Dr Corné Smith - Advanced Restorative Dentist - Cape Town

Dr Corné Smith - Advanced Restorative Dentist - Cape Town Advanced Restorative dentist

Follow up to previous post. Replacing two crowns. 32 year old patient presents with full ceramic crowns on 11 and 21, bo...
11/09/2022

Follow up to previous post. Replacing two crowns. 32 year old patient presents with full ceramic crowns on 11 and 21, both root canal treated. Her main complaint was the colour of the existing crowns.
The challenge with this case:
🔘Lateral incisors with a lot of natural characterisation
🔘Discolouration of the roots
🔘Uneven gingival levels
First, endo re-treatment of the 11 which was under-filled, done by Dr Bennie Smit. After the re-treatment the discolouration of the root significantly improved. No internal bleaching was done. Post and core build up done 3 months after the re-treatment.
Second, plan new gingival levels. We use the laterals as a guide, and adjust both of the preps.
Third we have to communicate with our dental technician to show the detail of the laterals.
This case seemed simple at first but required planning, and effective communication.

Replacing two crowns. 32 year old patient presents with full ceramic crowns on 11 and 21, both root canal treated.The ch...
07/09/2022

Replacing two crowns. 32 year old patient presents with full ceramic crowns on 11 and 21, both root canal treated.
The challenge with this case:
🔘Lateral incisors with a lot of natural characterisation
🔘Discolouration of the roots
🔘Uneven gingival levels
To match the lateral incisors we chose to use Emax with layering. All the credit goes to Shane Hansen and the team from Diceram to this incredible natural result.
In the next post I will discuss the planning and treatment process we through

31/08/2022

This weekend at the SADA congress! Lots of fun!!

Deep Class II restoration - Deep margin elevation. When the margin is below the CEJ and subgingival, a normal approach t...
28/08/2022

Deep Class II restoration - Deep margin elevation. When the margin is below the CEJ and subgingival, a normal approach to building will not give us an adequate seal and good adaptation. Following biomimetic principles, we can raise the margin coronally without a clinical crown lengthening procedure ,and thereafter proceed with our restoration with a conventional protocol.

We know from Pascal Magne’s paper in 2012 that we can elevate the margin and seal the subgingival area: Magne, Pascal, and Roberto C. Spreafico. "Deep margin elevation: a paradigm shift." Am J Esthet Dent (2012).

This technique has now also been evaluated by Samartzi, Theodora Kalliopi, et al. "Deep Margin Elevation: A Literature Review." Dentistry Journal (2022). In this article the conclusion is that we have to apply this technique with caution, respecting three criteria:
Capability of field isolation
The perfect seal of the cervical margin provided by the matrix
no invasion of the connective compartment of the biological width

Do you use this technique?
I find that there is a significant learning curve involved, and that it is very technique sensitive. However, once you get more confident with the procedure, it works really well.
What are the challenges you have with this technique?

The case I show here in the last slide has been stable for 18 months with no peri-apical involvement.



I really enjoyed this case. We used system. Our patient is a 36 year old woman with some existing restorations on her f...
18/08/2022

I really enjoyed this case. We used system.
Our patient is a 36 year old woman with some existing restorations on her front teeth that looks discoloured and needs to be replaced. She asked for porcelain veneers initially, and after discussing the difference between composite and ceramic, she decided to rather get composite veneers. Her choice was based on:
-the limited time she was in the country for the procedure (5 days)
-the cost of the procedure
We decided to use the iveneer injectable matrix system in combination with universal flowable composite from . This is very similar to our conventional injection moulding technique, but these are preformed single units that comes in different sizes.
In my opinion this system gives me predictability, saves a lot of time, and gives a beautiful shape and finish.
Thank you Itay, and for introducing me to this great product.


What does it take to run a successful dental practice. We all know we didn’t get much training on this topic, and lookin...
13/08/2022

What does it take to run a successful dental practice. We all know we didn’t get much training on this topic, and looking at the recent study done by most clinicians feel their training did not adequately prepare them to run a practice.
Join me and at the young dentist council session at SADA 2022 where we will discuss the roadmap to run your dental practice as the CEO.
Does your dental practice need a CEO? Reframe your thinking! If you own a practice, you have to be able to think like a CEO. I will share some of the lessons I have learnt from and the which has been life changing in my practice.
In my journey of practice ownership, initially I found that I spent most of my time working in the business, and not on the business. What challenges do you face running a dental practice?
Ask me a question in the comments!

Part II Preparing the deep class II. Preparation of our restoration is where we should spend most of our time. If we pre...
09/08/2022

Part II Preparing the deep class II.
Preparation of our restoration is where we should spend most of our time. If we prep properly, building the restoration will be much easier. What makes a deep class II tricky, is the fact that the cervical margin is sub-gingival.
My top tips for deep preparations:
1 Prepare with rubber dam and use a wooden wedge to create separation. The wedge will allow you to follow the margin without getting stuck in the rubber dam.
2 Sometimes you even need to remove the rubber dam to prepare. That’s ok! You can always replace it.
3 Create a smooth box for good adaptation with the sectional matrix. I use a metal strip for this.
4 Finish your prep with smooth lines, do a slight enamel bevel with a fine diamond.
5 Micro etch with 29 um aluminium oxide. I use the for this, it cleans the surface beautifully, and now we are ready for bonding!
Next… Part 3 Building a deep class II restoration.

Everyone deserves a beautiful smile.Sometimes we go through hard times.. and due to neglect, lots of energy drinks, late...
07/08/2022

Everyone deserves a beautiful smile.
Sometimes we go through hard times.. and due to neglect, lots of energy drinks, late nights and some falling dental work, we can loose our beautiful smile.
Treatment plan - team approach at
1 Get the gums healthy! Oral hygiene instructions, dietary counselling, and some motivation with a nice electric toothbrush. and .colegilbert went the extra mile to motivate and educte. they spent a lot of time with this patient before we committed to doing the veneers.
2 Restore the decay with he did an awesome job at restoring several posterior teeth that needed some attention.
3 Whitening of the lower teeth - excellent result with done by benita and cole.
4 Ceramic veneers on the 4 anterior teeth, and composite veneers on the canines and premolars. Planning done with
Emax monolithic ceramic was used, and Diceram did the beautiful ceramic work.
Asteria composite was used from tokuyama dental on the canines and premolars.

Everyone deserves a beautiful smile.Sometimes we go through hard times.. and due to neglect, lots of energy drinks, late...
07/08/2022

Everyone deserves a beautiful smile.
Sometimes we go through hard times.. and due to neglect, lots of energy drinks, late nights and some falling dental work, we can loose our beautiful smile.
Treatment plan - team approach
1 Get the gums healthy! Oral hygiene instructions, dietary counselling, and some motivation with a nice electric toothbrush. and .colegilbert went the extra mile to motivate and educte. They spent a lot of time with this patient before we committed to doing the veneers.
2 Restore the decay with ,he did an awesome job at restoring several posterior teeth that needed some attention.
3 Whitening of the lower teeth - excellent result with done by and .colegilbert .
4 Ceramic veneers on the 4 anterior teeth, and composite veneers on the canines and premolars. Planning done with digital design.
Emax monolithic ceramic was used, and Diceram did the beautiful ceramic work.
Asteria composite was used from tokuyama dental on the canines and premolars.

06/08/2022

Whole new world of microscope dentistry! Thank you ZUMAX South Africa - Equity Dental

Deep class II restorations can be difficult! Let’s look at it step by step, starting with planning. The inspiration for ...
04/08/2022

Deep class II restorations can be difficult! Let’s look at it step by step, starting with planning. The inspiration for this post is from the legend , his lecture on deep restorations on gives us some great tips.
In the planning phase we need an accurate diagnosis, plan the type of restoration, schedule the length of the appointment, and anticipate any potential complications.
The tip that gave was to schedule the appointment time with the following formula. LA time + complexity = appointment time. Deep class II restorations below the CEJ will take you at least 20 min longer to manage properly.
How do you think we manage the potential complications here?
Preparing the box that extends past the CEJ will most likely cause bleeding, and your bur might get caught in the rubber dam.
This preparation also seems very close to the pulp. Do we need to do anything to protect the pulp?
We have covered some of these concepts at composite course, and also the adhesive course with .
Please share your thought! Would love to hear your input

Next post on preparation…

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