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14 Apr 2019

Something that I've picked up through the years from Sam, Flem, Skramy and my wife, Kris, is that natural teeth have a lot of white in them.  When used well, I've found that it can make teeth really look a lot more natural and will give a monolithic restoration a lot more depth.  I use white to add decalcifications, mimick craze lines, enhance translucency and oftentimes, it is just what the case needs.  I will say this takes a little practice and it is easy to not have enough or too much.  For a few of the cases that I will show, I really think it adds a little extra and makes the restorations blend in better.  For many of you that see my posts, I often will use the Empress Stain and Glaze Kit on my cases because of it's ease of use.  (For IPS e.max, make sure you have the restoration crystallized first if you are going to use Empress Stain and Glaze).

1st Case:  VITABLOCS TriLuxe 1M2-A little sunset color stain gingivally but the rest is subtle white striations

Before:

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2nd Case: Empress Multi B1 #9-This is an off angle pic but really showcases using white enhance the restoration  embedded image

3rd Case: The before is the classic monolithic crown without anything.  I used VITABLOCS Mark II 1M1 and just added glaze and some white to attempt to match the white spots

Before:

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After:

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10 Apr 2019

This was my first 6 unit case with PrimeScan. From the time the patient was seated until he walked out the door, this case took 4 hours with one mill. Between the faster imaging, the 5 click process and faster proposals, this is a noticeable difference in time for me. 

This patient is in sales and has always wanted a better smile. We did the upper 6 last year and he like them so much he wanted to do the lower as well. This case is a perfect case to open his VDO but he has implants in all 4 quads and wasn't ready for that kind of financial commitment so we discussed what was realistic as far as how big the teeth would look and went for it. 

A couple of things I wanted to share with this case...

One of my favorite things I do when I work with anteriors is to design in BioIndividual but add a BioCopy folder for reference. 

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This comes in handy to know where your midline is and how much you want to increase your incisal length if you have the room. The software program does not use this folder for proposals and you don't have to draw the copy line (which speeds up the case). It is purely for reference if you select the BioIndividual in Administration.

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To turn on the BioCopy you click on Display Objects and then click on Lower BioCopy. Depending on which folder has the larger teeth you then use the slider bar to make the larger teeth more transparent so you can see the difference between the proposals and the original teeth. If the proposals are the larger teeth, make sure you group the teeth together so that they will all turn transparent or you will only be able to see one at a time.

My second recent find is an Ivoclar product called Cervitec Plus. It is a Chlorhexidine varnish that does not stain or taste. You dry the teeth and tissue and place it with a microbrush. It helps with sensitivity and tissue healing and I have absolutely fallen in love with this product. Here is a picture at seat date and one less than a week later. This patient has gingival hyperplasia from meds and his tissue is always a mess. I was so shocked at how fast he healed. My hygiene team has been using it a lot for perio as well and have loved the results at recall. 

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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. 

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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. 

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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. 

Get involved

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.  

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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!

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05 Mar 2019

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:

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16 Feb 2019

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.

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The plan was ready in a day and the surgery was the following week.

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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.

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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

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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.

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For further information, please contact:

John Isherwood

Tel.: 716-264-2121

E-mail: john.isherwood@ivoclarvivadent.com