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chairside-milling dentists reduce remakes with the wrong shade. 

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23 Apr 2018

With the release of Noritake Katana STML Zirconium block at Chicago Midwinters, there has been a buzz around the product and on the discussion boards of CEREC Doctors.  Could Katana replace eMax  for posterior restorations? Can it be as beautiful as the eMax we all have grown to love? Can Katana STML still be a single appointment chair side material? Could it be used in the anterior?  The simple answer is YES to all the above!

After using the material in my practice, I have enjoyed the beauty and precision fit Katana STML Zirconium offers. I want to share some time saving tips and tricks to help new Katana users be as efficient as possible. The processing time needed to complete a Katana STML restoration is slightly longer than eMax or CEREC Zirconium.

Total processing time for Katana STML:   16 mins on Fast Mill (dry), 30 mins Sinter in Speedfire oven, 9 mins spray glaze vs 8 mins polish= ~60 mins

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Total processing time for Emax: 14 mins on Fine vs 8 mins on Fast Mill, 15 mins in the CS2/3 (20+ mins in the SpeedFire) = ~30 mins with Ivoclar oven ~40 mins with SpeedFire

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Katana is going to take ~20-30 mins longer processing time than an eMax restoration of the same size.  Since you cannot try in zirconium it does save you a little time during the post mill protocol.

Tips with Katana STML:

Always FAST MILL Katana: As soon as the initial proposal appears click on the restoration parameters and verify or change the Spacer to 90-100 microns, Min Thickness Occlusal to 800 microns and the Margin Thickness to 100 microns.  This allows the restoration to be Fast Milled in the Manufacture Stage. Do These Changes in Local Parameters BEFORE your design! DO NOT Design and then change your Local Parameters! It wastes time if changing one of the parameters cause a recalculation of the proposal. 

BE Efficient with your Design Time: Zirconium designs should be quick! (less than 5 mins) The initial proposal should be 85% completed when it first appears.  If not then there may be something else wrong. (inadequate reduction, model axis is setup incorrectly, bad buccal bite) 

Manufacture Stage: Have Katana Block Code Ready! Fast Mill Selected! Cerec Speed Fire Selected!Position restoration in block with the Move Tool to get desired translucency!

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When the design stage begins, have the correct block placed in the mill and have the 7 digit code written down and handy at the Omnicam.  Move through this stage as quickly as possible.

Post Milling Handling: Waste no time removing the restoration from the block and polish away the sprue.  A red stripe football shaped diamond and a fine polishing diamond are pictured below. These are my go to burs for removing the restoration and the sprue. 

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 Notice the MCXL, air water syringe, and the hand pieces have been disconnected from any water supply.

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This ensures no moisture can contaminate the Zirconium.  We keep hand pieces and a large brush close to the mill and Speedfire oven. This prevents my team from running around and allows them to be more efficient.

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Place restoration cusp tips down on the firing tray when sintering zirconium. embedded image 

The 15 min extra sintering time is unavoidable so we need to keep the other steps moving along without any lags or delays. 

Glazing Katana vs Polishing: USE CEREC Zirconium Glaze Cycle to save 19 mins vs the Katana Glaze Cycle.  We use Indenco Spray Glaze or Enamelite. embedded image

These glazes can be used on Katana STML and run on the CEREC Zirconium Glazing cycle.  The CEREC Zirconium cycle will cool and glaze in ~10 mins.

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IF you accidently press glaze on the Katana cycle just cancel and go back and select a Cerec Zirconium Glazing cycle.

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 When the Speedfire is still hot from sintering the Katana it will take ~29 mins to run the Katana Glaze cycle. embedded imageembedded image 

These CEREC Zirconium glazing cycles can be used 3 times each.

I personally find that the spray glaze restoration looks more like a natural tooth or eMax restoration than the polished Katana STML block. But the darker the shade needed the more the polished Katana looks true to the shade when compared to eMax. You can see this in the photos below.

EMax A1LT, Katana A1 Spray Glaze (SG), Katana A1 Polished (P) vs eMax A3LT, Katana A3 (SG), Katana A3 (P)

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In this next photo you can see the Katana A1 Spray Glaze next to the Katana A1 Polished with the eMax A1 LT Spray Glazed below them both. Also shown is Katana A3 Spray Glazed next to the A3 Polished with the eMax A3 LT Spray Glazed below.

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Do not over polish the Zirconium if you do not like the iridescent shine. The far right crown has been slightly over polished in my opinion. If you go back with the pink polishing wheel it will dull down the iridescence. 

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Here is a case I recently completed with Katana STML. Crown on tooth #3.  This case was a biocopy design case.  It was completed in under 2 hours with polishing as my finishing technique.embedded imageembedded imageembedded image embedded imageembedded imageembedded imageembedded imageembedded image

Using these tips and tricks I have kept my Katana STML appoints to 2 hours or less! This has made working with Katana STML predictable and fun! I personally love this material and the extra processing time can be easily managed in a single appointment using the SpeedFire Oven. 

Let me know if I can answer any questions you may have.


Yes, it's true.  Love seeing something like this on the schedule; 18-MO, 19-MOD, 20-MOD, 21-DO.  Why?  CEREC.  Prior to having my CEREC system, a quadrant of CL II direct composites was not cause for celebration.  Why?  Because I would be tied-down to one operatory, start-to-finish, unable to do another/more profitable (and fun!) procedure.  Sorry, but tinkering with matrix bands, wedges and clamps doesn't excite me.  And sometimes, despite my best efforts, I'd remove a matrix band and find a void or open contact or...

With CEREC, my attitude (and how I approach the case) has completely changed.  Let's look at a recent case:  

 

Carmen presented with failing amalgams and interproximal decay in the LLQ; #18-MO, 20-MOD, 21-DO

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My workflow with CEREC is fast, predicable and results in better restorations that I can provide by hand.  In this case, I designated #18 & 20 as BIOCOPY restorations using the 3M MZ100 blocks.  These blocks are resin, not porcelain.  And unlike a composite that I place in my office, these are already polymerized; no shrinkage.  The result, better fit and longer lasting.  

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I delivered anesthesia and captured BIOCOPY images.  

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I prepared both #18 and #20...initial designs.  

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Only small changes were required before both designs were complete.  To leverage my time while the restorations were milling, I prepared #21.  Once #18 & #20 were seated, I built the contact against #20.  

 

Take Homes:

1.  Don't forget about the MZ100 blocks.  I find them useful for fillings, tempoary crowns, etc.

2.  If you have an EDDA and your state allows it, have them mill/deliver the restorations.  

3.  CEREC allows you to leverage your time.  While the restorations are being designed/milled, you're free to perform other dentistry.  

 

19 Apr 2018

Michael and Aaron,

As a general rule the longer you wait for bone grafts to heal the better. I always laugh when folks say they re-enter a socket graft after 3 months. I would always wait 1 year or more if I could but that's not practical so I typically re-enter at 5-6 months depending om the size of the defect.

In this case if the bone was solid at re-entry then all is good and the seam may just be less dense bone. However, in my experience if you see a seam like that then the bone graft is mostly soft/mush and will never really integrate. Remember that the healing of the bone graft occurs from the host bone so if there is a discontinuity there then that's not a good sign.

Couple of tips: In a big defect such as this one make sure the defect is thoroughly debrided and completely void of any residual soft granulation tissue, use a non-resorbable PTFE membrane instead of a resorbable membrane (resorbable membranes are not that predictable in my experience), and when you place the implant then place a 2mm healing cap instead of a cover screw (makes your life easier at uncovering).

Farhad

​P.S.: Is Gate$ really spelled with a $ sign? Of course it is.

19 Apr 2018

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I am looking forward to delivering this case after using the Atlantis workflow.  Once my Atlantis account was set up correctly, it's not only about the weborder.com setup, you need to let Dentsply Sirona know to set up your account for Omnicam scanning. 

Once the approprate accounts are set up the workflow is a breeze and importing the Core File and using Biocopy is flawless.

The crown is Katana A1 STML, glazed only.  The Atlantis Zirconia abutment is shade 20.  The implant is Straumann 3.3 bone level.

I will post more photos once the crown and abutment is seated in the next week or so.

 


I have had mixed feelings about the Katana (especially vs e.max cad) since using it.  On one hand, the Katana STML looks and fits fantastic.  On the other hand, you can expect it to take a good 20-25 min longer than a typical e.max (if glazed) and a little less if polished.  I have gone back and forth if the time is worth it.  After using it for awhile, I found myself starting to go back to e.max CAD due to the time.  After a little more thought and clinical results, I have decided that in a lot of cases, it's worth the extra time.  The stuff just looks and fits fantastic...AND there is better detail.

That being said, the other question is should you glaze or polish.  I have done both and they both work out nicely, but I have realized that you have to be a bit careful about shade when deciding how you want to finish it.

As a general rule of thumb... polishing zirconia tends to produce a pearl effect, but it ALSO will lower the value.  For that reason, I would tend to choose a shade that matches the shade you are trying to achieve (when polishing). As you can see in the slide below, the company recommends one shade brighter when polishing due to the decrease in value... but that might be overkill. 

If you are glazing, It will increase the value and make it brighter.  In that case, I would choose a shade one to maybe even two shades darker than your target shade.

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Here is a case that illlustrates that.  Both were done in A3 Katana STML.  Tooth #13 was polished and tooth #14 was glazed.  Both were clinically great... but notice the lower value of tooth #13 that was polished.

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I hope this helps


One of the greatest advantages we have as Cerec Doctors is the ability to conservatively treat caries without having to cut the whole tooth down. Nice smooth margins, no undercuts, and a really clean Cerec scan is key! .

Here is a case using Cerasmart A1 HT.

I like to pack a 00 Cord, then a size 1, after 2 minutes I pull the second cord.

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No adjustments needed!

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Immediately post cementation. In a few weeks time, these just disappear!

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27 Mar 2018

On 3/27/2018 at 1:46 pm, Mark Stockwell said...

Nice case Bob... no matter how much time  

Mark

100% agree.  

 


Register HERE for the Webinar

Expand Your CEREC® Capabilities with Confidence: New Treatment and Restoration Innovations

​March 29, 2018 5pm PST - California Time

Move beyond posterior crowns and learn new treatment innovations and material options for higher ROI. In this practical web clinic, you'll experience step-by-step protocols to confidently expand your chairside treatment with single-visit implant restorations, bioesthetic anteriors, zirconia considerations and more. Plus, novel cases and integrated workflows will be presented that can differentiate your practice while elevating the standard of patient care.

" Treatment plan single-visit implant restorations for long-term success
" Deliver the most bioesthetic, natural anterior cosmetics 
" Review available zirconia material options and shade considerations 
" Gain staff acceptance and implement immediate workflow improvements 
" Increase patient conversions and satisfaction for referral growth


 

18 Mar 2018

So although I am a Mentor and a Trainer for HS, I have enjoyed sideline status for a while being busy in private practice and soaking up many discussions here on CD.  Thanks to this forum and many great dentists to both educating and pushing my envelope.

I just got involved with a case the other day that allowed me to use many of my Cerec Tech skills that non-Cerec dentists may find challenging ways to accomplish, but certainly not the same way that we as a Cerec dentists would.

Patient A came in for Recall and had areas of recurrent decay as he usually does due to his less than ideal home care and reveals that he never restored tooth #8 which on prior recalls had a carious lesion.

The pre-op xray shows the extent of the decay and the photo of #8 and provisionally restored with a Cerec Milled Cerasmart crown.

After it was explained to patient A that #8 was not restorable, it was explained that at time of extraction an implant would be place and a temporary tooth would be placed on the implant as long as we could get adequate stability and as long as he understood that this tooth was NOT to be used for any reason other than smiling.  

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CBCT planning was performed merging Cerec data and CBCT data.

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After implant planning was performed, exporting the file cmg,dxd file back to the Cerec software allowed me to create and milled Cere guide 2 for implant placement prior to extraction.

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Patient A returned a few days later wearing the provisional that was created at the prior visit.  That provisional was removed just before the tooth was extracted so it could be used as the immediate load temp.

The extraction was performed and the guide placed.  After the initial osteotomy was created and guide pin was place an x-ray was taken to confirm position.

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Completion of the osteotomy was done and the Straiumann SLA Active implant placement was completed.

Just to confirm position I inserted the Straumann implant delivery abutment.

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At that time a Strraumann temp abutment was inserted and noted where it needed to be modified to allow for the temp to be luted to it.

The final photos show the completed implant placement and the screw retained provisional.

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Contacts were adjusted to remove any touching of adjacent teeth and because his overjet allowed, no contact with the opposing teeth was noted.


​He will be seen for a 1 week post op and regularly for 4 months until integration is completed.