Cost, value and Dentistry

If you buy a new car and it only lasts a year, that car is terribly expensive but if we buy a car and it is still providing great service after 8 years, we consider how lucky we are and what a great buy the car was. Several months ago, I was going to check one of my patients after she had her teeth cleaned by our hygienist. When I walked into the room and greeted the patient she said to me, " I come to you because I think that you are a good dentist but you are very expensive." I looked up to the computer screen and saw that I had not fixed a single tooth for this patient in more than 13 years. The fact was that all the work that I had done for this patient was performed 15-20 years ago. So I gently asked the patient why she thought that I was expensive since I hadn't fixed a single tooth in at least 15 years? When she thought about it, she knew that for the cost that I had charged fifteen years ago, she certainly did get her money's worth....value.Dentistry that is done well is one of the best values in American life.
Posted by Dr. B at

My new office in Saratoga

Every Friday I go to 18 Division Street in Saratoga to look at the progress in the construction of our new office. The building is a beautiful structure and it is a half of a block from Starbucks and all of the great restaruants in this beautiful City. We wanted our office to be elegant yet comfortable and I think that you will be very proud to refer your family and friends. Sue Barrett, who designed our office, has a wonderful esthetic sense and she told us that she would create an office which compliments the beautiful dentistry that we do.
I am thrilled with the construction progess and we look forward to opening our office about mid December.

Headaches and teeth

I am fairly well known around the country for my beautiful dentistry and that makes me very proud. What really makes me happy is when I am able to stop the headaches for a patient who is suffering. As you know, I am not a physician but it is estimated that about 50% of headaches in humans are due to the fact that their teeth do not meet evenly. I have studied with the best in the world for the last 17 years and I learned how to correct bites that are not in harmony; this enables the muscles to stay quiet and not contract repeatedly. No contractions means no spasms and no pain.
If you have headaches, see your dentist and see if they can balance out your bite...More thoughts on this another time.

Exciting times

These are exciting (yet scary) times in our practice. After 30 years in our present geographic location, we will be opening another office in Saratoga Springs, NY in mid December. We have a great office in a great small American city.
More great news: I have been selected by my mentor in Seattle to teach the teachers in his new direct patient care Institute in Scottsdale, AZ. I have spent thousands of hours in Seattle studying with Dr. Frank Spear who is regarded as one of the top 10 restorative dentists in the world and I was honored when he selected me to be on his faculty.

Promise To the Bride, Cosmedent, Inc., 2008.

Dr. Gerald Benjamin - The Bride

The Promise

On May 1, 2007 a 27 year old female presented to our office for a consultation for cosmetic dentistry. After being seated in the operatory to discuss what treatment she was interested in having, I introduced myself to the patient and asked her how I could help her. She told me that she was embarrassed by her teeth and smile and that she was getting married on July 7, 2007 and then she started to cry. I handed her a tissue and assured her that if she followed my suggestions, I promised her that I would make her a beautiful bride with a gorgeous smile. After examining her teeth, I wished that I had not made her a promise. Teeth # 5,6,7, 19 and 11 had advanced carious lesions with pulpal involvement. There were massive generalized deposits of supra and subgingival calculus indicating that the patient had failed to have professional dental hygiene care for many years. Lastly the patient’s central incisors were only 7 mm in length indicating that much of the enamel was below the level of the soft tissues.

I contacted my periodontist, Peter Collins of Troy, NY via email and attached the photos that I had taken and explained that I needed his immediate help in creating our beautiful bride. I next contacted my endodontist, Dr. Hilton Segal, also of Troy, NY and again asked for his help in salvaging as many of our patient’s anterior teeth with endodontic therapy as he could in an expedited manner. Dr. Collins performed debridement, deep scalings, intensive home care instructions and finally did full osseous surgery extending from #4 through 13. Tooth #5 was deemed hopeless and was extracted in conjunction with periodontal surgery. Dr. Segal performed root canals on teeth # 6,7,10 and 11 as well as #3 and 14.

Impressions were taken two weeks prior to the wedding date so that a waxup could be done and a PVS matrix impression using Splash (Discus Dental) could be fabricated from the wax up. The purpose of the waxup and matrix is to be able to quickly establish the correct width of each tooth and the exact incisal edge position without having to use trial and error methods.

A full day was set aside exactly 8 days prior to the wedding so that the patient could have as much healing time for her soft tissues as possible. It is virtually impossible to do esthetic bonding in situations where the soft tissue is inflamed and bleeding. The patient was called on several occasions during her healing from surgery to remind her how important her home care was to the success of the bonded restorations. A decision was made that restoring teeth # 4-13 would not meet our usual high level of meticulous attention to detail and the use of between 4 and 9 resin layers of Cosmedent Renamel as advocated by Newton Fahl. One Renamel Hybrid shade A1, one Renamel Opacquer shade A1-B1 and one Renamel Microfill Shade A1 would be used to complete the entire restoration. However, my esthetic sensibilities were offended by a monochromatic appearance to restoring a tooth and Renamel Microfill Incisal Light was added to the incisal 1/3 of each of the restored teeth in order to create realism.


Another decision was made that the reconstruction was not intended as the final restorations and that the restorations would only meet standards of excellence at 3 feet , the normal conversation distance, rather than meet the intense scrutiny of 1:1 close-up photography.

Unfortunately, as we began to isolate the area with rubber dam, we noted that the clinical crowns of teeth # 6, 10 and 11 were broken off 1 mm above the gingiva which necessitated the fabrication of direct bonded crowns. An indirect/direct fiber reinforced bonded bridge was planned to replace tooth # 5 which had been removed. Local anesthesia was administered on all teeth that did not have endodontics therapy and the labor intensive task of creating a beautiful smile began. All caries were removed and each tooth was treated with meticulous attention to bonding protocols while managing gingival seepage when it occurred. The palatal aspect of the Splash matrix was filled with Renamel Hybrid A1 , placed on the tooth and the resin cured 60 seconds. The Splash matrix was put aside for use on the next tooth. Renamel Opaquer A1-B1 then covered all of the Hybrid resin layer and any remaining natural tooth structure and cured for 60 seconds. The final contours of the restoration were completed with Renamel Microfill A1 with Incisal Light placed only in the incisal 1/3 of the finished restoration.

The direct/indirect bridge to replace tooth #5 was fabricated in the final hour of the 9.5 hour
appointment. A MO standard prep was placed on the occlusal surface of #4 and a post hole was fabricated to accommodate a medium fiber reinforced resin post for tooth #6. A standard crown and bridge Impragum impression was taken of the prep in tooth #4 and to pick up the post and its relationship to the remaining natural tooth structure of #6. The impression was removed from the mouth and immediately poured with Mach II (Parkell) die model material. The Mach II was removed from the Impragum impression after 6 minutes and an immediate model had been created to fabricate the bridge. A thin layer of a separating material was placed on the Mach II model to prevent the resin from adhering to the model. I went to my lab and fabricated a pontic using Renamel Hybrid A1 for 90% of the restoration with a labial layer of Renamel Microfill A1 for missing tooth #5 and placed it into the correct position on the Mach II die model. A trough was cut into the pontic to accommodate fiber reinforcement. A piece of Ribbond THM was cut to the appropriate size, covered with an unfilled resin and placed into the MO prep cut into tooth #4, through the trough cut into the pontic (which is correctly positioned in position #5) and around the fiber and resin post placed in the #6 post hole in the Mach II model . A sufficient amount of Renamel Hybrid A1 was placed around the Ribbond fiber and the fiber and resin were then cured for 60 seconds. The final contours of the labial surface of tooth #6 was added using Renamel Microfill A1 to the bridge framework that had been fabricated indirectly on the Mach II model. The Microfill was cured and the bridge was removed from the Mach II model and air abraded in preparation for bonding into the mouth. Teeth #4 and the root of #6 were etched with 37% phosphoric acid for 20 seconds and dried . A dual cured bonding agent was selected and placed into the mesial prep of tooth #4 and down the prepared post hole of tooth #6 without curing the bonding agent . Bonding agent was placed on the underside of the completed bridge and again not cured. Cosmedent Dual Cure Insure was used to bond the bridge to place. The completed bridge was equilibrated and the excess luting agent removed and polished.

After an intense 9.5 hour reconstruction, we had fulfilled our May 1 promise to give our
bride a fabulous smile. I have not included close up photos of the direct bonded resin restorations because the restorations were fabricated for the purpose of looking good at 3 feet.

Fractures 8 & 9, CQ Spotlight, Cosmedent, Inc., 2008

Dr. Gerald Benjamin - CQ Spotlight

This 19 year old man was playing college basketball when he landed on his face and broke his two central incisors. The fractures went up to but did not involve the pulp. Radiographs were taken and local anesthesia administered prior to isolating the area with a slotted rubber dam. A moderately deep 2 mm bevel was placed around the tooth #8 , adjacent to the missing fragment of tooth. The entire tooth was air abraded washed with water and then sodium hypochlorite. Following a thorough rinsing with water, the whole tooth was etched with 37% phosphoric acid and rewashed with water and dried. Tublicid Red was applied to the exposed dentin with a moderately dry fuzzy stick applicator. Optibond Solo Plus (Kerr) was liberally placed over all aspects of the tooth and dried lightly and cured for 60 seconds. Cosmedent Hybrid A1 was placed on the palatal aspect of the fractured area to approximate the missing incisal edge of tooth #8 to a thickness of 1/3 to 1/2 of the thickness of the tooth. Hybrid resin is the first resin placed when using a layering technique and is selected for its strength. A thin layer of Cosmedent Opaquer shade A1-B1 was painted over the entire layer of hybrid resin and extended 1 mm onto the circumferential bevel on the natural tooth. The purpose of the Opaquer resin layer is to prevent shine through of the restoration which lowers the value. Another reason for using the Opaquer layer is to eliminate a line of demarcation between the natural tooth and the restoration. The final layer of the build up was Cosmedent A1 Renamel Microfill and that was placed over the entire missing natural tooth (now restored in Hybrid) and the rest of the natural tooth. A sufficient thickness of Renamel Microfill was placed to restore the tooth to 95% of the contour of the final restoration. The remaining restoration was restored with Renamel Microfill shade Incisal light to bring the restoration to its final full natural contour.
A Microfill is used because it is a highly polishable resin that maintains its shine for many years. It also is highly color stable over long periods of time. The restoration was completed using fine diamond diamonds and Medium Grit 5/8 inch sandpaper discs from Cosmedent. Finally, the resin was polished with Cosmedent blue cups then pink cups with the final shine of the Renamel Microfill obtained with Cosmedent Enamelize placed on a polishing disc. Tooth #9 was treated next using all of the previously mentioned protocol to restore tooth #8.
The rubber dam was removed and the restoration was equilibrated to be in harmony with the natural occlusion. The final photos were taken 4 years after the restorations were placed. The benefits of the layering technique are the strength of the hybrid, the virtual invisibility of the restoration and a glassy smooth shine for many years.

Whoopi Goldberg Weighs In On Dental Care

From: www.soulfullvibes.com

"Comedienne WHOOPI GOLDBERG has urged U.S. TV audiences to take their dental health more seriously - after discovering she may lose her two front teeth during a recent check-up." See full article

New Business for Dentists: Fixing Botched Cosmetic Work

Wall Street Journal, 2004.
"The latest trend in cosmetic dentistry isn't a new kind of tooth-bleaching product: It is fixing other dentists' mistakes..."

See: http://www.mynewsmile.com/botchedwork.htm