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I used to restore all of my implants with a TiBase, then Atlantis came along and I found that workflow to be just so easy, that it is now my go to workflow even though it costs more. Almost all of my implant surgeries were with a cg2, but then Azento was introduced and now I'm doing a lot of my surgeries with Azento because the workflow is so predictable. One of the best features of CEREC is that you have multiple workflows for people that want to save money and control every step of the process (I still do sometimes) vs. spending more but having someone else take care of the majority of the work. Best of all, you don't have to choose one or the other, you can do both or pieces of each when it comes to implant placement and restoration.
This is just a routine Azento case where I chose to spend more, but have most of the work done for me.
The first appointment, my assistant did the CEREC and CBCT scans.
The plan was ready in a day and the surgery was the following week.
The patient was scheduled 3 months later for delivery. One week before her appointment, my assistant pulled the core file into CEREC, designed a standard crown on the included abutment, and cemented to the abutment that came with my Azento case to deliver a screw retained crown.
My total involvement was approving the Azento case, doing the guided surgery and placing the custom healing abutment (20 minutes), and seating the screw retained crown (10 minutes). I for sure could have saved money milling a cg2, scanning a scanpost and designing a screw retained crown, and the result would have likely been just as good, but I would have been much more heavily involved time wise in the whole process. Sometimes it's ok to be a little lazy :)
COLTENE BRILLIANT Crios Reinforced Composite Bloc is the Ideal Choice for Permanent Single Tooth Restorations
Ivoclar Vivadent Introduces First-Ever Intelligent LED Curing Light
New Bluephase®G4 offers automated assistance system
Ivoclar Vivadent announces the introduction of the new Bluephase®G4, the first intelligent LED curing light. Bluephase G4 automated assistance system detects if the handpiece moved during the curing process and the restoration can no longer be cured reliably. Depending on the extent of movement, the Bluephase G4 Polyvision™ either emits a vibration alert to inform the operator of the error and, if necessary, automatically extends the curing time by 10%, or—if the handpiece moves too much (e.g., slips off the tooth)—interrupts the curing cycle by automatically shutting off so the cycle can be repeated correctly.
Like its Bluephase Style predecessor—the top-rated LED curing light for the last six years—the new Bluephase G4 features Polywave™ technology to enable curing of all dental materials. With the addition of innovative Polyvision™ technology, the uniquely stylish, user-friendly, and efficientBluephase G4 facilitates reliable and complete curing during polymerization procedures.
Reliable, Efficient Curing
The Bluephase G4 features a light output of 1200 mW/cm2, Polywave LED technology in a broadband spectrum of 385 to 515 nm, and a 10-mm wide light guide with a homogeneous beam profile. Additionally, the curing light is also equipped with anti-glare protection to prevent activation in open space. Combined, these capabilities contribute to exceptionally efficient use, high-quality results, and short procedure time.
Overall, the new Bluephase G4 LED curing light promotes easy handling and discreet assistance for reliable curing results and satisfied patients.
About Ivoclar Vivadent
Ivoclar Vivadent is a global leader in innovative materials and processes for quality, esthetic dentistry. The company employs over 3200 people and operates in over 120 countries throughout the world. Ivoclar Vivadent is headquartered in Schaan, Liechtenstein. Its North American headquarters is based in Amherst, NY. For more information, call 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada.
For further information, please contact:
3M Raises the Bar in Same-Day Dentistry
New chairside zirconia optimizes strength, esthetics, process speed
for crowns and bridges
ST. PAUL‚ Minn. – (Feb. 4, 2019)– Chairside CAD/CAM dentistry has promised convenience since its inception, including the advent of the single-visit crown; however, with convenience can come compromise. While software and equipment technology has advanced continuously, materials have struggled to keep pace. A strong material might appear lifeless in the mouth, while a more esthetic material may crack or fracture. Recognizing the need for a well-balanced alternative that maximizes new high-speed sintering technology, 3M is introducing 3M™ Chairside Zirconia – a new CAD/CAM zirconia block optimized for the fast-sintering CEREC® SpeedFire Furnace1. The new block offers an optimal blend of high strength and esthetics to go along with a fast sintering time of approximately 20 minutes2,3for a thin-walled crown.
“The esthetics and better sintering time of 3M™ Chairside Zirconia have made this my go-to zirconia material,” said Daniel Butterman, DDS. “It polishes very easily and has a good level of translucency. I see no need to glaze this material.”
For easy shade matching, the material is available in eight different shades and two block sizes designed for crowns and three-unit bridges4to match the VITA® classical shades. Additionally, dueto its low minimum wall thickness of 0.8 mm, dentists are able to carry out less invasive preparations and preserve more tooth structure.
“The overall promise of chairside dentistry has always been efficiency in a single-visit appointment,” said Karen Burquest, Global Business Leader, 3M Oral Care.
“Our new zirconia is designed for high-speed sintering to deliver even more efficiency without compromises in strength or esthetics.”
3M Chairside Zirconia offers a high flexural strength option of over 800 MPa, and has a fracture toughness that meets stringent ISO standards. This gives it ideal strength for single-unit crowns and three-unit bridges.
The cementation process is simplified, as well, with the option to use either 3M™ RelyX™ Luting Plus Resin Modified Glass Ionomer Cement or 3M™ RelyX™ Unicem 2 Self-Adhesive Resin Cement. These easy to use, reliable cement options offer trusted solutions for your chairside zirconia needs.
3M Chairside Zirconia will be featured and available for pre-ordering at the Chicago Midwinter meeting February 21-24, 2019. 3M Chairside Zirconia will officially launch at IDS in March. Product will be available for sale in the US on May 1, 2019.
For more information about 3M Chairside Zirconia, please visit 3M.com/ChairsideZirconiaor call 1-800-634-2249.
1 3M provides sintering parameters for ovens capable of sintering zirconia in less than 2 hours. Please review the 3M Chairside Zirconia Instructions for Use for sintering details.
2 CEREC® SpeedFire furnace, restorations with particular designs (parameter integrated in CEREC® software; wall thickness 1.2 mm or less).
3 19.6 min for small, thin walled crowns; 22.4 min for all other crowns.
4 With one pontic supported on each side by a crown.
About 3M Oral Care
3M Oral Care promotes lifelong oral wellness through inventive solutions that help oral care professionals achieve greater clinical, professional and personal success. Learn more at 3M.com/dental.
At 3M, we apply science in collaborative ways to improve lives daily. With $32 billion in sales, our 90,000 employees connect with customers all around the world. Learn more about 3M’s creative solutions to the world’s problems at www.3M.com or on Twitter @3M or @3MNewsroom.
3M and RelyX are trademarks of 3M Company. All other trademarks are property of their respective companies. Used under license in Canada. © 3M 2018. All rights reserved.
3M Oral Care
2510 Conway Avenue
St. Paul, MN 55144-1000
Karwoski & Courage
Hello friends. #30 appeared to be unrestorable and the patient adamantly declined an implant.
Can "Herodontia" be used for treatment plan "phasing?"
We took a cbct scan to evaluate whether we could even keep the RCT in house and did not refer.
After a review of symptoms and pulp vitality testing we began the procedure and here is what we saw after we removed the PFM crown.
After gross decay removal we were all shocked the nerve was not exposed or even blushing.
Because Zirconia is so biocompatible with soft and hard oral tissues; we can place the crown quite subgingivally with great success.
Of course, the very guarded prognosis was reinforced again at the end of the appointment and the patient stated,
"Well, when this fails I want an implant"
The moral of the story is; "Herodontia" can be part of "Treatment Plan Phasing" that allows the patient to become more comfortable with previously refuted options. He was not mentally prepared to go from a crown straight to an implant. Despite my most thorough advisement; his previous dental knowledge, exposure and experience required him a stepping stone to the implant psychologically.
We all know CEREC is capable of producing great aesthetic results, makes restoring implants easier/faster, and can even mill surgical guides in office. For me, one of my favorite procedures is the same day root canal, build up, and crown. I know the clinical situation doesn’t always allow it, but when it does, I find that CEREC allows me to leverage my time for both the benefit of the patient and myself.
Last week, this patient appointed for an OB resin on tooth #30 and a root canal, build up, crown on tooth #31. The appointment was scheduled for 7 AM and the patient was out before 9. The appointment workflow looks something like this:
- Seat/numb patient (1 septo)
- Capture pre-op images of the opposing arch, BB, and mandibular arch.
- Use the cut tool to remove tooth #31.
- Deliver second carpule of anesthetic (septo)
- Place IsoDry.
- Prepare #31. I didn’t have to spend much time searching for the canals as the decay already involved in the pulp chamber. Also, reviewing my CBCT prior to treatment let me know exactly how many canals there were. As I know I’m doing a root canal, I don’t have to be timid about my occlusal reduction. As you can see, this is anything but a traditional prep. I would guess my prep took ~10 minutes. I don’t want to image with the pulp chamber opened, so I placed some packable resin and just took a few seconds to smooth it, simulating my core build-up (don't bond this into place).
- Capture CEREC images and pass the AC unit to my second assistant to design, mill, fire the restoration.
- Place rubber dam, remove resin in chamber, start RCT.
The RCT is relatively quick as I had already found my canals. Also, using my CBCT to estimate canal length and an M4 handpiece making getting to length relatively easy. The crown is usually out of the oven when I’m finished and is ready for try-in. I always seat the crown and let the patient see what it looks like to get their approval. After that, it’s prepared for bonding. The IsoDry is placed again in the crown is bonded in place. The resin on #30 can be completed at any time; before CEREC images, after bonding crown, etc.
The power of certain comes into play in that the crown preparation is completed prior to the RCT. If I find that I can’t get the canals dry or I need a second appointment to complete the RCT for whatever reason, I will usually mill an MZ 100 and bond that in the interim.
I was organizing some case photos and ran across these pics.
The first set of veneers were done back in 2007 with the Redcam using Vita Mark II blocks. The new veneers were done in 2016 with the Omnicam using Vita Triluxe blocks and I added staining at the incisal edge to give it the halo effect. I love to to characterize but sometimes there is beauty in the simplicity.
I did not redo these veneers because they were failing. I redid them because my skills improved and I knew I could do better. This is my charside assistant who I stare at every day and I was so happy she let me redo them. She shows them off to patients all of the time when they are nervous about getting restorations done in the anterior. She is one of my best marketers!
Going on 13 years of being a CEREC user and I still learn tips daily on how to make my restorations better and increase my skills as a practitioner. I love what we get to do every day!
So we had a patient arrived today as he heard weeded we did the same day crowns. He presented with some severe perio & class III mobility on tooth number 10. Patient stated that he is a teacher, goes back to work tomorrow and couldn't as he was. The tooth literally waved in the wind as he spoke to me. Yes, he was informed of his perio condition and the need to return for a full, comprehensive exam but he wanted his chief complaint address today. Here's his PA:
Solid as a rock.
We took a bio copy image of the tooth, extracted # 10 and imaged the site. I milled out a CeraSmart A1 and stained the cervical using my Cosmedent kit. I’ve seen a few cases completed by Kristine Aadland and I attempted to follow her lead; I failed. However, the patient was thrilled.
The restoration was delivered using Variolink DC and the patient left with an appointment for a full, comprehensive exam. With the neglect I observed in his mouth, I’ll be surprised if he returns. One can hope. The point of my rambling is this: we have amazing technology at our fingertips. No way I could work this into an already busy schedule without CEREC. Even after 10 years, this technology still amazes me.
I'm sure many feel like anteriors can be a labor of love, especially handling single centrals. I never feel like I charge enough for some of these cases. Here's a case I completed today. This was a college student who was heading back to school on Sunday and his family wanted me to complete his case before he headed back. He had some trauma to #9 about 7 years ago and had it repaired by his pediatric dentist. He also plays the clarinet competitively as well and the asymmetry between #8 and 9 was causing him some frustrations with his mouthpiece. Because of his scholarship for music, he had zero interest in orthodontics.
So when I see cases like this, I'm trying to plan the case before I touch the tooth with a bur. Mike, Sam and Flem really do a great job of getting you to develop a gameplan before you tackle these cases in Level 4. Prep design, Facial reduction, core color, occlusion, block selection, characterization, etc...
As you can see, the VITA Classic Shade of A1 is close in color to the adjacent tooth #8. I choose IPS Empress CAD Multi for this case and even though Empress to me tends to be a little brighter, I chose a B1 Multi block for this case. I know that with less facial reduction and the goal of trying to preserve enamel, I will get a value drop on these cases. Your facial thickness of porcelain is critical to take into account on all of these cases. If you ignore it, you can get burned quickly, ask me how I know.
The preps look aggressive but the facial reduction is minimal 0.5-0.7mm. I almost always break contacts and I try to have smooth, rounded margins to help allow the restorations to drop into place and have a great fit with CEREC. This case was stained and glazed with Empress Stain and Glazes and fired on P4. I missed the texture a little on this case and width could have been better as well. Overall, I would call the case a success with a happy young man and family before he heads off to college.
I don't normally work on Fridays but will come in for big cases. Today I was coming in to do a hybrid case with the periodontist in my building and as I was getting ready I got a panicked voicemail from a patient that she broke her veneer on her front tooth ("you know the one you were telling me that I would need to fix?"). No one wants to go through the day, let alone the weekend, with a broken tooth so I told her I would meet her in the office.
She did a great job at busting off half of her veneer on #8 and you can see the decay at the margins of #8 and #9. She also had this funny composite on #7 and didn't like the lingual tilt of #10 so she asked if there was anyway we could fix them all today... Sure! I felt like crowns on #8 and #9 were more appropriate given her bite and did more like an aggressive veneer on #7 and #10 because I didn't want her to break those. She wears a night guard but obviously has some grinding habits.
So we got her all fixed up with 4 restorations. I chose to do e.max BL3 HT mainly because it is what I had available in my drawer. I think Vita would have been a great block choice here too, but I do like how the e.max turned out. I used white stain to give the halo effect and small decal marks and then I mixed the I1 and I2 translucent stains for the translucency just to give it a bit more pop. This is a same day seat photo and I can't wait to see what it looks like with the tissue healed all the way.
Everyday I get to use my CEREC I am a little in awe of what we can do in our practices. This case took me 4.5 hours from her being seated to her walking out the door. The new updates with 4.6 have definitely sped up my design process with the new 5-click features. She knew she was going to have to sit for a bit but was ok with that because we were taking care of her last minute and she didn't want to go without teeth.
Now I get to deliver a hybrid conversion and change another smile. Today is a really good Friday!!!