If the crown is a metal ceramic crown and has been designed such that there is a collar of metal all the way round then the metal may be visible.

Mrs. Shioda : I would like you to replace these two old crowns with new crowns. Dr. Richard : First we must take some periapical radio graphs of the teeth to see what is beneath the crowns.
Chapter 3 5. Metal-ceramic crown replacement (2) Getting a nice appearance
Central incisors Root treated Cast metal posts Apical infection Cut off Root fracture All ceramic material High strength alumina
Zirconium oxide All ceramic Metal post Recede() Recession() Electric toothbrush Collarless metal ceramic crown Nature teeth
Shade: Technician: Face-bow: Ear tube (external auditory meatus): Iner-condylar axis: Palatal surface: Articulator : Informed consent:
5.Metal-ceramic crown replacement(2) Getting a nice appearance Mrs. Shioda: Can you see anything on the radio-graphs? Dr. Richard: Yes, a few things. Your two central incisors have been root treated and cast metal posts fitted. These cast posts are quite long. The good news is that there is no apical infection around the roots of the teeth. If we are to replace the two crowns we would need to cut them off but leave the cast posts in the roots. If we try to remove the posts there is a risk of root fracture.
5.Metal-ceramic crown replacement(2) Getting a nice appearance Mrs. Shioda: Can you replace the old crowns with ones without metal? Dr. Richard: There are all ceramic materials available such as high strength alumina and zirconium oxide, which are very strong. However, because we must leave the metal post in the roots, an all ceramic crown may not possess good esthetics because the metal may show through. Therefore, we would need to make two metal ceramic crowns.
5.Metal-ceramic crown replacement(2) Getting a nice appearance Mrs. Shioda: I understand that it would not be a good idea to replace the meterceramic with all ceramic crowns because the metal posts might be visible through the ceramic. You said that the reason why I can see the metal is that my gums have receded. Would this happen if I have new crowns made?
5.Metal-ceramic crown replacement(2) Getting a nice appearance Dr. Richard: Yes, it is possible that you may get some more recession. The amount the gums may recede depends on several factors. For instance, if you brush your teeth vigorously in a sideways motion, the brushing action may accelerate gum recession. Could I ask how you brush your teeth, Mrs. Shioda?
5.Metal-ceramic crown replacement(2) Getting a nice appearance Mrs. Shioda: I use an electric toothbrush. I hold it lightly against the teeth and let the bristles do the work. You also said that you would make new metal-ceramic crowns. Does that means the metal will be visible. Dr. Richard: What I propose is that we make collarless metal ceramic crowns. The underlying metal will not extend to the crown. The crown margin will be all in porcelain.
5.Metal-ceramic crown replacement(2) Getting a nice appearance

Mrs. Shioda: How will you get the color of the new crowns to match my natural teeth? Dr. Richard: We use a machine, which takes a digital reading of the color of your natural teeth. The reading is then matched with a shade of porcelain. If the color of your natural teeth is difficult to match then I will ask my technician to come in and look at your teeth. While you are here today I will take some digital photographs of your teeth and also some impressions of your upper and lower teeth. I will also take a face-bow recording.
5.Metal-ceramic crown replacement(2) Getting a nice appearance

Mrs. Shioda: Sorry, did you say face-bow recording? Whats one of those? Dr. Richard: I will put some wax on your upper teeth and them use a device, which consists of a metal fork and an arm, which rests in your ear tubes. This is a face bow. Its purpose is to relate the relationship of the maxilla with the intercondylar axis. The face bow is then attached to an articulator, which enables us to study the relationship of the upper and lower teeth. When we make new upper anterior crowns, it is very important to get the slope of the palatal surface correct.
5.Metal-ceramic crown replacement(2) Getting a nice appearance Mrs. Shioda: It sounds very complicated. I am sorry I will stop asking so many questions. Dr. Richard: Thats no problem. It is important that you understand the treatment we are proposing so you can give informed consent.
Chapter 3
5.Metal-ceramic crown replacement: (3) Crown removal
Numbed up Administer a local anesthetic Anaesthetize() Lidocaine(, ) Adrenaline Alginate impression() Temporary crown Gingival retraction cord Preparations Addition silicone Glaze
5.Metal-ceramic crown replacement:(3) Crown removal Dr. Richard: Would you like to come through, Mrs. Shioda? Mrs. Shioda: Thanks for seeing me early. Dr. Richard: How are you today, Mrs. Shioda? Mrs. Shioda: Not very well unfortunately. Dr. Richard: Whats wrong? Mrs. Shioda: Its my ankle. I twisted it a few days ago and now it is all bandaged up.
5.Metal-ceramic crown replacement:(3) Crown removal Dr. Richard: What happened? Mrs. Shioda: I was play tennis last Saturday and during the match I slipped while trying to reach a ball. Dr. Richard: Oh dear, Im sorry to hear that. Mrs. Shioda: Whats happened today? Dr. Richard: We are going to remove your old crowns and take some impressions for your new crowns. Mrs. Shioda: Will I need to be numbed up?
5.Metal-ceramic crown replacement:(3) Crown removal Dr. Richard: Yes, unfortunately we need to administer a local anesthetic. We need to anaesthetize your two upper incisors. The local anesthetic agent is a mixture of lidocaine and adrenaline. Your lip will feel numb for about two to three hours so please avoid hot drinks. Mrs. Shioda: Whys that? Dr. Richard: You will not have any feeling in your upper lip so you might burn it. Also you must be careful you dont bite it if you are going to try to eat.
5.Metal-ceramic crown replacement:(3) Crown removal Mrs. Shioda: I much prefer you to my last Dentist. He never told me anything. I always got quite worried abut what he was going to do. Could you tell me what you are going to do today so I know what to expect. Dr. Richard: Certainly. While the teeth are going numb, I will take an alginate impression. We will use this to make the temporary crowns. After that I will cut the old crowns so they can be carefully removed from the teeth. Mrs. Shioda: Sorry to interrupt you, but is that a piece of string you are cutting off?
Dr. Richard: It is like string but a bit thicker. Its called gingival retraction cord. We have removed both crowns and tided up the preparations. Before I take the impressions I am going to place this gingival retraction cord around the preparations. Mrs. Shioda: May I ask why? Dr. Richard: The retraction cord keeps the edge of the gum away from the tooth. It is soaked in a solution, which stops any bleeding. This way we can make a good impression. Mrs. Shioda: Which impression material are you going to use?
5.Metal-ceramic crown replacement:(3) Crown removal
5.Metal-ceramic crown replacement:(3) Crown removal

Dr. Richard: I think I will use the addition silicone sample, which the sales representative gave me last week. Its in the drawer on your right. Dr. Richard: You are doing well Mrs. Shioda. We are on the last stage now. I just need to make some nice temporary crowns for you. Mrs. Shioda: I hope they are better than the ones my last Dentist made for me. They went yellow. Dr. Richard: Dont worry that shouldnt happen with these. I will put a special glaze on them so that food wont stain them
Chapter 3 5.Metal-ceramic crown replacement (4) Characterization
metal-ceramic crown Porcelain butt margin Shade Characterization Staining Natural teeth Ultrasonic scaler Internal characterization Surface texture Mimic I am looking forward to ~ing
5.Metal-ceramic crown replacement (4) Characterization
Dr. Richard: How are things, Kaz? Kaz Yoshioda: Fine thanks, I stopped by to talk to you about Mrs. Shiodas new crowns. Dr. Richard: Yes, we are making two new metal-ceramic crown with porcelain butt margins for her upper central incisors. Kaz Yoshida: I wanted to discuss the shade and shape of these crowns with you. You wanted some special characterization.

Dr. Richard: Yes. Her adjacent lateral incisors exhibit some staining. Mrs. Shoida would like the new crowns to also have some staining. Her existing crowns are all one color and do not blend in with her natural teeth. Kaz Yoshioda: I have printed out the digital photos, which you e-mailed me. They clearly show that the existing crowns appear to stand out from the surrounding natural teeth. The lower anterior teeth also have some staining. Is the staining permanent or can it be removed with an ultrasonic scaler( )?

Dr. Richard: Its permanent. It would not come off with an ultrasonic scaler. Mrs. Shioda says they have been stained for many years. Kaz Yoshioda: I will need to add some internal characterization using different shades of porcelains. It is important that I also create some surface texture. It looks from the photos that the adjacent lateral incisors have some vertical dark lines so these will need to be mimicked in the crowns. I will put a faint brown stain in the porcelain to mimic the brown lines in the lateral incisors.
Dr. Richard: That sounds very good. I took several photographs at different exposures to try to give you a good idea of the different colors. I am looking forward to seeing the finished crowns.
Chapter 3 Treatment 5.Metal-ceramic crown replacement (5)Cementation
Temporary crown : Cement : Cementation : Zinc phosphate cement : Glass ionomer cement : Resin cement : Consistency : Film thickness : Restoration : () Adjacent natural teeth :
5.Metal-ceramic crown replacement (5)Cementation
Dr. Richard : We have your new crowns, Mrs. Shioda . Mrs. Shioda : Very good. Im looking forward to seeing how they look. Dr. Richard : The plan today is to remove the temporary crowns and then let you see the new crowns in place before cementation . So, what do you think of them ?
Mrs. Shioda : Im really pleased with them. Their color is very good. They dont stand out anymore. They blend in with the other teeth.
Dr. Richard : I am pleased to hear that . Are you happy for me to go ahead and cement them in place ? Once they have been cemented , the only way to change them would be to cut them off.
Mrs. Shioda : Yes, please go ahead . May I ask a question ? Dr. Richard : Of course. Mrs. Shioda : What kind of cement do you use to cement the crowns? Dr. Richard : There are many different cements. There are basically three types of cements ; Zinc phosphate, glass ionomer or resin cement. Each one has advantages and disadvantages .
Mrs. Shioda: Which one will you use today ? Dr. Richard: I think I will use a resin cement . Resin cements stick well to both tooth and metal .Their main disadvantage is that they are a little thick in consistency and have a high film thickness. Mrs. Shioda: Is that a problem ? Dr. Richard: It can be sometimes .
Dr. Richard: Because resin cements are quite thick in consistency and have a high film thickness, sometimes it can be a little hard to cement the restoration exactly in place. Mrs. Shioda: Well, Im sure you know what you are doing. I am attending a party tonight so I wonder if anyone will notice my new crowns . Dr. Richard: Hopefully no one will. If the crowns blend in with the adjacent natural teeth then they will not be so visible.
Chapter 3 Treatment 6. New technology (1)Microscope
Loupes Microscope openings of the root canals Eye surgeons Radiograph X Anaesthetize Extirpate the pulp Prepare and dress the root canals Symptomless Root fill
6. New technology (1)Microscope
Dr. Richard: How are you doing, Mrs. Watanabe? Mrs. Watanabe: To tell the truth, Im feeling a bit nervous about today. Dr. Richard: Ill try to explain whats going to happened so youll feel more relaxed. Today, Im going to begin cleaning the roots of your lower right first molar then youll get no more pain from the tooth.
Mrs. Watanabe: How can you see what you are doing because a tooth is so small? Dr. Richard: I have a pair of loupes, which can magnify the tooth about 2 times. The practice also has an operating microscope . The microscope is excellent for locating the openings of the root canals. That is the microscope over there. It is just like the operating microscope eye surgeons use.
Mrs. Watanabe: Its big isnt it? How powerful is it? Dr. Richard: It can magnify the tooth about 12 times. It is on wheels so it can be easily moved around the surgery. I will be using it today. Before we do any work on your tooth we must first take a radiograph and then anaesthetize the tooth. Dr. Richard: Miss Suzuki, can you start getting the microscope ready while I am taking the radiograph?
Miss Suzuki: Ill ask Miss Kato to just come in and help me move it across the surgery. Will you be filling the roots today? Dr. Richard: No, Ill just extirpate the pulp, and try to prepare and dress the root canals today. If the tooth stays symptomless, Ill root fill it next time.
Chapter 3 Treatment 6. New technology (2)Ni-Ti file
The anesthetic wore(wear) off: Channel : Root canal : Rotary instrument : File : Nickel-Titanium : Handpiece : Endodontic treatment : Microscope : Fiber optic illumination :
6. New technology (2)Ni-Ti file

Dr. Richard: How has your tooth been, Mrs. Watanabe? Mrs. Watanabe: It was a bit sore the first few days. After the effects of the anesthetic wore off, it was a bit tender when I chewed on it. Now its better. Dr. Richard: your tooth is quite difficult. It has three roots and the cannels inside the roots are very narrow. One was blocked and it took some time to clear the blockage. We didnt have time to finish cleaning and shaping of the root canals. Today we are going to use some special rotary instruments in the root canals.
6. New technology (2)Ni-Ti file Mrs. Watanabe: They look like miniature files. Dr. Richard: They are miniature files. They are made of Nickel-titanium, which makes them flexible. This allows them to negotiate curved root canals. We use them in a special handpiece, which rotates at a constant speed of a few hundred revolutions per minute. Mrs. Watanabe: Do you think you will finish preparing the tooth this morning?
Dr. Richard: Yes, I will. The most difficult part of endodontic treatment is probably trying to find and negotiate the root canals. We managed to do this at the last appointment so we just have to carefully enlarge the canals. Mrs. Watanabe: Are you going to use your microscope again? Dr. Richard: Dr. Sato is using it at the moment so Ill use my loupes. They are quite good. I have 3 times magnification and fiber optic illumination of the tooth.
Mrs. Watanabe: Are they the same as what surgeons use? Dr. Richard: Yes indeed.
Chapter 3 Treatment 6. New technology (3) Periodontal surgery
Periodontal surgery Calculus Put stitches in Suture (s) Heal up Local anesthetic Resorbable sutures Gingivial papilla Periodontal pack Remove the sutures Painkillers
6. New technology (3) Periodontal surgery Dr. Sato: Are you OK, Mr. Okuda ? We have almost finished. I have removed all the calculus from around the roots of the teeth and we just need to put the gum back. Mr. Okuda: Are you going to put stitches in? Dr. Sato: Yes, I need to put some sutures in to hold the gum in the correct position so it will heal up nicely. Mr. Okuda: I cant feel any pain.
6. New technology (3) Periodontal surgery Dr. Sato: Thats good. I gave you plenty of local anesthetic. The microscope helps things a lot, Miss Kato. It makes things so much easier. I can see the root surfaces much more clearly and it is easy to see any remaining calculus. I wish we had bought this microscope sooner! Miss Kato: Which suture material are you going to use? Dr. Sato: I wont use resorbable sutures. I will use silk because we need to be very precise with the positioning of the gingival papillae.
6. New technology (3) Periodontal surgery Miss Kato: Ill get the periodontal pack out as well. Dr. Sato: Yes, that will be good. Dr. Sato: Thats it. Weve finished, Mr. Okuda. Well need to see you again in a weeks time to remove the sutures and check how the gum is healing. I will also give you a list of instructions. You wont be able to brush your teeth where we were working so you will need to use a mouthwash. It might be a good idea to take some painkillers before the local anesthetic wears off. Mr. Okuda: Thank you for all your hard work.
Chapter 3 Treatment 6. New technology (4)CAD/CAM
Filling: Fall out: Cavity: Anesthetizing: Take (make) an impression: Ceramic: Optical impression:
Milling machine Glazed Tried in: Adhesive resin cement: Ceramic restoration: Re- cemented
6. New technology (4)CAD/CAM Dr. sato : Whats happened, Mr. Yamada? Mr. Yamada: A filling has come out from one of my back teeth . Dr. sato: Ill have a look . Ah yes . Quite a large filling has fallen out of your upper first molar. Mr. Yamada : Can I have a white filling this time please ? Dr. sato: You have three choices of white fillings , Mr. Yamada. First , we can use composite resin . We can either pack the resin directly into the cavity after anesthetizing and cleaning the cavity.
6. New technology (4)CAD/CAM Dr. sato: Or we can take an impression and make a resin filling in the laboratory. The third choice is filling made of ceramic . Mr. Yamada : I would like a ceramic filling please . Will it take a long time to make ? Dr. sato: Actually no . We have purchased a new machine for making ceramic fillings. It is called Cerec 4D . Its quite clever and uses CAD/CAM technology . You can watch your filling being made in the other room .
6. New technology (4)CAD/CAM Mr. Yamada: Could you tell me a bit more about Cerec 4D. I have heard about CAD-CAM of materials before but did know it was used in Dentistry. Dr. Sato: Certainly. After we have prepared the cavity, we can take an optical impression of the cavity. We design the shape of the filling using special software. A ceramic block is placed in a separate milling machine and cut to the required shape. It takes about an hour in total. When the filling has been made it is glazed and is then ready to be tried in the cavity.
6. New technology (4)CAD/CAM

Mr. Yamada: That sounds really good. Do the fillings fall out? Dr. Sato: We use a special adhesive resin cement, which cements the ceramic restoration in place. But yes, occasionally the fillings do fall out but they can be easily re-cemented.
Chapter 3 Treatment 7.Bleaching: (1)A consultation
Whitening() Bleach teeth() Sensitive() In the surgery(clinic) () At home() Gel() Tray()
7.Bleaching (1)A consultation

Miss TanakaAre you ready for the next patient, Dr. Richard. Dr. RichardIndeed I am. Miss TanakaPlease have a seat, Mrs. Ono(). Mrs. OnoYoure very kind, thank you. Dr. RichardGood afternoon, Mrs. Ono. What brings you to see us? Mrs. OnoI am not happy with my yellow teeth. My daughter is getting married next month and I would like my teeth whitening. I read in a magazine that you can bleach teeth.
Dr. RichardYes, I can bleach your teeth for you. It is not quite as simple as it seems. I have to warn you of a few things first. The first problem is that in some patients it is difficult to lighten the teeth. Also your teeth can become sensitive while we are bleaching the teeth. The other thing is that bleaching is not permanent. The teeth tend to darken again over time and you will need to have them bleached again.
Mrs. OnoI dont mind having them bleached again. I heard that there are two ways you can bleach teeth. One way is in the clinic and the other is at home. Is that true? Dr. RichardYes. When the teeth are bleached in the clinic a gel is put on the teeth and a powerful light shone on the teeth. If the teeth are bleached at home you have to wear a bleaching tray to keep the gel against the teeth.
Mrs. OnoWhich method do you prefer? Dr. RichardI prefer to make you a bleaching tray. Then you can control how white you want your teeth. What Ill do is give you these leaflets, which explain how bleaching works and Miss Suzuki, our receptionist will tell you how much it will cost. Mrs. OnoThank you for your time.
Chapter 3 Treatment 7.Bleaching (2) Home bleaching
Bleaching trays () Bleaching gel () Fome bleaching () Shade () Alginate impressions ()
7.Bleaching (2) Home bleaching

Miss Tanaka: Shall I call Mrs. Ono() in? Dr. Richard: Yes please. Miss Tanaka: Please have a seat, Mrs. Ono. Ill take your coat. Mrs. Ono: Thank you. Dr. Richard: So you have decided you would like me to bleach your teeth. Mrs. Ono: Yes, I have been reading the magazines, which your practice manager gave me and I definitely would like you to try to lighten them if you can.

Dr. Richard: The way I prefer to bleach teeth is to make the bleaching trays first then give you the trays at your next appointment along with the bleaching gel. You can then continue using the gel until you feel your teeth have become lighter. Mrs. Ono: I read that you can bleach teeth in the clinic. Wouldnt it be better if you did it? Dr. Richard: I prefer home bleaching. You have more control over any color changes. Is this OK for you.

Mrs. Ono: If you think its better, Ill follow your advice. Dr. Richard: What I will do today is to photograph your
teeth so we have a record of the shade of your teeth before we start any treatment. Then I will take some
alginate impressions of your upper and lower teeth so our technician Kaz can make the bleaching trays. Mrs. Ono: Do you know when the trays will be ready? Dr. Richard: Yes, theyll be ready in three days time. Today is Monday so they will be ready for Thursday. When you come back on Thursday, I will give you a couple of boxes of the bleaching gel. Mrs. Ono: Thats great, thank you. My son, Hitohiro ( ), has an appointment with Dr. Sato mow.
Chapter 3 Treatment 7.Bleaching (3)Bleaching tray and gel
Fit() Side-effects() Sensitivity() Carbamide peroxide()
7.Bleaching (3)Bleaching tray and gel

Dr. Richard: Have Mrs. Ono bleaching trays come back? Miss Tanaka: Yes, Kaz brought them this morning. Shall I call Mrs. Ono in? Dr. Richard: Yes please. Mrs. Ono: Thanks for seeing me again so soon. Dr. Richard: No problem. These are the trays. I will check if they fit comfortably or not and I will show you where to put the gel
7.Bleaching (3)Bleaching tray and gel

Mrs. Ono: How often shall I use them? Dr. Richard: As much as possible. Certainly at nighttime. I will see you again in a weeks time. Mrs. Ono: Are there any side-effects? Dr. Richard: Yes, it is possible you may get some sensitivity. This is temporary. Mrs. Ono: What is the gel made of? Dr. Richard: It is carbamide peroxide. If you dont see much of an effect in a week you will need to continue using the trays for longer.
Chapter 3 Treatment 8. An orthodontic consultation: (1)Draculas teeth( )
Canines() Buccally() Orthodontist() Specialist() Erupt() first premolars() Extract() Arch()
Bracket() Bond to() Wire() Elastics() Living tissues() Biology of tooth movement( ) Study model()
8. An orthodontic consultation:Draculas teeth

Miss KatoYou can come straight through, Mrs. Ono. We are ready for Hitohiro(). Dr. SatoI hear youre not happy with your front teeth, Hitohiro. Hitohiro OnoNo, they are horrible. I look like Dracula! Dr. SatoHow old are you, Hitohiro? Hitohiro Ono12. Dr. SatoWell, you are at the right age to have them straightened. Let me have a look. . .I see you keep them nice and clean. Hitohiro OnoMy mum makes me brush them three times a day.

Dr. SatoThats good. I see your upper canines dont have much space. They are coming through buccally. Dont worry Hitohiro. The situation looks worse than it is. Hitohiro OnoCan you fix them? Dr. SatoI cant but I will refer you to an orthodontist. Hitohiro OnoWhats an orthodontist? Dr. SatoAn orthodontist is a dentist who is a specialist in straightening teeth. Mrs. Ono, I tell you what is likely to happen. There is not enough space for Hitohiros upper canines. As a result, they are erupting buccally. To treat this problem, Hitohiro will have to have a couple of teeth taken out to make some space.
8. An orthodontic consultation:Draculas teeth Mrs. OnoDo you know which teeth? Dr. SatoUsually both upper first premolars are extracted because they are in the middle of the arch but it will depend on the orthodontist. Mrs. OnoHow does the orthodontist straighten the teeth?

Dr. SatoBrackets are bonded to the teeth and then a wire is attached to the brackets using elastics. This enables a controlled force to be applied to the teeth, which moves them through the bone. Mrs. OnoSorry did you say the teeth are moved through the bone? The bone is solid, how can that happen? Dr. SatoBone is a living tissue, which contains many cells. When a controlled force is applied to the tooth, bone is removed from around the tooth allowing the tooth to move to a new position. These movements are done very carefully. Once the tooth is in a new position, new bone is laid down.
Mrs. OnoIt sounds very complicated. Dr. SatoYes, the biology of tooth movement is very complex. I will need to send the orthodontist some study models and radiographs of Hitohiros teeth. You are coming back on Thursday to collect your bleaching trays arent you? Mrs. OnoYes, 4pm on Thursday. Dr. SatoWell, to save you two visits, I will see Hitohiro after Dr. Richard sees you and then I take the impressions and radiographs. Mrs. OnoThats very kind of you.
Chapter 3 Treatment 8. An orthodontic consultation: (2)Cephalometrics( )
Dental Pantomogram() Dephalometric lateral skull radiograph( ) Erupt () Mandible () Maxilla (). Decay () Alginate impressions () Models ()
8. An orthodontic consultation: (2)Cephalometrics Dr. Sato: Mrs. Ono, today we are going to take some radiographs of Hitohiros teeth. We are going to take two. One is called a Dental Pantomogram known as a DPT and another called a true cephalometric lateral skull radiograph. Hitohiro, would you like to follow me to the room in which we take the radiographs Hitohiro Ono: Are those the machines()? Dr. Sato: Yes. We will use one machine but we will take different views. Well take the DPT first. If you can move into machine and just gently bite on this bit of plastic. The top of this machine is going to move around your head. You just need to keep still for about 20 seconds. Well be watching you outside.
8. An orthodontic consultation: (2)Cephalometrics

Hitohiro Ono: Ok. Dr. Sato: Thats great. Now we just need to take the lateral skull Hitohiro Ono: Can I see the pictures when you have finished? Dr. Sato: Certainly, we can discuss them together. It will be about 15 minutes. So if you have a seat in the waiting room in the meantime. Miss Kato: Hitohiro, your radiographs have been developed. Would you and your Mum like to follow me? Dr. Sato: So these are the radiographs, which we have taken. Hitohiro Ono: What can you see?
Dr. Sato: These radiographs show us which teeth are present and the location of teeth, which are about to erupt. We can also see the relationship of the mandible to the maxilla. The good news is that I cant see any decay in your teeth. Before you go I just need to take some alginate impressions of your upper and lower teeth. I will then send the models and radiographs to the orthodontist, who will send you an appointment in a few days.
Miss Kato: Which size of trays would you like? Dr. Sato: Medium for both upper and lower will be fine. Miss Kato: Shall I start mixing? Dr. Sato: Yes please. Hitohiro Ono: Does it taste of anything? Dr. Sato: Peppermint. Ok, Im going to take the lower impression first so try to relax and breathe through your nose
Chapter 3 Treatment 9. Chrome denture() (1)Broken acrylic denture( )

teeth () Partial acrylic denture Missing Cobalt-chromium Bar Framework
False

Replace Implant Hygienist Scale Primary impression
Clasp
9. Chrome denture: (1)Broken acrylic denture : (1)

Miss Tanaka : Are you ready for your first patient? Dr. Richard : Just about. Its Mr. Inoue() and hes broken his denture. Miss Tanaka : Thats right. Apparently you are the third dentist he will have seen this year! Dr. Richard : That doesnt sound good. We had better see why he has come to see me Dr. Richard : Mr. Inoue, good morning. Come in and make yourself comfortable How can I help you? Mr. Inoue : Its my lower false teeth. They keep breaking all the time. My friend recommended you. Here is my lower denture.

Dr. Richard : I think I can help you. You have a lower partial acrylic denture, which replaces your missing right and left lower premolars and first molars. There is a thin piece of plastic, which runs behind your lower anterior teeth. What I suggest we do is to make you a lower partial cobalt-chromium denture. Instead of the bulky plastic behind your lower anterior teeth there will be a thin bar of mental. Because the framework of the denture is mental, it will be much stronger and less likely to break. Mr. Inoue : Will the mental be visible?

Dr. Richard : We usually place a couple of clasp on the canines, one on each canine. These will stop the denture lifting up when your eating. These can be made in gold if you wish. The other option is to see if we can replace the missing teeth with implants but these are much more expensive. Mr. Inoue : A new lower denture in mental sounds fine. My lower teeth are not so visible when I speak so the mental clasps will not be a problem. When can you begin making them? Dr. Richard : First I need to carefully examine all your teeth and gums and maybe take some radiographs
9. Chrome denture: (1)Broken acrylic denture : (1) Dr. Richard : Your fillings dont need replacing but I can see that you have some calculus present so I will book you in with our hygienist to have your teeth scaled and polished. I will give you an appointment so we can make the primary impressions after you have seen the hygienist. I will also give you a treatment plan so you can see how much the treatment will cost. Mr. Inoue : That sounds fine. Thank you. Ill see you next time.
Chapter 3 Treatment 9. Chrome denture(): (2)Impressions for denture design ()

chrome denture primary impression Plaster design survey the model Undercut metal framework component clasp rest seat tray
lower
9. Chrome denture: (2)Impressions for denture design :

Miss Tanaka : The weathers terrible today. Its causing all sorts of problems with the transport. Dr. Richard : Yes, my train was late this morning. Hopefully the rain will ease this afternoon. I guess some of patients may also be a little late. Who is our first patient? Miss Tanaka : Its Mr. Inoue. Hes just arrived. The clinic is set up now so Ill call him in if you want. Dr. Richard : Yes, were making him a new lower chrome denture. Today well be making the primary impressions using alginate.

Mr. Inoue : I almost couldnt make it today because of the weather. Dr. Richard : Awful, isnt it? Are you ready to have me make some impressions of your month? These will be the primary impressions. We take some more next time. Mr. Inoue : My last Dentist only took one lot of impressions? I didnt have to come back twice! Dr. Richard : Making a well made, comfortable, good fitting lower chrome denture takes time. We will cast the primary impressions in plaster and then use the models to design the lower denture.

Mr. Inoue : I didnt know you have to design a denture. Dr. Richard : Yes, we first survey the model to find out which teeth have undercuts and then we design the metal framework. The framework has various components such as the clasps, which go around the teeth and rest seats. There will be small areas where the metal will rest on the teeth. Where this occurs we adjust the occlusal surface of the tooth slightly so the metal will not interfere when you bite together. I then send the design to my technician.
Dr. Richard : Miss Tanaka, ready when you are for the alginate impressions. Ill do the upper one first. Dr. Richard : Mr. Inoue, were going to make the upper impression first. So I will ask you to lean forwards slightly and when I put the tray in your mouth, to concentrate on breathing through your nose. Ok. Here goes
Chapter 3 Treatment 9. Chrome denture(): (3)Discussing denture design with the technician( )

special
tray(custom or individual tray)
buccal surface periodontal condition abutment teeth handle stub handle
9. Chrome denture: (3)Discussing denture design with the technician :
Miss Suzuki : Miss Kato, could you let Dr. Richard know the technician Kaz is on phone? Miss Kato : Ill ask him to take the call in his clinic Dr. Richard : Good afternoon Kaz, what can I do for you? Kaz: Im calling you to talk about the design for Mr. Inoues lower cobalt-chrome denture and the special tray. I have surveyed the model and the lower second molars dont have very much undercut. What do you think we should do?

Dr. Richard : I would like to clasp the lower second molars so Ill add some composite to the buccal surfaces to create some undercut. Their periodontal condition is good so they are useful abutment teeth. Kaz: Also, how about the handles on the lower acrylic special tray? Would you like a single handle over the lower incisors or two stub handles in the premolar region? Dr. Richard : Two stub handles will be better, Mr. Inoue has a very active tongue, which will tend to dislodge the tray so I need good control of the tray in the posterior region.
Kaz : I think thats it. The design looks straightforward and we are not replacing any anterior teeth. Does Mr. Inoue know the clasps on the canines may be visible? Dr. Richard : Yes, I have warned him and he is not worried about the clasps, Thanks for calling Kaz : Its always better to discuss things if there is any doubt about something.
Chapter 3 Treatment 9. Chrome denture(): (4) Final impression for lower chrome denture( )

the final impression special tray prepare rest seats cobalt-chromium framework gum tooth-supported design () cavities occlusal surface sensitivity silicone metal framework laboratory ()
make
9. Chrome denture: (4) Final impression for lower chrome denture:
Dr. Richard : How are you today Mr. Inoue? Mr. Inoue : Im fine thank you. May I ask what you plan to do today? Dr. Richard : We are going to make the final impression for your lower chrome denture. This is the special tray Kaz has made for us. Before I make the impression, I need to prepare some rest seats in a couple of your teeth. Mr. Inoue : Sorry did you say rest seats. What are they?
9. Chrome denture: (4) Final impression for lower chrome denture :
Dr. Richard : Ill try to explain what rest seats are. The denture we are making for you has a cobalt-chromium framework. This means the denture will be stronger and less bulky. It also rests on your teeth and not the gums. We call this a tooth-supported denture. The advantage of a tooth-supported denture is that it will cause less damage to your gums. The design we have made for your new denture has three rest seats. I will cut some small cavities on the occlusal surface of three of your lower teeth.
Mr. Inoue : Will you be cutting a lot of the tooth away? Dr. Richard : No, very little. The rest seats are quite thin so I just have to remove only a thin layer of enamel. You wont have any sensitivity. After I have prepared the rest seats, Ill make the final impression in silicone. Mr. Inoue : What is the next stage after the impressions? Dr. Richard : Next time you come Ill hopefully have the metal framework back from the laboratory. I am just going to adjust the tray a little before I put the silicone in your mouth. Miss Tanaka : Can I mix the silicone?
Dr. Richard : Yes please. If you can sit forward a little Mr. Inoue that will be great. The tray will be in your mouth. The tray will be in your mouth for about five to six minutes so if you can concentrate on breathing through your nose that will be good Ok. Here we go( )
Chapter 3 Treatment 9. Chrome denture(): (5) Chrome denture try-in( )
Lower incisors: Acrylic denture: Arm: Try in: Occlusion: Process( ) Shade guide:
9. Chrome denture: (5) Chrome denture try-in

Dr. Richard: This is the metal framework we have made for you, Mr. Inoue. Mr. Inoue: It looks very different from my denture. Will it fit? Dr. Richard: Yes, its thinner behind the lower incisors so it should feel less bulky. It shouldnt break like your acrylic denture. Mr. Inoue: Are those little metal arms, the clasps? Dr. Richard: Yes, Im just going to adjust them slightly before I try the framework in. Dr. Richard: Thats good. It goes in fine. Now we have to return it to the laboratory to put the teeth on. How does it feel?
Mr. Inoue: Quite good actually. Its not hurting me and it feels better near my tongue. Dr. Richard: Im pleased with this framework. Kaz has done a good job. So well make you another appointment. Mr. Inoue: Im not trying to rush you but do you know how many more visits will be needed? Dr. Richard: Hopefully just two more. The metal work fits. Next time, the teeth will be in wax. If you are happy with them and their occlusion is good they will be processes in acrylic. We just need to choose a shade

Could I have a shade guide please, Miss Tanaka? Are you happy with the color of the teeth on your existing denture? Mr. Inoue: Yes, but if possible, Id like some lighter looking teeth. Dr. Richard: C2 seems a good match. Ill let you have a look. Next time well check how they bite together and let you check the color. Could you bring someone with you? Its sometimes a good idea for a friend or family member to check the appearance as well. Mr. Inoue: Yes, Ill bring my wife. Thanks' Dr. Richard, Ill see you again.
Chapter 3 Treatment 9. Chrome denture: (6) Wax chrome try-in
Trial denture Bracket table( ) Alignment Lirregular
9. Chrome denture: (6) Wax chrome try-in Dr. Richard: Good morning, Mr. Inoue( ). Mr. Inoue: Good morning, Dr. Richard. Ive brought my wife as you suggested. Dr. Richard: Good morning, Mrs. Inoue. Very nice to meet you. Miss Tanaka: Ill put the trial denture on the bracket table. Dr. Richard: Ok. Lets see how it looks What do you think Mr. Inoue? Mr. Inoue: You can hardly to see the claps. Dr. Richard: Yes, theyre hidden by your lower lip. What do you think about the color of the teeth?
9. Chrome denture: (6) Wax chrome try-in Mr. Inoue: I like them. Dr. Richard: How about the color of the teeth, Mrs. Inoue? Mrs. Inoue: The colors better than the current ones and I like their appearance. They look quite natural. Dr. Richard: Im pleased you like them. I asked Kaz to make the alignment of the teeth slightly irregular. Do you want me to change anything? While theyre in wax we can make some alterations but once they are converted to acrylic it is much more difficult. Mr. Inoue: No, my wife and I are happy with them.
Chapter 3 Treatment 9. Chrome denture: (7) chrome fit
Treatment Rub Ulcer , Wear Put in
9. Chrome denture: (7) chrome fit Dr. Richard: Is Mr. Inoue here, Miss Tanaka? Miss Tanaka: Sorry, I forgot to tell you. He called to say that hell be a few minutes late. Dr. Richard: No problem. I can finish entering our previous patients treatment into the computer. Miss Tanaka: Hes here now. Ill bring him in. Mr. Inoue: So sorry Im late. There was an accident on one of the train lines and the trains are running a bit late. Dr. Richard: No, thats fine. It gave me a chance to catch up with the paperwork. I have your new denture here so Ill put it in and see how it is..
9. Chrome denture: (7) chrome fit

Dr. Richard: Does it hurt anywhere? Mr. Inoue: No. Not at the moment. Dr. Richard: You seem to be contacting both sides at the same time. Mr. Inoue: Yes, they feel very good. Dr. Richard: I have a few instructions for you. You probably know these already but please eat slowly at first and try to cut your food up. Eating may feel a bit strange at first but thats normal. If they start rubbing please take them out otherwise youll develop an ulcer. Please be careful with the clasps. Please dont adjust them yourself. They can correct anything. If you find you cant wear them, please put your old denture in.
Chapter 3 Treatment 10. Implant overdenture: (1) A problem denture
Waiting room: Emergency patient: Dental implant: Extensive exam: Place: CT scan: Complete lower denture: Computerized tomography: (CT) Surgeon: ( )
10. Implant overdenture: (1) A problem denture Dr. Sato: We seem to be doing well today, Miss Kato. Is there anyone in the waiting room. Miss Kato: Yes there is. Mr. Obata( ) is waiting to see you. He is an emergency patient. His lower denture has broken. Dr. Sato: Sorry I forgot that we had an emergency patient. Please could you bring Mr. Obata in. Miss Kato: Good afternoon, Mr. Obata. Please follow me. Dr. Sato: My receptionist tells me you are not happy with your lower denture, Mr. Obata.
10. Implant overdenture: (1) A problem denture Mr. Obata: Yes, thats right. Ever since I had my first lower denture ten years ago I have not been happy. They are always loose and move around. Last week I read about Dental Implants in a magazine. I have come to ask if I could have a new denture fitted on implants. Dr. Sato: I do have a couple of patients who have had implants placed and then I made the new dentures on top. We will need to carry out an extensive exam before any implants can be placed. Mr. Obata: Thats fine.
10. Implant overdenture: (1) A problem denture

Dr. Sato: I will let you know what happens in our practice. As part of the extensive exam we need to arrange for you to have a special radiograph of your mandible. The radiograph is a CT scan of your mandible. We can then examine the bone in detail and plan where the implants will be placed. For a complete lower denture we usually place four implants in the central region. Two will remain buried for future use and two will be use to support the denture.
Mr. Obata: Excuse me whats a CT scan? Also, do you place the implants yourself?
10. Implant overdenture: (1) A problem denture

Dr. Sato: CT stands for computerized tomography. I have an experienced surgeon who I refer my patients to for placement of the implants. It is important that the implant is placed as carefully as possible otherwise it will not integrate with the bone and may become loose. I will carry out the oral examination today and then arrange for you to have a CT scan. Then I will give you another appointment to discuss the results and what stages are involved. In the meantime please take these leaflets home to read. They will give you an idea of what treatment to expect. Mr. Obata: Very good. Thank you.
Chapter 3 Treatment 10. Implant overdenture: (2) Implant planning
10. Implant overdenture: (2) Implant planning

Miss Kato: Shall I call Mr. Obata in? Dr.Sato: Yes please. Miss Kato: How are you today, Mr.Obata? Mr.Obata: My shoulder is a bit sore. I think I hurt it while I was practicing my driving at the Golf centre last night. Dr. Sato: Do you have a chance to play a game of golf? Mr.Obata: Sadly not very often. I am a member of a golf club but usually I am busy at weekends so it is difficult to the driving range.

Dr.Sato: Well, I have received a report on your CT scan and it seems you have enough bone fore four implants. To help the surgeon place the implants in the correct position in the mandible we need to go through the stages to make a wax trial denture. With the denture teeth in their correct position, we can then see where the implants should be placed. I will show you some pictures of what I mean. We can then duplicate the denture to make an acrylic stent. Mr. Obata: Ah yes, I see what you mean. How does the acrylic stent work?

Dr.Sato: Once we have made the acrylic stent, which is similar in shape to how the final denture will be, we can drill holes in the stent. The surgeon will use these holes as guides for placing the implants. If the surgeon does not use a guide when drilling holes in the mandible then the implants may not be in the correct position. This may cause some major complications. Once the implants have been placed it is necessary to wait a few months. Mr. Obata: Oh, so I won't have the denture fitted on the implants straightaway?

Dr. Sato: I prefer to wait four to six months. The implants are made of titanium and if the implants is going to be there a long time, bone must grow up against the surface of the implant. If this occurs then it is said that osseointegration has occurred. The published long-tern studies show that it is better to wait few months. If the implant is loaded straight away, then there is a greater risk that osseo-integration will not happen and then the implant will fail. Mr. Obata: Yes, I see what you mean. What happens after we have waited for a few months?

Dr. Sato : The surgeon will uncover the implants and then place what are called healing caps to give the surrounding soft tissues the correct shape. Then we take some impressions to make either a bar or magnetic attachments for the denture. The finished denture will either clip on the bar or rest on the magnets. Mr. Obata: It sound very complicated.
10. Implant overdenture: (2) Implant planning Dr. Sato: There are many steps, which are needed in order to get a successful outcome. Thats why implant treatment is expensive. We'll book a series of appointments for you to make the acrylic stent as soon as possible. Mr. Obata: Thanks very much.
Wax trial denture: Duplicate: Acrylic stent: Titanium: Osseo-integration: Load: Uncover: Healing cap: Surrounding soft tissue: Bar: Magnetic attachment: Clip on:
Chapter 3 Treatment 10. Implant overdenture: (3) Implant-supported lower overdenture
10. Implant overdenture: (3) Implant-supported lower overdenture

Miss Kato: Shall I call our next patient in? Dr. Sato: Yes please. Ah yes, its Mr. Obata. He had four lower implants placed six months ago and he's back for us to make him a complete lower overdenture. Mr. Obata: Good morning Dr. Sato. nice to see you again. Dr. Sato: I heard the surgery went well. How have you been? Mr. Obata: Very well thank you. I saw the surgeon last month and he is happy with the implants and for you to begin making the new overdenture. Am I right in thinking that you are going to make a bar for the denture to clip onto?
10. Implant overdenture: (3) Implant-supported lower overdenture Dr. Sato: Yes. You have had four implants placed in the lower incisor region. The surgeon has placed healing caps on two of them and left the other two covered up by gum. These are socalled "sleepers" . They will be used only if the uncovered implants fail. Mr. Obata: How is the bar going to be made?

Dr. Sato: It will be made by Kaz, our technician. I am going to remove the healing caps and take an impression of the two implants. In order to get an accurate impression of the implants we use pick-up impression copings. These are screwed into the implant while we make the impression. After the impression has set, I will unscrew the retaining screws that hold the impression copings in place. Then I will remove the impression. Kaz will attach implant laboratory replicas to the impression copings before pouring the impression in stone.

Mr. Obata: I think I have an idea of how you are going to make the impression. I was wondering how is the bar going to be attached to the implants? Dr. Sato: Next time you come, we will screw abutments into the implants and then the bar will be screwed onto these. I will adjust your lower denture so that it fits over the bar The new denture will have some clips, which will clip onto the bar. Mr. Obata: That sounds really good. Its a very complicated isnt.
Lower incisor region Healing cap Sleeper Technician, dental technician Take an impression Pick-up impression copings Screw Set Impression coping Implant laboratory replica Pouring the impression in stone Abutment
Chapter3 Treatment
10. Implant overdenture : (4) Overdenture try-in----
10. Implant overdenture : (4) Overdenture try-in

Dr. Sato: Is Mr.Obata here, Miss Kato? Miss Kato: Yes, but he hasnt been waiting long. Shall I get him? Dr. Sato: Yes please. Mr. Obata: Good afternoon Dr. Sato. How are you? Dr. Sato: Im fine thank you. Mr. Obata: Can you tell me what you have planned for today?

Dr. Sato: Ill show you. This is the wax trial denture, which Kaz has made. Its different from the denture you had before. You can see there is a bar on the model, which connects the two abutment. If you look on the fitting side of the wax denture you can see there is a gold clip. This will clip onto the bar. Mr. Obata: It looks as if it will stay in better than the one I have at the moment.

Dr. Sato: Yes, definitely. Your new denture has a bar to clip onto. Today, I will cement the bar in place then try the wax denture in. After the bar has been cemented in place, I need to adjust your existing denture. So, Ill cut out a groove in your acrylic denture where the bar is and then reline it with soft acrylic. I will have your new denture back in two days How does the wax denture feel? I have cemented the bar in place and I need to check how the wax denture bites together. How does the bite feel? Do you bite together evenly or is one side contacting first?

Mr. Obata: No, they feel great. The back teeth on both sides contact at the same time. Im looking forward to getting the new one. They look great too!
wax trial denture: model: fitting side: fitting surface clip: cement: () adjust: groove: reline: soft acrylic:
Chapter3 Treatment 10. Implant overdenture : (5) Overdenture fit
10. Implant overdenture : (5) Overdenture fit

Miss Kato: Shall I call Mr. Obata in? Dr. Sato: Is his denture back? Miss Kato: Yes, its in the disinfectant solution. Dr. Sato: Good. I was worried Kaz wouldnt be able to get it back in time. Dr. Sato: Good new, Mr. Obata, we have your new denture! Mr. Obata: Excellent. Dr. Sato: First, Ill make sure it doesnt hurt you anywhere and that you bite together evenly. Its very important we get your occlusion correct otherwise we might overload the implants.

Dr. Sato: Good it fit well. How about the occlusion? Are you biting together evenly. Mr. Obata: Almost. I seem to be catching one of the back teeth first tough. Dr. Sato: Ok. If you can just bite on this piece of articulating paper Ah yes. There is a slightly heavy contact on the lower first molar. Mr. Obata: May I ask how you know that. Dr. Sato: Can you see the blue marks? So this tells us that you have a premature contact. You are hitting this tooth slightly before the others.

Mr. Obata: Does that mean you have to adjust the teeth? Dr. Sato: Yes, I shall just grind the tooth a little Dr. Sato: Hows that now? Mr. Obata: Much better. Now Im contacting both sides at the same time and the denture doesnt rub anywhere. Dr. Sato: Ok. I wont do any more adjustments. Ill let you try the denture for a few days then Ill see you again.
disinfectant solution: occlusion: overload: articulating paper: heavy contact: premature contact: grind: rub:
Chapter3 Treatment 10. Implant overdenture : (6)review
10. Implant overdenture : (6)review

Dr. SatoHows the denture been Mr. Obata? Mr. ObataIts much more secure than my old one. I can eat many more foods than I could before. Im really pleased with it. Theres just one area where its starting to rub a little. Dr. SatoIll brush this white paste onto the fitting surface and see if I can detect the area that is rubbing. Mr. ObataWhats that paste called? Dr. SatoIts called Pressure Indicating Paste. Its quite useful. Dr. SatoHows that now?
10. Implant overdenture : (6)review

Mr. ObataAh yes. Much better. Dr. SatoI must stress to you that its very important to keep the area around the implants very clean. Please also keep the denture clean. If plaque builds up around the implant, an infection may develop, which could affect the implant. Peri-implantitis is a condition in which the mucosa around the implant becomes inflamed. If this develops the implant may become loose. Mr. ObataIll take great care. Thank you so much for all your help.
fitting surface: Pressure Indicating Paste : PIP Plaque : inflection: peri-implantitis: mucosa: inflamed:
Chapter3 Treatment 11. A Sore Mouth
sore mouth: cancer: lump: hard palate: ulcer: apthous ulcer : apthous medication: prescibe: Benzydamine oral spray( numb: general health:
11. A Sore Mouth

Miss TanakaYour next patient, Mrs. Dejima( ), is here. Shall I call her in? Dr. RichardYes please. Do you know what she wants? Miss TanakaApparently she has a sore mouth. Would you come this way Mrs. Dejima. Dr. RichardPlease have a seat Mrs. Dejima. How can I help you? Mrs. DejimaThe roof of my mouth has been quite sore for several days. I am a bit worried that it may be cancer.
11. A Sore Mouth

Dr. RichardWhen did your mouth begin to feel sore, Mrs. Dejima? Mrs. DejimaAbout three days ago. I can also feel a slight lump. Dr. RichardIll have a look. Ah yes. In the middle of your hard palate there is a reddish area. Mrs. DejimaIs it serious? Dr. RichardNo. You have a large mouth ulcer. Also known as an apthous ulcer. Mrs. DejimaWill it go away?
11. A Sore Mouth

Dr. RichardYes, it will get better in a few days. You have a large ulcer. The tongue is very sensitive so the ulcer feels larger than it actually is. It is probably at its worse now. Mrs. DejimaIs there any medication you can give me to stop it hurting when I eat? Dr. RichardYes, I can prescribe you a spray. It called Benzydamine oral spray. It will make your mouth feel numb. You should spray the ulcer a few minutes before you eat. Unfortunately the spray may affect the taste of the food. . .Would you mind me asking you a few questions about your general health, Mrs. Dejima?
11. A Sore Mouth

Mrs. DejimaNo, not at all. Dr. RichardDo you find your life stressful at the moment? Mrs. Dejima : No more than usual. Dr. Richard : How about your die? Are you eating a well diet? Mrs. DejimaI think so. Can my diet be connected to my mouth ulcer? Dr. RichardIt can be. Nobody knows what exactly causes mouth ulcers. But certainly people who are stressed and not eating well may develop mouth ulcers. . .What I will also do is give you an appointment for two weeks time to see if the ulcer has healed up. In the meantime please make sure you eat plenty of fruit and vegetables. Mrs. DejimaI will, thank you.
Chapter 4 Dental hygienist 1.Scaling, brushing (1)Bad brush
appointment: deposits:
supra and subgingival: pocket charting:
halitosis: gum: bleeding: bad breath:
Calculus inflamed: heal: ultrasonic scaler: hand scalers: periodontal probe: pocket depths: dental floss: interproximal brush: fluoride toothpaste:
swelling: plaque: scale: Caries acid: dissolve: enamel:( ) remineralize: check-up: appointment: cleaning and polishing:
Mouthwash, mouthrinse Disinfectant Inflamed gum Fluoride Electric toothbrush Bristles( ) Sensitive toothpastes Potassium nitrate Dentinal tubules( )
1.Scaling, brushing (1)Bad brush

Miss Suzuki: Miss Yoshita( ), Mr. Ishida( ) has arrived. Shall I send him down? Miss Yoshida :Yes please ..How are you Mr. Ishita.? Mr. Ishida: Fine thanks. Dr. Sato( ) said there was some calculus on my teeth and booked an appointment for me with you. Miss Yoshida :Yes his clinical notes say that you have several deposits of both supra and subgingival calculus. Also, a couple of your teeth are getting loose so he would like me to carry out pocket charting of all your teeth.

Mr.Ishida: Im a little embarrassed to say this but my wife says I have halitosis. Also my gums have been bleeding. Can you do something about that? Miss Yoshida :Yes, once I have cleaned all your teeth your breath will smell better. Also your gums will stop bleeding. The reason for the bad breath and bleeding is your gums have become inflamed. Once all the calculus has been removed the gums can heal. Mr. Ishida: What is supra and subgingival calculus?

Miss Yoshida : Supragingival calculus is calculus that is found above the gum and subgingival calculus is found below the gum. Mr.Ishida: How are you going to clean the teeth? Miss Yoshida: I will use an ultrasonic scaler and hand scalers. We have a special probe called a periodontal probe to measure the pocket depths around the teeth. Mr.Ishida: Can you give some advice on how to clean my teeth properly?

Miss Yoshida: as well as using a toothbrush, it is important that you clean in between your teeth using dental floss and an interproximal brush. You can buy an interproximal brush at the reception desk if you wish. It is also important to have your teeth checked-up and scaled every 2 to 3 months. Mr.Ishida: I will try harder to keepe them clean. I dont want to lose any more teeth.
Chapter 4 Dental Hygienist 1.Scaling, brushing (2)After scaling and brushing
1.Scaling, brushing (2)After scaling and brushing

Miss Yoshida: Your gums look better, Mr. Ishida. Mr. Ishida: Yes, following your advice I am now brushing my teeth three times a day using fluoride toothpaste. Miss Yoshida: Your gums are much pinker now. The redness and swelling has reduced. By brushing tree times a day you are preventing the build-up of plaque. Are you also using the interproximal brush and dental floss, which you bought last time.

Mr.Ishida: Yes I am. I have also noticed that since you scaled my teeth, the bleeding has stopped. And most importantly, my wife says my breath smells better! Miss Yoshida: Thats very important. Flossing your teeth regularly, removes plaque and food debris from between the teeth and beneath the gum line. It is also important to eat a balanced diet. Try not to eat too many sweet things and eat plenty of fresh vegetables. Do you smoke? Mr.Ishida: No I stopped a few months ago. The problem is that I have started eating more sweets.

Miss Yoshida :You have to be careful with your sweet intake. If you have too many sweets, you will develop caries in your teeth. The best time to eat sweets is at meal times. When you eat something sweet, the sugars are broken down to acids, which dissolve the enamel surface. It take 3-4 hours for the enamel surface to remineralize. Mr. Ishida: Thanks for that advice. When should I see you next? Miss Yoshida: Please book a check- up appointment with Dr. Sato in about two months time and then he will make a treatment plan, which may include an appointment for cleaning a nd polishing. Mr. Ishida: Ill do that.
Chapter 4 Dental Hygienist 2. How to use dental floss
2. -How to use dental floss

Miss Yoshida: Please have a seat, Mr. Obata(
).
Mr. Obata: Thank you. Miss Yoshida: Dr. Sato has asked me to show you
how to use dental floss. Do you floss your teeth, Mr. Obata? Mr. Obata: Sometimes but I usually forget. It makes my gums sore. I prefer to use woodsticks.

Miss Yoshida : Ill show you an easy way. First
take about 30cm and wrap it around one finger of each hand. Then carefully slide it down between the teeth. Dont saw it from side to side otherwise you will wear away your teeth. After sliding it down between the teeth, gently pull it out. Have a go( ), Mr. Obata. Theres a mirror over here.
Mr. Obata: This way seems much better. How

often should I floss?
Miss Yoshida: At least once a day, please. Mr. Obata: Yes Ill do that, thank you.
Chapter 4 Dental Hygienist 3. How to choose mouthwash
3. -How to choose mouthwash

Miss Yoshida: Do you have any questions, Miss
Jones?
Miss Jones: I would like to know which

mouthwash you recommend? There are several for sale in my local supermarket where I live but because my Japanese is not very good I get confused. Miss Yoshida: We sell mouthwashes here. Ill show you which one to buy.

Miss Jones: That will be great. Miss Yoshida: There are basically two
types. One group are disinfectants. They are helpful if you have inflamed gums. The other group contain fluoride. Miss Jones: whats the difference?

Miss Yoshida: If you use a disinfectant type,
your gums will be healthy but you will find your teeth will get stained after a while. I prefer to use a mouthwash that contains fluoride. Fluoride makes the surface of the teeth stronger. Fluoride is incorporated into the mineral structure of enamel. You rinse your mouth with the mouthwash for one minute then spit out.

Miss Jones: Do you sell fluoride mouthwashes
at reception? Miss Yoshida: Yes, we do. They cost around 600 yen. We have a special offer at the moment. If you buy two you get one free.
Chapter 4 Dental Hygienist 4. How to choose toothbrush
4. -How to choose toothbrush
Mrs. Kasahara(
): Im
thinking of buying an electric toothbrush, Miss Yoshida. What do you think? Are they better then manual toothbrushes?

Miss Yoshida: Thats a difficult question to
answer. Certainly an electric toothbrush would be better if you had difficulty moving your hand. If you had difficulty moving your hand it may be hard to use a manual toothbrush effectively. The aim is to make sure the bristles clean all the surfaces of the teeth. If you use dental floss once a day and brush all the surfaces of the teeth then that will be good. Mrs. Kasahara: What about the size of the toothbrush head and the bristles?

Miss Yoshida: Dont buy a brush with a
big head. Buy one that has a medium sized head and medium to soft bristles. If the bristles are too hard you may abrade the surfaces of the teeth.
Mrs. Kasahara: Do sensitive toothpastes

work, Miss Yoshida?

Miss Yoshida: They do actually. They contain
chemical substances such as potassium nitrate. These chemicals can block exposed dentinal tubules and stop sensitivity. Mrs. Kasahara: Thank you so mush for your advice.
Chapter5 Equipment woes 1.Autoclave trouble

autoclave : sterilization : attend meeting : dental unit : waterline : handpiece : cancel the appointment : rebook :
1. -Autoclave trouble
Miss Tanaka : Today is not starting well. The
autoclave in Dr. Richards surgery is not working properly. I think we will need to call someone to come and look at it. Miss Suzuki : What happening with it? Miss Tanaka : It will not complete the sterilization cycle. I have looked through the hand-book, which was sent with the autoclave. However, it is indicating a fault, which is not listed.
Miss Suzuki : Have you checked the door
seal?
Miss Tanaka : Yes, I have cleaned the door

seal and dried it twice. I have talked to Dr. Richard and he agrees that we will have to contact someone.
Miss Suzuki: OK. I will call the company with
whom we have a service contract. We are lucky today. Dr. Sato is away today. He had to attend some meetings so you can use his clinic.
Miss Tanaka: Thats good. I will let dr.

Richard know we will be working in Dr. Satos clinic.
Chapter5 Equipment woes 2. Unit trouble
2. -Unit trouble
Miss KatoI think well have to delay
our next patient, Dr. Sato. Dr. SatoWhys that ? Miss KatoHave you looked on the floor ? theres A big puddle . I can see water coming out the dental unit .
2. -Unit trouble
Dr. SatoOh dear. You' re right. It's getting
bigger. Ill get some towels. First, Ill have A look at the waterlines to the handpieces. Miss KatoI ll get A mop. Dr. SatoIts looks like a valve has broken. Can you switch off the unit and that will stop the water coming out. Ill have to call an engineer. I ll go to reception and apologize to our next patient.
2. -Unit trouble
Dr. Sato Miss Suzuki, we have an '
emergency in my surgery. It is flooded. Miss Kato is mopping up water!
Miss SuzukiYour next patient is setting

in the waiting room, Dr. Sato.
2. -Unit trouble
Dr. Sato Oh dear, It's Miss Saito. She's not
going to be happy when I tell her I am going to cancel her appointment today Miss Saito, I'm afraid we have had an emergency in my clinic and it is flooded. I can't do anymore treatment until the engineer comes. I'm sorry but I'll have to cancel your appointment today and rebook you. I'm very sorry for wasting your time.
2. -Unit trouble
Miss Saito That's ok. I wasn't feeling

well anyway and was thinking of telling you that I didn't want much treatment done today. So actually, I'm quite relieved that I am not having treatment today. Thank you for telling me.

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Chapter 1 At the reception desk () 1. Making an appointment ()

Chapter 1 At the reception desk () 2. Cancelling an appointment ( )

Chapter 1 At the reception desk () 3 .Changing an appointment ( )

Chapter 2 Emergency () 1. Broken tooth ()

Dr. Sato: Youre back again, Mr. Ishida. Is it the

Chapter 2 Emergency () 2.A denture tooth has broken off ()

2.A denture tooth has broken off

2.A denture tooth has broken off

2.A denture tooth has broken off

2.A denture tooth has broken off

Chapter 2 Emergency () 5. An avulsed tooth ()

Chapter 3 Treatment () 1. Composite filling ( )

Chapter 3 Treatment () 2. A painful tooth, endodontic treatment (, )

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

2. A painful tooth, endodontic treatment

3. porcelain veneer: (1) preliminary discussion with the dental technician

3. porcelain veneer: (1) preliminary discussion with the dental technician

Cheap 3 Treatment 3. porcelain laminate veneer: (2) Wax-up

3. porcelain veneer: (2) Wax-up

3. porcelain veneer: (2) Wax-up

3. porcelain veneer: (2) Wax-up

3. porcelain veneer: (2) Wax-up

3. porcelain veneer: (2) Wax-up

3.Porcelain Veneer: Tooth preparation

Cheap 3 Treatment 3. porcelain veneer: Tooth preparation( )

3.Porcelain Veneer: Tooth preparation

3.Porcelain Veneer: Tooth preparation

Cheap 3 Treatment 4.Making a new denture: (1)Complaints about old dentures

4.Making a new denture: (1)Complaints about old dentures

4.Making a new denture: (1)Complaints about old dentures

4.Making a new denture: (1)Complaints about old dentures

Cheap 3 Treatment 4.Making a new denture: Making an impression

4.Making a new denture: Making an impression

4.Making a new denture: Making an impression

4.Making a new denture: Making an impression

4.Making a new denture: Making an impression

4.Making a new denture: Making an impression

Cheap 3 Treatment 4.Making a new denture: Jaw registration( )

4.Making a new denture: Jaw registration

4.Making a new denture: Jaw registration

4.Making a new denture: Jaw registration

4.Making a new denture: Jaw registration

Chapter 3 4.Making a new denture:

4.Making a new denture: retruded contact position

4.Making a new denture: retruded contact position

4.Making a new denture: retruded contact position

4.Making a new denture: retruded contact position

4.Making a new denture: retruded contact position

Chapter 3 4.Making a new denture: Try-in

set-up: prominent: process: ,

4.Making a new denture: Try-in

4.Making a new denture: Try-in

Chapter 3 4.Making a new denture: Insertion

4.Making a new denture: Insertion

4.Making a new denture: Insertion

4.Making a new denture: Insertion