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05 Sep 2018

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)

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I exported the .stl file and put a base/hollowed out with inLab 18 and 3D printed the model

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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

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We then fabricated a maryland bridge out of GC Cerasmart...

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All ready for surgery next week!


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  • REGISTER for Thursday, September 13: 12 p.m. 
  • REGISTER for Thursday, September 13: 2:30 p.m.
  • REGISTER for Friday, September 14: 10 a.m.
  • REGISTER for Friday, September 14: 3 p.m.
  • REGISTER for Saturday, September 15: 12 p.m.
Zirconia Characterization from A to YZ Hands-On Workshop Perform a monolithic makeover with zirconia and get highly esthetic results. We'll show you how to make your restorations stand out by blending in with the perfect shade match. Featuring Dr. Daniel Vasquez and Dr. Todd Ehrlich. Become a Shade Master Experience a color blindness assessment and see how new digital technology can provide you with more accurate and reliable shade determination.
  • Thursday, September 13: 11:30 a.m. to 6 p.m.
  • Friday, September 14: 8:30 a.m. to 7:30 p.m.
  • Saturday, September 15: 8:30 a.m. to 5:30 p.m.
MUST-SEE BREAKOUT! "Join the 1%: Deliver Perfect Anterior Restorations"  Dr. Yao-Lin Tang | Thursday, Sept. 13, 4:30-5:30 p.m. in Room Suwannee 13 Restoration on tooth #6. Case courtesy of Dr. Yao-Lin Tang. Expand your CEREC use beyond posterior crowns and join an elite group who are growing their practices through new materials and indications. Dr. Yao-Lin Tang will show you how to elevate your game and deliver highly esthetic -- and profitable -- anterior restorations. Dr. Yao-Lin Tang, DDS, BDS   Dr. Tang has over 20 years of practical knowledge in cosmetic and general dentistry. He currently practices in San Mateo, California, and is a mentor and visiting faculty at CERECdoctors.com, a Patterson-certified CEREC trainer and a co-leader at the CEREC study club of Taiwan. Dr. Tang's formative years were spent on the island nation of his birth, Taiwan, where he received his Bachelor of Science in Dental Surgery. He later ventured to California where he earned his Doctor of Dental Surgery degree from University of Pacific School of Dentistry. 
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30 Aug 2018

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.  

 

CASE 1:

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Gentleman fractures #9, implant placed.  The surgery isn't the point of this post, so we'll skip to the restorative portion.  

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Healing abutment.  I've set myself up for success.  Now I just have to not F it up.  

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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.  

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Again, he's happy with it but with minor corrections, this case could have turned out much better.  

 

CASE 2:

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PFM #8.  Pt not happy with appearance.  

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What I found as soon as I removed the crown.  Prepare tooth, blockout with Cosmedent Pink Opaque.  

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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!!!

30 Aug 2018

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.

24 Aug 2018

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 onlyembedded image

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.embedded image

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.

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17 Aug 2018

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

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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.  

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And here is his final restoration (Vita Trilux) completed this year


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What a fun case to complete after all these years!

16 Aug 2018

Posted by Jeremy Bewley on August 16th, 2018 at 11:39 am
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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:

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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:

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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.

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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!

15 Aug 2018

Posted by Rich Cooper on August 15th, 2018 at 10:06 am
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Pt presented to office after taking ipad to face.  She fractured the incicsal 1/2 of tooth, no mobity or alveolar trauma.  While I couldn't see a direct exposure, I could see pink.

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We explained options, placed composite as an esthetic fix while we evaluated pulpal status.  Ultimately it was irreversible pulpitis and causing patient some discomfort and she elected RCT.

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We used wave one and bc sealer.  Now with the tooth asymptomatic , we prepped for crown.

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We placed empress multi a-2 with some white staining to mimic 9

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Sorry for the blood but patient was happy we were able to match 9 and didnt need to crown 9 to get a shade match.

Fun to take on the single anterior with cerec

13 Aug 2018

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With now a few Level One Trainings under my belt, teaching the F.O.C.C. (Fissure Height, Occlusion, Contours, Contacts) concept as a systematic process to design definitely streamlines the chairside approach.  But as I also have two new assistants learning the ins and outs of CEREC design, I realized a BIG "O" was missing!  When a proposal is first generated, it is automatic that I look at the buccal/lingual corridor, without question, first, so that I am able to position the restoration in the arch to my "ideal" by using the "MOVE" tool or simply, Anatomical 2D.  Inevitably, as my assistants and new users waited to position the tooth in the "Contours" Step (previous Step 3), we would almost always have to jump back to the "Occlusion" (previous Step 2) and refine. I thank Kristine Aadland for coming up with the original PDF (which I have edited) showing these steps to help ourselves, our assistants, and new users not to get overwhelmed by the tools and tricks of design. As from here on, I will choose the Big "O" to begin the  F.O.C.C approach!

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12 Aug 2018

Posted by Kristine Aadland on August 12th, 2018 at 09:14 am
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Here is a woman that came in with an old PFM that had recurrent decay but she was nervous to replace it because she didn't want the new one to "stick out". These are the cases I love!!

One tip that I like to do is mix my stains to get the color I want to achieve. This is a great example of that. She is pretty bright overall with a lot of translucency. Normally when I use brighter shades like B1 I would use "I 1" (the blue stain) to mimic the translucency, but in her case blue was just too bright- so I mixed it with the "I 2" (the grey stain) to tone it down but still give it some richness in color. I did the same thing for the body stain as well. The "1" stain (A range) was just a little too strong, so I mixed it with "creme" to tone it down. This only takes a few extra seconds but it gives you a huge palate of colors if you are willing to mix them. 

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The second tip that I have learned from others on this site is to look at the case from different exposures. I just wanted to show that in this example with the two different pictures- immediate seat and follow up. Looking at the different exposures can really help see the color in the tooth in more distinction. To do this with my twin flash, I take one picture with my flashes all the way tilted back and take a second photo with my flashes all the way tilted forward. Some of this will depend on the light in the room as well, but this is just a fast way for me to look at the teeth in different light. You can also do this on a lot of apps- like the photo app on your iphone. ​

What do I do when I am done with these cases? I look at my photos and see what I would have done to change it. I do this with my assistant, never in front of a patient. This is how we all learn to be better and hopefully improve with each case. Posting cases are also a great way for all of us to improve. That is the value of cerecdoctors! 

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Here is what I would have done differently:

I would have added either a little bit of glaze to the mesial incisal corner to sharpen it, or contoured #8 to match. This is an area that drives me nuts. If you use the smooth tool at all in the area it will round the mesial incisal edge and this is what you will get. I try to over close this area prior to mill just for this reason, but I got a little carried away here in my contouring. 

I would have used "creme" for the craze lines instead of white. In the mouth this doesn't show up as dramatic but my camera never lies. Using creme would have been more subtle and matched her other teeth better. 

One tip that I picked up from some cases here on the boards- add the body stain at the incisal edge of worn looking teeth. Often if you look at anterior teeth there is a lot of color right at the incisal edge- dentin showing through with the wear. I love to add a little of the same color I used at the gingival 1/3 here to mimick the other teeth. 

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What was cool about this case- The patient was in my chair for 2 hours and left with a new crown that she loved. That is the power of CEREC that we have available to us every day.