This patient had type III (localized IV) periodontitis with class 1 mobility in sextant 5. I was lucky enough to have Dr. Ecklman as my faculty to show me how to hand scale her teeth so as not to do more damage.
After two appointments of scaling, I placed arestin in 8 sites around the posterior of this patient. When she came back for evaluation there was only 1 site that we did not see at least 1 mm pocket depth reduction.
![](image/jpeg;base64,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)
This patient presented with black line stain on the buccal of his maxillary molars and the lingual of his anterior teeth. He comes in every 3 months to have it removed with the prophy jet. I have treated him and removed his staining 2 times.
![](http://www.dentistryindia.net/content/DI/img/2008/01/DI200801_107x.jpg)
I have learned how to place a rubber dam and then place a sealant and used this technique 5 times on 3 separate patients.
I have treated 3 children in the clinic, a 7 year old, an 8 year old and a 9 year old. the 9 year old had staining on all of the lingual surfaces due to an iron supplement that he was taking and that had to be scaled off. I also placed 2 sealants on children with cotton rolls for isolation.