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22 Aug 2019

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. embedded imageembedded imageembedded image

Hope everyone has a great weekend. 

08 Aug 2019

Posted by Michael Snider on August 8th, 2019 at 08:02 am
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I know there has been quite a bit of discussion on the boards in regards to the Azento procedure, costs, etc.   But, every time I restore one of these cases I am so impressed.  

This patient presented with a symptomatic #19 with existing RCT.  I explained to the patient that the root canal was failing and our best solution was to restore the area with an implant.  

The PA really didn't communicate the area of infection to the patient.

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But, this is why I love having the CBCT in the office.  The ability for co-diagnosis with the patient is much easier.  

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The tooth was extracted and socket preservation was completed with prf, sticky bone, and long term resorbable membrane.

Pt returned 6 months later and was scanned and Azento was used for the planning process.

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I really like the design of the guides with Azento that allows for the window on the lingual.  Access with the drills when performing the osteotomy is greatly improved.

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The procedure is so slick with the keys being built into the the actual drill.   Start to finish this case took around 20 min.  

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The best part of this procedure is the restorative component. 

This patient returned this morning.  The custom healer was removed and the custom abutment was placed.  There was no need for anesthesia or releasing incision as the custom healer and the custom abutment have the exact same emergence profile.

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Using the core file we were able to mill the final restoration before the patient came in to have the final abutment placed.  The fit is excellent.

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The new pricing structure with Azento and the efficiency associated with this procedure, now makes it a no brainer for me.

 

 

 

25 Jul 2019

Some years ago I kind of desisted to do more than 2-4 anterior or cosmetic cases in the office. For time, results or whatever reason. Since prime scan came out, I started to push its limits and that along with the evolution last years in digital design, 3d printing evolution has encouraged me to  do this cases again in the office, with a little help of a DT friend of mine we have been doing this cases lately with very nice results. Saving lots of time and money without sacrificing results.

So basically we take all the data, scans, (prime/3shape) pictures. The digital wax up is done either Inlab or meshmixer.   Print for mock up/temp, prep and biocopy (nothing new about that. I also take a quick pvs to finish up contacts and adjustments, also print a resin model. This case was done with empress multi BL3

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Over the last few years as I have become more involved in the CEREC community, I have had the pleasure of being surrounded by some incredibly talented dentists. Often these dentists will show me their cases and I am constantly in awe of what they have accomplished in such a short amount of time using their CEREC. What I love even more is their drive on how to improve their skills even more. My constant push (and often harassment) is to get these doctors to post their cases but posting can be intimidating. I hear over and over the same reasons why doctors won't post cases: "my work isn't good enough", "I don't have anything new to share", "people can be mean in their feedback and I don't want to be bullied", etc... As a CEREC doctor we take a lot of pride in our cases because often we create them with our own hands, so getting feedback feels personal. My point in this post is to show a progression of what you can do if you are vulnerable enough to put yourself out there and try.  

Here are some of my early cases starting in 2010. I happen to have a really poor post-op photo of my very first anterior case. I was so proud of this when I first began using my CEREC. 

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One of the best pearls I got in a class was if you want to improve, start taking pictures of your cases, so I did. The problem was my photography wasn't stellar and I still didn't know what I was looking for to be able to make improvements. These restorations definitely made improvements in each of these patient's smiles, but now when I see these cases... worried 

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Jumping ahead a few years, I got involved with the mentor group and started posting cases more often. This case in particular was one that was emotional to my entire team because we watched the physical changes that took place with this patient after we changed her smile. I was so proud of this case. After I posted, Mike Skramstad took the time to photoshop the case on ways I could improve it. My first reaction was nausea and to quite dentistry, but once I could reframe that and understand that he was truly trying to help me improve, it was so much easier to actually see what he was talking about with the photoshopped photos so that the next time I wouldn't make the same mistakes. Now did I cut the crowns off and redo the case? Absolutely not. This patient was thrilled. She could not see the nuances that we can, but what I learned from the feedback was unvaluable to my growth as a dentist. It also became a challenge over the next years to see what cases did or did not need photoshopped big grin

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After case after case after case, I began to actually see the nuances of line angles and color patterns and became much more comfortable with my anterior work as the cases became more repeatable. 

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Now if a case like this walks in the door, it's not a huge deal to squeeze them in and get a good result for our patients. All of this is because of the constant feedback from this community.  It's fun to see how all of us have improved over the last 9 years as technology has changed, materials have changed and how we constantly challenge each other. I wouldn't change my path for anything in the world, but I do hope that it takes others a lot less time than it took me to make restorations look natural ;) 

 

 


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02 Jul 2019

Posted by Michael Fernandez on July 2nd, 2019 at 03:02 pm
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This long time patient had been self conscious for years with her diastema and ugly crown/tooth size discrepancy.  14 months of Invisalign and a new crown and 3/4 crown on #9 and she is happy and smiling.

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27 Jun 2019

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The Isolite 3 dental isolation system gives you the all-important isolation and moisture control you need when performing restorations.

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13 Jun 2019

Posted by Liz Manji on June 13th, 2019 at 01:23 pm
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Watch our latest Featured Video, 3M™ Chairside Zirconia.   3M™ Chairside Zirconia combines strength and esthetics with a fast sintering time, offering more efficiency in a single-visit appointment.

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Inventory.  It's a love hate for me.  I love to try out new materials and have lots of material choices and have all the shades under the sun. 

But as a business owner who is trying to run a successful, profitable practice and set the tone for our doctors, I need to be smart.

When I first started using CEREC, I saw post after post from doctors warning us against using IPS e.max HT. If you do, you will get the dreaded "grey" crown.  As many of you have seen, I do a lot of HT in the anterior, for crownlays, and if I'm trying to match a patient with a C-shade.  In my eyes, C shades are just a lower value of A shades.  Sometimes we just say the tooth is "grey" but on the flip side, we can use this to our advantage.  If I see a lower value, C-tones or "greyness" in a tooth, my thought isn't to pick a C-shade, it is simply to use IPS e.max HT.

Here's my rationale.  It keeps my inventory simple.  As I already stated above, I have a lot of uses for the HT block.  One of the other qualities of an HT block is that the value can be dramatically affected by the color of your cement.  For a case like this, I can use this to my advantage by understanding the nature of qualities of my block on hand.  People have argued that I should just pick a C2 or C3 LT block and that is just easier.  I look at it from the other end of the spectrum in that using the HT block kind of bails me out if I don't choose the exact right shade.  Let's look at this case.

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I put the A3.5 shade tab up just to show the lower value of the teeth compared to the tab

This is a case that I see C-shades and automatically think about HT. I told my assistant that we would be doing A3 HT and that she would be doing the rest.  I'm really been trying to train up my team members and not do all my stain and glazing.  

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Below are the Pre-Op, Try-In and Delivered Crown. All we had was A2 HT left, so this made my assistants job a little more challenging with staining down this crown to get it to match.  I told her to use a little of the e.max "1" stain for the gingival 1/2, some of the I-2 stain for the cusp tips to drop the value down a little more and to add some white to create some craze lines.  Overall, she did a good job with the staining.  At Try-In, the value was too bright for my tastes though I wasn't trying to match the "darker" canine, I still wanted to lower the value down more.  If I had done the C2 or C3 LT block, the different color resin cements wouldn't make too much of a difference.  In fact, the thicker your porcelain, the less of a difference the colored cements make. As you can see from the photos, the occlusal of the tooth is relatively unaffected from the Warm + cement.

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There isn't anything too incredibly special about this case, but wanted to share some things I've learned about IPS e.max HT and how I use it.  I hope this can help others not be intimidated by the block and utilize it when appropriate.

Dan