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Crown Lengthening (Closed) #9 performed by Timothy Anderson, DDS
This procedure includes the removal of both soft tissue and bone. It demonstrates Solea’s precision, minimal bleeding and very fast healing.
Case Summary: A 60-year-old female patient presented to the practice with complaints about the appearance of her front crown. After full consultation, it was determined that she was not only unhappy with color/contour of the existing crown, but also the gingival architecture that framed her smile. The patient had a defective restoration on tooth #8 PFM with asymmetry of the gingival zenith on the tooth #9, but did not want to undergo an invasive gum surgery. Therefore, the clinical objective was to obtain an esthetic restoration and gingival architecture on the tooth #9 utilizing a non-invasive closed crown lengthening surgical approach with Solea. The full coverage restoration on tooth #8 and partial coverage on teeth #7,9,10 were prepped immediately following the crown lengthening
Technique Used: To start, a gingivectomy was performed on tooth #9 to ablate the gingiva to desired height. The dentist used Solea utilizing the 1 mm spot size with cutting speed between 20-40% and 20% mist to remove the excess tissue. The bone was then sounded with a period probe to determine the amount of crestal bone that needed to be reduced to ensure adequate biologic width. The alveolar bone reduction was completed by directing the laser beam down the long axis of the tooth (slightly towards the tooth) using the 0.5 mm spot size with cutting speed between 20-40% and 100% mist. Sulcus depth was checked periodically to verify how much bone had been removed. Once adequate probing depth had been achieved, the teeth were then prepped and temporized. 1 carpule of 4% articaine with 1:100K epi was used during this treatment as 4 teeth were prepped for crowns at the same time.
- With traditional methods (e.g., a scalpel and sutures) the entire surgical procedure would have been a separate 60 min visit, compared to under 10 minutes with Solea.
- This case highlights Solea’s exceptionally clean surgical cutting with predictable, rapid healing and minimal bleeding.
- The dentist was able to perform this procedure in-house rather than refer it out.
- The patient was thrilled not only with the esthetic outcome, but also the speed and lack of the more invasive “traditional surgical approach” needed to complete the procedure.
Results: Solea’s precision enabled complete control of the tissue and the outstanding clinical results. The procedure was finished quickly and there was almost no bleeding. With Solea, the crown lengthening and tooth preparations could be completed in a single visit. This allowed for proper tissue healing around temporaries, fewer appointments for the patient, and less chair time for the clinic. The patient noted no post-op discomfort. She said that the final restoration and process exceeded her expectations.
Anterior CEREC Veneers with Esthetic Crown Lengthening Using Solea
performed by Dr. Jeffrey Rohde
This procedure demonstrates precision, minimal bleeding and very fast healing.
Case Summary: A 43-year-old female patient presented to the practice for her regular check-up. Patient has had chipping and various composite repairs for over two decades. She was unhappy with her smile and the way her teeth looked. The oral evaluation of the patient indicated that teeth #7,8,9,10 had discrepancy in the size of the teeth. The “Golden Proportion” was disrupted due to variable interproximal bonding, chipping on incisal edges, and widely variable height to the gingival contour of those teeth. The dentist advised a mix of esthetic gingival contouring and esthetic crown lengthening to correct variations in gingival height as well as porcelain veneers to restore the maxillary central and lateral incisors. The clinical objective was to reduce gingival height to improve esthetics in placement of veneers.
Technique Used: The treatment plan included diagnostic wax up, surgical guide fabrication (to show the height of reduction), crown lengthening using Solea, prep for veneers, fabrication of provisional crowns (to test out esthetic design and function). CEREC veneers were made using Ivoclar’s eMax. While performing the crown lengthening procedure, the dentist utilized Solea with the 1.25 spot size, 8 ml/min mist, and 40% cutting speed. He easily transitioned from soft tissue to bone by simply varying the pressure on Solea’ s footpedal. The procedure time was 4-5 minutes with Solea, whereas the average procedure time doing traditional flapped crown lengthening would be at least 45-60 min.
- No flap and no sutures were needed for this case, incredible precision of Solea made this procedure minimally invasive.
- Blood-free preparation, clear surgical site, and no charring of tissue.
- No heat transferred to bone causing unpredictable healing.
- Reduced procedure time to 4-5 minutes compared to approximately 45-60 minutes with traditional tools.
- Patient experience was improved compared to using traditional tools, and approach was minimally invasive resulting in faster healing (in under 1 week) and minimal discomfort in gingival tissue.
Results: Without Solea, this case would have been sent to a specialist for traditional crown lengthening that involves heavy local anesthesia, raising a flap, use of a drill creating heat and friction, and placement of sutures. The healing time would have been a minimum of 6 weeks. If a diode was used, it would not have been able to remove bone, and the tissue would have been left charred and ragged. The dentist was able to utilize multiple technologies (Solea and CEREC) for improved clinical results and patient experience than any traditional method.
Gingivectomy and restoration on tooth #8 performed by Joshua Weintraub, DDS
This case demonstrates how Solea can be used to ablate both hard and soft tissue with no anesthesia, no bleeding, and fast healing.
Case Summary: A 67-year-old male, who has been a long-time patient of the practice, presented for his follow-up appointment. The oral evaluation revealed the recurrent subgingival decay on tooth #8 DFL (Class III/V combination) under an old composite restoration. The clinical objective was to restore #8 while performing a gingivectomy to access subgingival decay. Total procedure time from start to finish was less than 30 minutes.
Technique Used: No topical anesthetic or injectable anesthetic were used for this procedure. To start, a gingivectomy was performed to enable removal of the subgingival decay and achieve a clean margin for proper restoration. Next, the old composite and recurrent decay were removed with Solea. The removal of gingiva was performed using the 1 mm spot size with cutting speed between 30-50% with 20% mist. This took less than a minute and did not require anesthetic. The 1 mm spot size with cutting speed between 30-60% with 100% mist was used for removing the decay and old composite. The enamel was beveled with a diamond bur. Finally, the tooth was restored. The entire procedure was completed blood-free (the slight redness on the ‘Restored’ photo was caused by the finishing bur at the gingival margin).
- The treatment was completed without anesthetic, was blood-free, and completed in less time compared to traditional approach.
- The soft tissue healed extremely rapidly due to the minimally invasive precision of Solea.
- The patient experience was enhanced due to not being injected with anesthesia, avoiding post-operative pain, and a shorter appointment time.
Results: With other instruments, the patient would require an injection in the maxillary anterior region – one of the most uncomfortable places to receive an injection, regardless of dentist’s skill level. This procedure would have likely taken much longer to complete with traditional instruments and techniques, compared to under 30 minutes with Solea. Time savings were achieved without the need to inject the patient and then wait for the patient to become numb. In addition, rapid and easy management of the soft tissue saved time. The patient was excited to avoid the shot, possible post-op pain, and hours of numbness after the appointment.
Deep Troughing for Margin Isolation #5 performed by Timothy Anderson, DDS
This case demonstrates how Solea easily enables virtually blood-free soft tissue procedures without anesthesia resulting in better digital impressions for CEREC restorations.
Case Summary: This patient of record presented to the practice with a failing restoration and recurrent decay on tooth #5. The patient stated that he really disliked being numb and wanted to avoid the injection. As can be seen radiographically and in the pre-op photo, the distal restoration was significantly subgingival. No anesthetic was used during the treatment.
Technique Used: The existing composite and decay were removed using Solea. The tooth was prepared for an Emax crown with the Meisinger CEREC Doctors prep kit. Solea was then used to remove adequate tissue for imagining in a clean, bloodless field. No cord was needed and the troughing took less than 15 seconds. The final scan was taken with the CEREC Omnicam. The restoration was designed with CEREC 4.6 Chairside software. The crown was milled, stained and glazed. Crown was then bonded with Variolink Esthetic.
- Solea enabled the dentist to perform this treatment anesthesia-free.
- With Solea, the procedure was completed in less than 15 seconds compared to several minutes traditionally.
- Solea’s ability to precisely and virtually blood-free trough gingiva allowed for an effortless perfect scan.
- The dentist delivered an impeccable patient experience including not administering anesthetic, a shorter appointment time, and increased patient comfort post operatively.
Results: The key to a successful CEREC same-day restoration is the ability to have smooth clear margins with separation at the time of scanning. Traditional methods, like retraction cord in a single or two-cord technique, increase procedure time and don’t always deliver predictable outcomes. Solea’s unparalleled precision enabled the dentist to sculpt the tissue for restorative excellence and immediately proceed with definitive restoration. Thus, the Solea and CEREC combination allows for the simplified same day dentistry.
Crown Lengthening (Clinical) #14 performed by Timothy Anderson, DDS
This case highlights Solea’s exceptionally clean and precise cutting of soft and osseous tissue that enhances the CEREC’s same day dentistry workflow.
Case Summary: A 62-year-old male patient presented to the practice with very deep decay to the level of the alveolar crest. Tooth #14 required clinical crown lengthening to restore with a crown. With Solea, performing the surgery and placing the definitive restoration on the same day was possible.
Technique Used: To start, the existing amalgam was removed with a carbide bur. Caries was then removed utilizing Solea. A full coverage crown preparation was completed using Meisinger CEREC Doctors prep kit and an electric handpiece, and some minor troughing was performed to expose margins for a final scan without the need for retraction cord. An Emax crown was designed utilizing the CEREC 4.6 Chairside software and fabricated. Crown lengthening was performed during milling and glazing. A minimally invasive flap was reflected with a periosteal elevator. There was minimal tooth structure coronal to osseous crest on the distal and distal-lingual surfaces. Solea was used to remove and sculpt osseous tissue until there was 2 mm of tooth structure coronal to the bone. Positive bony architecture was maintained. Solea provides unsurpassed precision and clear visualization allowing removal of bone without iatrogenic damage. The final restoration was inserted with SpeedCem Plus self-adhesive resin cement. A single 4-0 chromic gut suture was placed.
- Solea’s remarkable precision and improved visualization allowed for removal of osseous tissue without iatrogenic damage.
- Solea enabled complete control of soft and osseous tissue resulting in a very fast and minimally invasive surgical procedure (completed in under 10 minutes with only minimal bleeding).
- The Solea and CEREC combination allowed the dentist to finish the entire treatment, crown lengthening and the crown itself in the same visit – a true “crown in a day”.
- The dentist was able to perform this procedure in-house rather than refer it out.
- The patient was thrilled not only with the esthetic outcome but the speed, comfort, and efficiency, at which the treatment was completed in one visit.
Just wanted to share a 3 year recall on one of our earlier anterior cases. Patient finally allowed me to replace an old existing PFM. What was interesting about this case is the spacing was not the same and we informed the patient of the challenge. She did not want to pursue ortho, so we had to mask the discrepancy with contouring. Overall, I think it turned out well and the material has held up great over the last 3 years. Again, if you are not doing anteriors, get yourself to Level 4 in Scottsdale or Charlotte to get some training.
This was Vita Triluxe done with 1 fire.
3 year Recall:
It's been a while since I've posted anything. Long summer and trying to get back at it. I think for all of us on here, we are thankful for technology and the constant evolution of materials and digital dentistry.
This case I'm sharing is something that all of us see each day. How I approach this today is different than I would have approached this pre SpeedFire and pre-Katana. I simply love the fit of Zirconia and the anatomy right out of the mill. I can be much more conservative with my margin preprations and edge stability of Zirconia during milling is wonderful. The other reason I do a lot of chairside zirconia and Katana is that I love the ability to cement on those deep margins or those patients where it is really difficult to isolate and bond well. (I will say that Kuraray-Noritake does not advocate cementing Katana STML with RMGI) To make myself feel better on these cases where I am not bonding Katana, I am making sure my fissure height on my design is 1.20mm or greater.
So here is a case that I just did. Tooth #30 had gold onlay that came off.
I tend to choose a shade that is one shade darker than I am shooting for. In this case, I wanted to match the shade of the occlusal 1/2 of tooth #29. I felt like that was A1 so I choose A2 Katana STML.
Deep recurrent decay that I removed and built back up to ideal.
It does take extra time but I do think there is significant improvement in esthetics with a Katana crown that has been glazed versus polish only. In this case, I pre-polish my crowns before I sinter them. Post sinter, I lightly air abrade the crown to take away the surface tension so the glaze will adhere uniformly. In this case, I choose to use Empress Stain and Glaze and fire on P4.
I schedule all of my crowns for 2 hours so this isn't really a huge deal for me to spend the extra time for a glaze fire. I tell the patients it will be about a 45 minute wait. During this time I am doing another procedure. I haven't received a complaint from a patient. But our team does prep all patients before they schedule to expect to be at the office for 2 hours.
Overall I'm quite happy with the final results and esthetics. I know there are some that don't have a SpeedFire and doing Katana is not possible, but for those of you that do, I think Katana is a wonderful material and I am using it more and more.
This is just one of those cases that meant a lot to me. This women walked in my practice looking for a third or fourth consult for her front teeth. She was celebrating 1 year of being cancer free after undergoing pretty severe chemo and radiation with low survival rates. She beat the odds but her teeth suffered. She had something to smile about now and wanted her teeth to reflect that. She hated her smile and I was so grateful that she chose me because I wanted to be a part of her story.
Major damage from erosion was done to teeth #7-10. The canines also show buccal erosion and pitting on the cusp tips. She has obvious tetracycline staining as well and in her smile we decided to work from #5-12 knowing that she could always add in #4 and #13 at a later date if she wanted.
When I am looking at the shape of her teeth, I see that the laterals are a bit wide, I want to lengthen #8 and 9 due to the amount of wear and erosion (meaning I have to pay attention to occlusion here) but I really like the overall shape of her teeth.
I set this up in the computer as Biogeneric Individual, but then manually add a BioCopy Upper folder so that I know where her midline, incisal length papillae are.
This is a case I delivered in one appointment and a tip that I have definitely learned over the years is to trust biology. I have a huge fear of black triangles and I know I am not alone. Patients hate the look of having pepper stuck in their teeth and are always asking if we can fix it. It's not an easy task with a tiny bit of composite for natural teeth, and then with crowns, I just used to make these long, broad contacts to avoid it at all costs. The problem with those long, broad contacts is that they just don't look quite right. Now it's this constant struggle in my mind of making sure there is no black triangle and trusting biology to fill in the triangle.
Here is an example of that-
1 week post op and praying to the papillae gods
3 week post op
This was such a fun case for my entire team getting to know this woman who has more courage and strength than I could fathom. She affected every one of my team members in a positive manner and now can't stop smiling. She scheduled to do her lower anteriors in a month and I can't wait. She was an amazing reminder of why I love what I do.
Patient presented wanting his smile fixed. Concerned with the laterals and #5. After 5 years of seeing him finally allowed me to do 7 first. Once he saw it signed up to do 5 and 10 in 2 weeks. When we finished this week he said now he can stop smiling on just one side. 😂 Vita Triluxe 7,10. Empress CAD 5. It is very rewarding to be able to change a patient’s esteem with their smile.
Hope everyone has a great weekend.
Richard has been a patient of mine for the last eight years. He’s 32 years old, single, and an overall great guy. Earlier this year he made a consultation appointment for his front teeth to discuss veneers. When we finally sat down, I asked him what made him decide to move forward with this treatment. He mentioned that he was tired of being single and knew that he needed to do something about his smile if he wanted to feel confident enough to enter the dating scene and find a life-long partner.
We had a lengthy conversation about what he wanted to be sure I could meet his desire. His request was simple: make is teeth white. Overall, the position of the teeth was good; no ortho or soft-tissue treatment was required. As this was a straightforward case and the patient wished to begin treatment as soon as possible, I elected to begin without a wax-up. While this is not my normal protocol, I felt confident I could deliver and the patient would be happy. A pre-op putty was taken and his teeth prepared.
CEREC images were captured and the putty was used to fabricate the provisionals. Even though the temps were the same shape/position prior to preparation, he was quite happy at the fact that his teeth were no longer discolored. Without a wax-up to copy, I decided to send the case to Weston Hatcher and allow him to design it. Weston and I spoke about the case and I let him know what I was looking for regarding facial anatomy (minimal to none), embrasures, etc. The final design was emailed back to me a few days later and the restorations were milled in-office.
After the congratulations, handshakes, and hugs, I walked him to the front door. When he walked outside, he raised his hands in the air Rocky Balboa style and shouted, “I’m beautiful!” Cases like these make all the tough days hard to remember. I wish the young man well in his social life with his new-found confidence. These restorations are Emax BL4 and were hand polished only. I chose not to add any incisal or cervical characterization as the patient’s primary desire was to have teeth that were simply one color.