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This update of On The Chair is a everyday routine situation one faces in the dental office. It is a presentation of how dentistry has changed over the last decade and how the approach to dental therapy has changed.Dr.Ajay Kakar presents a case treated by his wife Dr. Mona Kakar The Joy of Modern DentistryDental therapeutic technique and technology have both changed so dramatically over the last decade. The speed of treatment and quality have improved by leaps and bounds. It is indeed a pleasure today to complete routine everyday jobs within a day or two with a minimum time requirement from the patient.
The point being established is the simplicity, ease and speed with which endodontic therapy can be achieved today for almost all cases requiring endodontic treatment subsequently being followed by good direct restorations in large carious lesions which has become possible, courtesy, resin based restorative materials. The entire treatment was easily accomplished in two short sittings in a span of only two days without any requirement of systemic antibiotics or other medication.
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A very good example is a case treated at my
clinic a few days ago. There is nothing very difficult
about the case nor is the treatment methodology very
special or unique. Such kind of cases walk in every other
day. The major difference is the approach to the case and
instant decision making and successful therapy. I speak
of an era when we were taught in dental schools to do
amalgam restoration using G.V.Blacks principles. I also
speak of an era when we were taught conventional multiple
visit endodontic therapy with intra canal medications
between visits. All this was not very long ago. It was in
the 1980's. All that was learnt in dental school was
implemented in private practice and in my clinic the same
principles were followed till about 4 to 5 years ago.
Continuing Dental Education in India and abroad led to
the learning of more and more techniques, new material
handling and ultimately very different dentistry. 
A 39 year old male patient walked in with a
complaint of pain on biting in the upper left second
premolar. On examination it was noticed that he had a
Class II DO amalgam restoration placed in 1987. This was
one of the earliest cases done at my clinic by my wife.
The restoration had fractured at the distal end about 3
weeks ago and the patient had not been able to come in
for treatment earlier. There was no pain on percussion
but the tooth was mildly tender. On removal of the
amalgam secondary caries was apparent. The caries was
extensive and had invaded the pulp. 
A decision was immediately taken to carry
out a root canal therapy. All the caries was removed with
a very conservative approach and the pulp was extripated
under Local Anaesthesia and the biomechanical preparation
done with the Fine Cut Files with circumferential filing
(Dr. Jacklich's technique). 
The biomechanical preparation was completed
in about 10 minutes and the canal obturated with the
Multi-Mode Syringe. This took another 7 to 8 minutes. In
fact more time was consumed in removing the amalgam &
caries and evaluation of the tooth for need of endodontic
therapy. 
On
completion of endodontic therapy a temporary cement was
placed in the access cavity and the patient was called
the next day for a restoration. The next day micro-hybrid
composite was used to place a direct restoration. The
cavity was a large Class II Mesio-Occlusal cavity. A dead
soft matrix band was used. The preparation was not a
conventional design and as much tooth structure as
possible was conserved. 
The restoration was finished with occlusal
stains and grooves mimicked effectively. The restoration
was then polished and the patient was very comfortable
and completely symptom free. The entire procedure in the
second sitting took all of 30 minutes from the time the
patient was seated on the chair and the patient left the
clinic. 