Blog Recent Articles
Here is a patient that recently came to me frustrated because she had three different dentists try to fix her front tooth and the shade was "never quite right." She had pretty severe trauma that resulted in a root canal and it needed full coverage due to missing tooth structure.
Anytime I hear that a patient has gone to multiple dentists I get a little nervous. She was upset because the first dentist "cut down her tooth a lot" and "it turned black underneath." She lost trust in the first dentist and went to the next dentist where other problems kept happening. One of the other dentists referred her to me to see what I could do.
She liked the shape of the tooth, but the crown was definitely bright. Part of the problem I saw was that her teeth were pretty translucent and the previous dentists kept trying to use zirconia to mask the darkness of the prepped tooth. This is when opaquers come in so handy!
I applied the pink opaquer to mask the black and then used buildup material and A1 opaquer to make the substructure appear more natural.
I milled out both an e.max B1 MT block and a Vita Mark II, 1M1 block for this case and I ended up using the Vita block. I wasn't worried about strength as much as I was about the color. The Vita tended to have a little more warmth in it than the e.max.
I warned her ahead of time that I couldn't get rid of the greyness of her root showing slightly at the gums, but with her smile I think it masked pretty well. The opaquers were my saving grace for sure in this case.
Here is one more reason why I love CEREC!
This is a young woman who isn't quite finished with ortho but has senior pictures coming up and pictures trump finished occlusion so I discussed it with the orthodontist and she didn't see a reason why we couldn't restore the laterals.
What I love about this case is that it is about as conservative as you can possibly get. My assistant pumiced the tooth, imaged and then started the design process. I finished the design, we milled it with GC Cerasmart, polished and bonded them on. I did nothing fancy with this case- no characterizing, just contouring and polishing. It was efficient and effective.
Implant crowns are by far my biggest ROI when using my CEREC and I love not only how simple the process can be but how gorgeous they are. I schedule my patients for two, 30 min appointments and often they are out the door before that. My assistants do the initial scanning, the initial design, and then I check it and make sure I like the emergence profile and push mill (this way I can say I made it ;). My assistant places the crown on the Tibase and we get the patient in within a few days at the most. My personal time with the patient is typically about 10 min unless there is a hiccup. It's amazing.
We have really been trying to focus on just taking a few minutes to contour and characterize all of our restorations instead of racing from the mill to the oven. It's so much fun for my team to see what they are capable of doing and it really does just take a few extra minutes.
If you are not doing implant restorations, do yourself and your patients a favor and take level 3! You will love the results!!
Check out this upcoming webinar!
The introduction of a highly translucent zirconium-reinforced lithium silicate glass ceramic foundation, supporting average biaxial strengths of over 541Mpa will be presented. Be one of the first to learn about the benefits of milling a partially-crystallized material without a lengthy workflow process that may compromise marginal integrity. This “Out of the Box” silicate material will help you meet the patient needs of strength, shade reproduction, minimally invasive preparation, with ideal translucent esthetic results. Clinical case indications, cementation protocol and results will also be showcased.
Program Objectives Include:
· Understanding of available chairside materials to meet patient indications.
· Learn streamlined digital chairside process flow to minimize post-mill adjustments.
· Streamlined processing of lithium-silicate restorative materials.
· Effectual “color correction” staining techniques to reproduce a shade tab.
· Long-term success through effective cementation protocols.
When: March 28, 2019 at 5pm MST
Register through this link: https://zoom.us/webinar/register/d704f87f6f0ffb79c5b9141539e44ee6
Considerations for High-Temperature Sintering Furnaces
Why a High-Temperature Sintering Furnace Could Work for You
By: Dr. Steve Ozer
For most of our decisions as clinicians and business owners, the motivation is “how will this impact those I treat?” Whether it’s investing in updated technology or implementing new procedure methods, the decision must prove mutually beneficial for the practice and patient. That’s what got me into chairside dentistry 14 years ago. Keeping the restorations in-house was attractive to me from a cost standpoint, but more importantly, it enhanced the patient experience by eliminating the second appointment to remove temporaries and fit the lab restoration. It was nice to be completed faster, for both parties.
More than a decade later, I’m still experiencing the benefits of the chairside investment and that is what pushes me to continue to expand to innovations like high-temperature sintering furnaces. I’ve found that this new device complements my existing chairside workflow, while increasing efficiencies overall.
Know how you want to use it
Two years ago, I introduced a high-temperature sintering furnace into our process because of its capacity to sinter zirconia. My practice uses an oven for staining and glazing, and a four-motor milling unit to perform the dry mill of the zirconia. High temperature furnaces certainly have universal capabilities and can serve a dental office in many ways, but for our needs, specifically, we were excited by the sole purpose of firing zirconia for small three-unit bridges and single unit crowns.
The furnace I use is the CEREC®SpeedFire by Dentsply Sirona because it is extremely quick as indicated by the name. It has the capability to dually sinter and glaze, and it reaches high temperatures fastto reduce downtime waiting for the outputs. This furnace is also the smallest of its kind available on the market. I appreciate this smaller footprint given that I have other ovens and chairside equipment I use in combination with the SpeedFire, but I don’t have to devote scarce space to house it.
Find the right materials
The choice of material used in the furnace has the power to drastically affect the final outcome. There are many factors that all contribute to the material selection and that may require a trial to know what works best. Some factors I examine are the prep design, the esthetic requirements, and strength.
For second molars, I lean toward using the strongest material available. Ideally, you find a material that is well-balanced in terms of strength and esthetics.
As more new materials are developed and introduced, the efficiency of high-temperature sintering furnaces will be invaluable. Using a new material in an old furnace could take up to 90 minutes to heat and completely cool. With a furnace like the SpeedFire, it would be closer to 20 minutes for the same material.
Despite where our comfort levels may lie, the industry is changing and will continue to push forward. The best reaction we can muster, even though it may be hard at first, is to get involved. Learn the new technology and jump in head-first because it’s not going backward. If we continue to invest in modernized materials and machinery, we’ll look back and appreciate the value and reap the rewards.
My cerec unit made what could have been a very difficult case very routine.
1) The patient has max and mand tori the size of boulders. Good luck taking impressions!
2) The patient needed the crown retrofitted to a partial. Thank you Biocopy! While I didn't have the entire crown, I had what I needed for the crown to fit the partial!
3) I hate prepping lower anteriors! This case I didn't have a choice. Extra fine mode milled this tiny tooth to perfection!
This patient was unhappy with the appearance of her teeth; crowns on teeth #8,9 were too wide, multiple stained/failing class V resins, and wear facets.
A wax-up was ordered, patient viewed it, approved the design.
Teeth were prepared, wax of design was transferred to the teeth. Occlusion checked/adjusted.
Patient was seen while in temporaries to check function and esthetics. She requested changes as they appeared "too masculine." Incisal edges were rounded and embrasures opened to soften/feminize the teeth. Eight Empress restorations were milled and hand-polished; no glaze. Final photograph is three months post-delivery.
1. Start with a wax up.
2. Use reduction guides to ensure that you remove enough tooth structure
3. Have the patient 'test drive' the provisionals; use this time to evaluate esthetics and function.
4. Once the patient is happy, simply copy what's there. All the guesswork is removed from it.
5. Don't be afraid of using CEREC for anterior cases. Take the Level 4A hands-on workshop & see what's possible.
I am posting this for a couple reasons:
1. This is the first full mouth reconstruction I have done with Primescan. It was amazing and yes MUCH easier than with Omnicam for comprehensive treatment
2. We have has many questions as to what we are doing in our 4B course we have now available. THIS IS ESSENTIALLY IT! How do you execute larger more comprehensive cases with a digital workflow. If you are interested in this, I encourage you to attend. I will be answering any questions you may have on this thread... but nothing replaces a workshop on advanced topics like this.
So some brief background. This patient had two rounds of ortho and orthagnathic surgery. She had previous veneers that were destroyed over the years and with ortho (removing brackets, etc...) and she wanted a new, yes BRIGHT smile, and needed her occlusion restored.
I executed this in two visits....yesterday and today. Exhausting days for sure, but was able to complete it because of proper planning and knowing how to execute it. I just completed it, so the pictures are immediate post op.
I will post the pictures below and we can discuss it however much you all would like:
To get to the second one...
Patient is going through an extensive treatment plan but was concerned about #7. He stated he feels like he has a hole there when he smiled, and because it sat so far back, it was dark. He is not interested in ortho but asked if we could “bring it forward.” He wasn't interested in #10 before this, before anyone asks. We were able to help him out today and now he is ready to do #10 interestingly. Very minimal prep on facial and I’ll try and dig up prep photo tomorrow.
Felt like value is slightly low. Assistant did a great job with block selection and stain and glaze. One critique may have been we could have used a lighter cement. Great to take photos after these to learn and critique your work.
Block is Vita Triluxe 3m2
Try In out of miller