A Peg Lateral, A Missing Tooth, and More

March 27, 2018 Richard Hunt DDS

Every patient has a story that makes their case unique. When we embrace their path to treatment and make an effort to understand their motivations, we can provide even more excellent care.

A great example of this simple lesson came in the form of my patient Anne. I knew Anne well, as she ‘grew up’ in our practice and had been a regular patient for many years. This fact added an unexpectedly challenging element to her case. I knew I needed to re-familiarize myself with her interests and background instead of taking our past relationship for granted.

Restorative Case For a Future Hygienist

Anne is nineteen and currently training to become a dental hygienist. Her personal dental experiences spurred her interest in the field. She’s excited to provide patient care that improves both oral health and self-image.

All of these details about Anne informed how I approached her treatment. Her primary esthetic concerns were a peg lateral #7 and a congenitally missing #10. She also had canted axial alignment, mottled enamel, and uneven gingival zeniths with a high smile line.

We decided on comprehensive restorative treatment approach that would correct these problems and provide her with a result she could readily show off. The treatment consisted of orthodontics, an implant for #10, and periodontal surgery to reposition gingival levels. We also moved ahead with occlusal equilibration and a diagnostic wax up.

To round out the case, we did tissue sculpting on #10 in addition to esthetic/functional testing and refinement via provisionals. Anne got beautiful e.max veneers on #5, 6, 7, 8, 9, 11 and 12. Finally, she got an implant supported e.max crown on #10.

Matt Roberts CDT handled the lab side of Anne’s case and did a stellar job. She can now go forth confidently into her career and help others embrace treatment that can change their lives.

What case put a smile on your face recently? We’d love to hear what you think in the comments! 

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E3: Restorative Integration of Form & Function

DATE: October 5 2025 @ 8:00 am - October 9 2025 @ 2:30 pm

Location: The Pankey Institute

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Understanding that “form follows function” is critical for knowing how to blend what looks good with what predictably functions well. E3 is the phase of your Essentials journey in which…

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Richard Hunt DDS

Dr. Richard Hunt is a native of Rocky Mount, NC and represents the third generation of dentists in the Hunt family. He earned his Doctor of Dental Surgery degree from the UNC School of Dentistry in 1989. Dr. Richard has served his profession as president of the NC Dental Society and the Dental Foundation of N.C. He is also a former chair of the Dental Assisting National Board. Dr. Hunt realizes the importance of life long learning and attends over 100 hours of continuing education every year in order to remain knowledgeable about current topics and techniques in his profession. In turn, he also enjoys teaching other dentists about the joy, happiness and satisfaction that can be achieved through patient care based on a trusting relationship and clinical excellence. Dr. Hunt has served as a member of the Visiting Faculty of the Pankey Institute for Advanced Dental Education in Key Biscayne, FL. since 2002. He returns regularly to teach dentists from around the world about the clinical and behavioral skills necessary to lead a progressive, health centered dental practice.

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The Technique for the Carolina Bridge

December 2, 2017 Harald Heymann

The Carolina bridge is an all-porcelain bonded pontic that can be used as an interim prosthesis and for many other valuable purposes.

In my last blog, I discussed why I love the Carolina bridge and its many applications as a restorative alternative. Now, I’ll provide an overview of the design and how to begin a case using the bridge.

Carolina Bridge Design

The design of the Carolina bridge bypasses problems found in Maryland bridges and adhesion bridges. The all-porcelain Carolina bridge is very esthetic because there is no metal substructure. There is also incredible light penetration.

Maryland bridges, on the other hand, are not esthetic due to the the graying created by metal wings. All-porcelain pontics, such as the Carolina bridge, often can be used when tooth anatomy comes before or restricts the prep and placement of a Maryland-type bridge. Also, it is easier to repair the proximal resin composite retaining connectors of Carolina bridges.

Carolina Bridge Case Technique

A case that illustrates a Carolina bridge technique is one where an adolescent patient presented with a missing maxillary right lateral incisor. A team consisting of a periodontist, an orthodontist, an endodontist, and a restorative dentist determined that a dental implant would be the best treatment once the patient reaches maturity.

The team decided to orthodontically submerge the endodontically treated root to best preserve the bony site for implant placement. They selected a Carolina bridge as the best interim prosthesis because the occlusal relationship was favorable and there was sufficient crown length of the abutment teeth.

At the first appointment, shade selection was determined and an elastomeric impression was made of the anterior segment. A working case, an impression of the opposing arch, and a bite registration were created. An all-porcelain pontic was fabricated of feldspathic porcelain by the laboratory. At the second appointment, the involved abutment teeth were fully cleaned and rinsed.

The pontic was trial positioned to assess the shade accuracy and the adaptation of the pontic to the residual ridge. Once the accuracy of the shade and fit was verified, the pontic was readied for cementation.

A silane coupling agent was placed on the etched proximal surfaces of the porcelain pontic to improve the bond strength. Preparation of the abutment teeth was done by lightly roughening the proximal surfaces with a coarse, flame-shaped diamond stone. At this point, the pontic was ready for bonding into the edentulous space.

Dr. Heymann will be a featured lecturer at the Pankey 2018 Annual Meeting in Nashville, TN.

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About Author

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Harald Heymann

Dr. Heymann is particularly active in the clinical research of esthetic restorative materials and participates in a dental practice devoted largely to esthetic dentistry. He is a member of the Academy of Operative Dentistry, the International Association of Dental Research, and is past-president and a fellow of the American Academy of Esthetic Dentistry. He is also a fellow in the International College of Dentists, the American College of Dentists, and the Academy of Dental Materials. He also serves as a consultant to the ADA. The author of more than 190 scientific publications, Dr. Heymann is co-senior editor of Sturdevant's Art and Science of Operative Dentistry and the editor-in-chief of the Journal of Esthetic and Restorative Dentistry. He has given more than 1,400 lectures on various aspects of esthetic dentistry worldwide and has received the Gordon J. Christensen Award for excellence as a CE speaker. Dr. Heymann graduated from the University of North Carolina School of Dentistry. He is past chair and graduate program director of the department of operative dentistry and currently is the Thomas P. Hinman Distinguished Professor of Operative Dentistry at the UNC School of Dentistry

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