Le Prosthodontiste

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Montreal, QC
Le Prosthodontiste

Dr Samer Mesmar - a dental specialist in reconstructive and esthetic dentistry, and implantology

01/16/2025

Patient presented with a fractured and infected front tooth that requires extraction and replacement. Note the first video shows the tooth restored a temporary crown bonded to the adjacent teeth. Patient had initially a black triangle in between central incisors. Dr Mesmar explained to the patient the complexity of the treatment considering the triangular shape of the teeth, great length, significant size papilla with a contact point located at a distance greater than 5 mm from bone level. Such case is probe to have gingival recession and/or papilla retraction which is the very difficult to bring back. Dr Mesmar informed the patient of all likely scenarios with different apporaches to restore the tooth esthetically. An atraumatic extraction was performed with an immediate implant placed free hand with simple guidance of the adjacent teeth. Dr Mesmar was able to achieve great primary stability to perform immediate load with a fixed temporary crown. Proper emergence profil is crucial to promote thickening of the soft tissue while providing good support. Adequate and delicate suturing was performed in order to support the gingival tissue. Note the two weeks post op video showing good gingival response and the fantastic 3 months post op video showing thickening of gingival tissue and a more coronal position of the marginal tissue providing room for modeling without any soft tisshe grafting no flap management. When all critereas are met, the power of immediate implant and temporisation is greatly demonstrated. What would you have done differently if it was your case ? How would you manage a gingival recession if it had happened ? The patient is ready go return see his referring dentist to do the final crown. Surgery and pros done by Dr Mesmar. Bon jeudredi 🤓

07/06/2022

In some cases, implant-supported crowns have to be cement-retained on a custom abutment for several reasons. Management of cement excess is critical to avoid biological complications. One technique is to punch a small piece of rubber damn prior to insertion to create a barrier. It is important to note that some cements are radiolucent and that a radiograph only shows the mesial and distal aspect. Leaving part of the abutment screw access channel empty as a venting space helps as well. Bon Mercredi !

06/22/2022

A conservative approach can present challenges when it comes to esthetics. In this case, patient had an old bridge with a fractured central incisor and teeth restored with multiple amalgam and composite restorations. A maxillary arch rehabilitation was planned with a combination of indirect restorations: tooth-supported bridge, implant-supported crown, full and partial coverage crowns, veneer and vonlays. Different materials are used (zirconia and lithium disilicate) with different optical properties, different thickness and difference substrat color … once all bonded/inserted, color match is a must. Knowing the materials with their different opacities once bonded with a specific cement shade is key to be able to communicate the info to the lab and work together to achieve a beautiful smile. Preping for crowns is certainly an easier option but in today’s modern dentistry, a conservative adhesive approach is the way to go. Stay tuned to see the before and after clinical presentation. Bon Mercredi

06/15/2022

Digital impression taken with Trios from 3Shape for implant and tooth supported restorations. Mutli-implant restorations can be tricky to capture and might not be precise depending on how many pontics and mobility of soft tissue in that area. The field of view of the camera must always include a rigide structure (digital impression coping). It certainly has a learning curve, but patient experience makes it worth it !

06/07/2022

Not every implant can be saved ! Patient presented with an implant placed overseas several years ago with significanf bone loss and infection. Peri-implantitis can be treated using a surgical approach by decontaminating the implant surface using a specific protocol. In this case, considering the bony defect (unable to graft predictably with high risk of thread exposure), Dr Mesmar decided to remove the implant. An occlusal access was made to locate the screw (cemented crown) to then remove the implant using the NeoBiotech removal kit. Debridement and primary closure are then done. Following soft tissue healing, a CBCT is taken to evaluate the best approach to regenerate bone amd consider all treatment options. Bon Mardi 🤓

06/01/2022

When it comes to adhesive dentistry, rubber dam isolation is a must ! In this case, tooth 17 needed a porcelain onlay to replace an old defective amalgam. Isolation helps with access by retracting surrounding tissue and provides a saliva free environment. Moreover, management of amalgam removal is much easier. Adequate clamp and rubber dam selection & experience/practice are key to become efficient. Note that metal clamps can be modified by selectively grinding their “teeth” or arch form for better adaptation around the tooth. Bon Mercredi 😎

04/14/2022

Minimaly invasive approach to rehabilitate the smile. Veneer preparation is a delicate intervention requiring proper planning based on a diagnostic waxup to determine the parameters of tooth reduction. Insertion path, incisal reduction, contact point configuration, final color and characterization are some of the important aspects to consider. Stay tuned to see the impression taking 🤓

03/17/2022

What you are looking at is a titanium bar being held in place by 4 implants placed by Dr Mesmar. The high quality acrylic teeth will be supported by the bar to provide the patient with the feel, comfort and look of natural teeth. Different bar designs have each their particularities … in this case, a Montreal bar with pink silicoating was selected. Passivity is a key factor that require precision during impression making … tactile feel while tightening the screws is a good indicator while keeping in mind the effect of soft tissue pressure from the bar. Next step is to do a final try-in of the teeth onto the bar prior to acrylization and insertion of definitive fixed prothesis. Stay tuned to see remaining of the steps 🤓 Bon Jeudi !

02/22/2022

Insertion day is a big day … proper isolation is not always easy (clamp selection, stability, accessibility etc), trying of each restoration individually and all together (marginal adaptation, interproximal and occlusal contacts etc), bonding (sequence, strategy, excess management etc) … not to mention managing patient’s expectations and satisfaction of end result, in addition to long term care and follow ups. Those are few steps involved in a therapeutic rehabilitation of the dentition. Bon Mardi 😎

02/02/2022

Indirect sinus lift performed with osteotomes is less invasive when bone morphology allows for it. Implant primary stability is key in addition to proper implant selection. An osteocondensation protocol is performed using Densah burrs. Once the osteotome is through the sinus floor, a resorbable membrane is placed first prior to introducing bone particles to “pad” and protect the sinus membrane in case of undetected tiny tears. Large diameter tissue punch is used to cut the resorbable membrane which then pushed through the osteotomy (a bit like opening an umbrella-ella-ella-ay-ay 🤩). Mesial implant site shows nicely the floor of the sinus fragment pushed up. What’s important in all this nerdy description is to give a shout ou to Rihanna 💃🏻 !

01/25/2022

Full arch rehabilitation using a conservative adhesive approach. In this case, combination of Veneers, Onlays and Vonlays ceramic restorations will bonded to restore vertical dimension and provide adequate function. To facilitate impression taking, Optragate, dry angles, restraction of the tongue using mirrors are used. Stay tuned to see the before and after pictures.

01/18/2022

Insertion of an upper porcelain fixed implant-supported prosthesis and a lower acrylic prototype fixed prosthesis. Prosthetic parameters are mainly guided by upper prosthesis in terms of smile design, tooth display with lip dynamic … etc. Occlusion and vertical dimension is tested with the lower prototype by having the patient function for a couple of weeks. Modifications are them made, if necessary, prior to rescaning lower prothesis on the master cast for the lab technician to finalize the procelain definitive prosthesis. Stay tuned to see intra-oral presentation of the case. Bon Mardi !

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Montreal, QC

Telephone

+15146840135

Website

http://www.leprosthodontiste.com/

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