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Just wanted to give a quick heads up that I will be remaking the zirconia infiltration and anterior contouring videos in the next month or two to reflect changes I've made in the way I do things.
Here is a quick tip to get great finish...Diashine Course Soft. I learned this from one of my biggest ceramic mentors Bill Marais (this case below is his)...I know many of you are already using the Fine Soft for a big shine (and I use that too on Zirconia).
The Course Soft after contouring and before staining removes all the surface tension from the restoration. Since it's oil based it can be cleaned really easily with Steam. After Staining and glazing, it really creates a nice, natural finish. Check it out.
Watch Dr. Mike Skramstad as he discusses the key features and important tips for optimizing outcomes with Celtra Duo, a fully crystallized, tooth shaded block with dual processing pathways.
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We all have this happen to us, our schedule laid out the way we want for a productive smooth running day, then something happens to throw a wrench in it. My Wednesday morning I had a crown on #8 to start the day and then an implant right after that. The crown patient came in with the crown #5 off at the gum line.
Now we have a problem. I only have one room set up for implant surgery. I don't have time to make a guide for this case, get the tooth out and place the implant before my next patient comes in and needs her implant placed. So the decision was made to go ahead and extract and place the implant free hand. Normally implant surgery is done with a guide in my practice. There are times that either the guide doesn't fit or fabrication of the guide is not feasible. This is why it is important for doctors to have the surgical abilities to place an implant free hand.
The plan in this case was to split the roots and place the implant in the interseptal bone to get primary stability.
The roots were sectioned with a high speed hand piece with a long shank surgical bur. This serves to purposes. One is to make the removal of the roots easier. Secondly it also gives a guide for the drill to not kick buccal or lingual during preparation of the osteotomy. Now all we need to do is manage the mesial distal position during the osteotomy preparation. Having the CBCT did however help show where we needed to section the tooth and how deep to go to make sure that the tooth was sufficiently. Unfortunately due to the time constraints trying to get the case done before my next patient gets here I didn't get a photo of the sectioning. Once the osteotomy was finished the roots were removed atraumatically. The implant was then placed with 35+ncm of torque and the root areas were grafted with cortical/cancellous
Could this case have been done guided, sure but I would have either had to reappoint the patient(they are not the most reliable patient) or run behind and make my next implant patient wait. As it was the patient got the tooth extracted and the implant placed and we were on time for our next patient. Guides are great but ultimately the surgeon needs the skills to know how the surgery should go even if they don't have a guide.
I have been posting a lot lately on infiltration... tried it today on a zirconia abutment (Incoris F0 Meso). There is a of pictures here.. but I thought I would post a full protocol!
Initial Situation. Heroic "try" with aggressive prep. We knew it would not work long term... was done 9 years ago
Implant plan on #12. Based on the plan and screw access, I knew I was going to do a screw retained restoration.
Healed implant 5 months later ready to restore:
Took images into CEREC
Final design... notice position of screw access compared to initial Galaxis plan:
Infiltrated with A3 Vita Liquid:
Sintered in SpeedFire:
Torqued into mouth:
Just an update on infiltration. I have been messing around with the Vita YZ HT liquids based on a couple recommendations. Like everything it's a work in progress, but I like it a lot. Seems to be pretty intuitive and the colors really come out nicely. I think there are some good methods to lower the value of zirconia using a couple different recipes...
Here is just a really quick one I did this afternoon between patients messing around. It was an A2 block with A3 shade in the intaglio and cervically. An A chroma shade in the fissure and Blue on the cusps and ridges. I got the "A chroma" a bit sloppy and I think i'm going to try the pens on this to make it cleaner.
It's definitely got some potential for sure! This is obviously just polished.
The mantra goes "pink esthetics before white esthetics" and I thoroughly agree. What our scalpel-wielding friends can achieve for our patients is truly remarkable. Here's an anterior restorative case with combination clinical/esthetic crown lengthening that simply would not have been possible without perio surgery:
I can see the issue because of your excellent photography but I submit that it is not noticeable to the naked eye at conversational distance and nobody cares about this but you. However, if you can sell it to the patient, God Bless You. The people I see would laugh me out of the operatory.
What Parameters are you using?
I think Mike said that the key to the movements was the midline point of the incisors for movement and setting the arch into the articulator.
I'm no expert on this so let's see what others say, but wow, great job and great photography. The lateral incisors are begging to lose that labial flare.. perhaps go after those next to make a difference
This happens in all of our practices. A long time patient schedules an appointment yesterday for a "chipped tooth" I walk in to the op and see the case below. As you can see cerec handled the case as we would all expect. I spent time discussing the options with the patient to include:
1) extraction, implant, abutment and crown
2) extraction, Chairside FPD
3) endo, post/core, crown
As I presented the options, I even stated that option number three is becoming outdated in its philosophy and that dentistry as a profession is moving away from the less predictable long term prognosis of the endo/post/ core. I also stated that I did not like option two because of the uncertain condition of #9. The patient chose option #3. I know him very well and as I stated, he has been a patient of mine for twenty years. So I asked him why he chose that option. His answer, "I am 80 yrs old, I have had 17 surgeries in the last 9 years, and I just don't want another one if I can avoid it." Can't argue with that at all. So the question is, what would you guys have done? With all of the technology we have at our fingertips, are we forgetting traditional dentistry?