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There are situations where the spacing for implant therapy is not ideal one way or the other. With the CEREC-Galileos integration we have the ability to create 2 different plans and decide which one works better.
What do you guys think, 2 or 3?
Late night CERECing thoughts...
It's very humbling to look back on cases when I started using CEREC 12 years ago. I was so happy to take a crown straight out of the mill and put it in the patients mouth. I had no idea what I was looking for when I looked at a tooth, other than if the color was right (which really meant was it close but not perfect). Today, I look at teeth in an entirely different way. I love to see the color patterns, the anatomy, the contouring and the light reflections. I am able to see this now because I posted cases and other doctors were willing to show me how to improve. I was also willing to accept those answers. That is what I love about this forum. We are all here to grow.
So what do I see in a case like this...
Anatomy of a youthful tooth: sharp line angles, prominent central lobe and contouring at the gingival embrasures on the mesial and distal. This is contouring that is done post mill.
Fun color patterns: the white bands at the gingival 1/3, the blue translucency and the white framing along the incisal edge.
Reflections: Do my reflections mirror each other? If so, then my anatomy is similar. If not, I need to re-contour to get them to match.
and the final...
Don't you just love that we have this capability in our office? So.dang.cool.
Ivoclar Vivadent Reprises “Just Cure It!” Bluephase® Style Initiative
Company to donate $100 for each curing light sold to support breast cancer research
In honor of Breast Cancer Awareness month, Ivoclar Vivadent will once again donate $100 for each pink Bluephase® Style LED Curing Light sold during the month of October to Susan G. Koman for breast cancer research. Ivoclar Vivadent employees have also supported the cause by participating in the Susan G. Koman Race for the Cure. This marks the sixth year for Ivoclar Vivadent’s “Just Cure It!” campaign, which was initiated in 2013.
“Each year we are inspired by how well-received this campaign is, and we remain committed to helping to fund the research that is so essential to finding a cure,” emphasized Robert A. Ganley, CEO of Ivoclar Vivadent.
Withits Polywave™ technology, the Bluephase Style provides the broadest spectrum available to efficiently cure all dental materials, and its specially designed light probe easily accesses posterior teeth. The Bluephase® Style can be used cordless or corded, and its slim design and intuitive two-button operation is lightweight, very small, and ideal for any treatment.
According to the National Cancer Institute (NCI), an estimated 266,120 new cases of breast cancer are expected to be diagnosed in the United States in 2018, which underscores the aggressive and deadly nature of the disease. While there is still much to learn about breast cancer, the NCI has reported a steady decline in breast cancer deaths since 1990, which is attributed to advancements in diagnosis and treatment. For more information, contact the National Cancer Institute at the National Institutes of Health at www.cancer.gov/cancertopics/types/breast, or by phone at 1-800-4-cancer.
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:
Here is a technique that will save you time when provisionalizing implants.
Patient needs tooth #10 extracted and grafted. At the consult appt, I took a scan of just his upper teeth (has an anterior open bite)
I exported the .stl file and put a base/hollowed out with inLab 18 and 3D printed the model
Next, I went to the Omnicam and selected Bridge Mode (veneer #9 Biogeneric and pontic #10 Biocopy) and scanned the 3D printed model in as the Biocopy. Next, using a carbide bur, I went ahead and cut out tooth #10
We then fabricated a maryland bridge out of GC Cerasmart...
All ready for surgery next week!
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Happens all the time. You complete a single-central and feel you've done a great job. Then, as many others on here do, you photograph your stellar work only to find that your "A" is more like a C+. Statements such as, "The patient was thrilled..." can be found all throughout this site. And while that's important, we (I feel I can speak for many here) know it's not the only factor...nor is it the most important. Here are 2 such cases where 'the patient was thrilled' but my efforts were less than ideal. Hopefully you'll see something that can help you in your next case and avoid these pitfalls.
Gentleman fractures #9, implant placed. The surgery isn't the point of this post, so we'll skip to the restorative portion.
Healing abutment. I've set myself up for success. Now I just have to not F it up.
Notice how 'bulbous' the restoration is? Way too round. I didn't take my time and contour in the mouth before delivering. Incisal edge has no characterization and the distal incisal edge is too short.
Again, he's happy with it but with minor corrections, this case could have turned out much better.
PFM #8. Pt not happy with appearance.
What I found as soon as I removed the crown. Prepare tooth, blockout with Cosmedent Pink Opaque.
Shade, texture are ok but the distal line angle/incisal edge are too short. Also, I could have closed the incisal embrasure a bit more btwn #8/9. I also missed the incisal translucency present on #9; could have been corrected with some blue on the lingual of the restoration.
Overall, small items...but items that were missed/are lacking nonetheless. Thanks to those who post cases from which I have learned a lot...my hope is that I can do the same for someone else. And if you haven't, make your way to AZ or NC for hands-on courses...you will cover this in depth.
Enjoy the Holiday weekend!!!
When staining and glazing a Celtra Duo crown, I've found that sometimes my assistants have a hard time holding on to them with a locking crown holder, especially on very shallow intaglio crowns. The other worry is that if they spray, they'll get glaze on the intaglio of the crown and often don't get enough glaze around the margins because of this.
I got a tip from a Dentsply Sirona Consumable rep that has worked great. We use silicone ear plugs (you can get them on amazon for around $3) and seat the milled crown on the plug. It's sticky enough that the crown doesn't fall off and it gives you something to hold onto while staining and glazing. The silicone also blocks out the intaglio from glaze getting under the crown. After glazing, you just lift it off with a cotton pliers by the contacts and put in the speedfire. I've been doing this for a few months and my assistants love it.
I know there is a lot of discussion about what materials to use in the anterior zone. I don't think there is necessarily a universal answer but what I've learned over the years is to understand the properties of these materials and their strengths and weaknesses.
In general, I'm trying to use Feldspathic porcelain (VITABLOCS typically for me Mark II or TriLuxe) or Leucite Re-inforced Glass Ceramics (IPS Empress) in the anterior region. I feel like they have more vitality, given the right case, you can just mill polish and cement and get a really nice result. This is a case with VITA TriLuxe 1M2 polish only
I know the go-to block when using e.max in the anterior region is e.max MT. I really like the block and use it quite often as well. My point for this discussion is that a lot of doctors will shy away from e.max HT. There is the big fear of the dreaded "grey" crown or a crown that has "low" value. It is a real concern. I've had it happen to me and if you aren't careful, it can happen quite easily. This was my first case I posted on CEREC doctors and at the time I thought it was quite good. Now I would have approached it differently because of the "low" value of #8,9.
This case I did about a year ago. It's not perfect but it is a vast improvement over what she started with. She is quite happy, but I always evaluate my photos and have other CEREC doctors look at them and give me their feedback. Dr. Tom Monahan and I share cases back and forth, and aren't afraid to pick apart our cases. It makes us better and I would encourage you to do the same.
So I chose HT for this case because I felt like I did see some C-tones in this case. I felt like MT would be too bright or high in value for this and I didn't feel great about using Feldspathic on this case because of limited space on the lingual. So I used A1 HT. I compensated about 2 shades in order to offset the drop in value. I wish I would have taken a pre-op pic with a shade tab but she was closer to A3.
There are a lot of ways to approach these anterior cases, but I felt like e.max HT was the best solution and what I saw for the case in my eyes.
This is a case that I've literally been working on for 10 years... interesting to see patients this long and treat the case.
In 2008, this 12 year old came into my office with a fractured #8 from a trauma. The tooth was fractured pretty good and needed endo. After endo was done, we bonded in his old fractured piece of tooth and added to it with composite and prepped a minimal thickness veneer.... and restored it with Vita MK II
I knew that eventually this would have to be redone because he was not done growing and eruption would change his situation quite extensively over the years. He kind of disappeared from my office for awhile and came in again last year. Just like we thought, the tooth had erupted and changed over the years and needed a new full coverage restoration.
And here is his final restoration (Vita Trilux) completed this year
What a fun case to complete after all these years!
I love being a dentist most of the time. The times I don't? Saturday afternoon is one. We all get these calls: "I broke a piece of tooth off and my filling came out! My tooth hurts every time I breathe or drink something! Can you help?"
"No," you think to yourself, because you'd rather play with your kids or go golfing, but being a decent human being, you say "yes" to the guy instead and head to the office to help a person in need.
Here's the situation: He's broken the mesiobuccal cusp off his maxillary first molar and lost the filling, exposing a deep prep and a liner. After cleaning things up a bit and refining the prep he looks like this:
Here's one of my favorite uses for HT emax: partial coverage restorations in molars. It's esthetic and strong and bonds really well to the tooth. After a very short milling cycle (about 6 minutes), it takes only 2 or 3 minutes to characterize it and get it in the oven for its firing cycle. It's very important to be careful with application of glaze in these cases, should you choose to do so as I did; sloppy application can lead to difficult to clean sharp glaze edges after firing that can resist seating. I would probably polish only if I were to do this case again. Here's what it looked like out of the oven in this case:
We all have religion when it comes to how we choose to bond our restorations. I switched to Peak Universal from Ultradent years ago (well before my CEREC journey began) when patients started asking me about BPA in my bonding agents, and Ultradent gave me the clearest answer on this. I wanted to use a cement system from the same manufacturer as my restorative material, and the good people of Ivoclar said they were comfortable with me using Peak Universal with their bonded resin cements, so I have done so without complication for the last 7 years or so. This case was one of the last Multilink cases I did before switching to Variolonk Esthetic. You can see it is still esthetic, but it was more difficult to clean up excess cement than the newer generations.
So the moral of the story? I spent less than an hour making this patient whole, provided a great service and great patient experience without a huge time investment, and this last one makes my wife happy. Hard to calculate the ROI on that one. I might not always like being a dentist when it cuts into my personal time, but I ALWAYS love what CEREC has done for me, my practice, and my patients!