Jakob the Chimpanzee

The "happy” team consisted of Dr. Gudrun Schöffmann and Mag. Isabelle Iff, see Fig. 1
 

They insured that sedation, pre-anesthesia; anesthesia and post-operative recovery and pain control was performed in the same exquisite and flawless manner as always.
 

The surgical team consisted of: DDr. Stoian Camil, Dr. Hubert Simhofer, Mag. Helene Widdman and Mag. Dirk Neuhoff.
An older acquaintance and patient of ours was "Jakob the Chimpanzee”, a 27 years old, male, with 50 kg body weight and, with a quite sad face due to dental pain as obvious in Fig 2.

About 2 months ago we performed an extensive multiple tooth extraction due to advanced perio-endodontic lesions of no more or less than 9 teeth.
 

This time the procedures would be much more conservative and less invasive, and will consist of a single root rest extraction and multiple caries treatment with a combination of composite and amalgam filling according to the type of restoration needed.

Pre-medication consisted of 1,8 ml Zoletil administered intramuscularly, induction with 45 mg of Propofol and 50 µg of Fentanyl, both administered via intravenous catheter. Maintenance anesthesia was performed via endotracheal intubation and using inhalation narcosis with isoflurane.
 

When the anesthesia team gave their ok, we proceeded in the treatment of the carious lesions present in all of the upper incisors, and left premolars and molars as well as both lower canini.

The mechanical preparation was performed using a micromotor straight handpiece with an extension flexible cord and capable of 37000 rotations per minute. We used steel round burrs with a long shaft (Meisinger HM 1023) for removal of the necrotic dentine and diamond reverse cone burrs (Horico Diamant) in order to ensure additional retention in the enamel of the margins of the cavity for the composite and mechanical retention for the amalgam fillings.

Since the micro motor was an industrial device and not specially made for dentistry it was imperious to ensure copious cooling to prevent dental pulp hyperthermic injury by means of a 50 ml syringe with water, and an aspirator to prevent accidental inspiration of liquids and material particles, see Fig.3

The upper incisors had neck caries which resulted in a class V cavity preparation, Fig 4

After the thorough mechanical preparation of the cavity we applied a lining (capping) of the deep areas close to the dental pulp with Calxyl –a calcium hydroxide cement specially used for application in the vicinity or even to close up the accidental pulp openings, Fig 5 Calcium hydroxide is the only histo and bio-compatible material suitable for direct contact with the dental pulp.
 

After mechanically removing the CaOH surplus material by means of a reverse cone steel burr we applied 37 % ortophosphoric acid for etching (chemically engraving and indenting the surface of enamel in order to increase adhesion of the composite material), Fig. 6. Additionally we used bonding material than applied self curing composite (Adaptic, Dentsply, Brasil) Fig.7
 

The premolars and first molar after preparation of the class V cavities, and application of the Calcium hydroxide base were filled with amalgam (non-gamma 2 amalgam from capsules-ds-Alloy, Demedis, Germany), Fig 8. The amalgam fillings were properly condensed and burnished and after 20 minutes, polished to a high glossy surface with amalgam polishers (Shofu, Japan). The first right side upper molar (1.6 Triadan nomenclature) had present only a root rest that needed extraction, see Fig 9.
 

During polishing of the composite filling for some reason (we had no air spray and a tiny amount of saliva might have penetrated and prevented the adhesion of composite)we lost the filling at the upper central incisor and decided consecutively to apply amalgam which might not be so physiognomic but has increased mechanical resistance. Our Jakob looks now like a ferocious South American drug dealer, but only adds to his charm a note of originality and chic, Fig 10.
 

After the surgery which lasted a whole 2 hours, Jakob wanted to "give us a hand” but we considered over polite from him and refused his help, Fig 11.

DDr. Camil Stoian PhD, Mag. Helene Widmann