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Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Former Faculty, UCLA Center For Esthetic Dentistry
Speaker, Catapult Education
LEGIONpride.com, Online Training Challenge for Dentists
Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA
Aesthetic Dental Designs®
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IDENTIFY THE PROBLEM
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TMJ SIGNS & SYMPTOMS▪ Wear facets
▪ Pot holes
▪ Abfractions
▪ Gingival recession
▪ Mobility
▪ Occlusal & Incisal wear
▪ Linea Alba
▪ Tongue scalloping (Crenations)
◼ Muscle hypertrophy
◼ Muscle tension/tenderness
◼ Muscle rigidity
◼ Limited opening
◼ Guarding on CR closure
◼ TMJ noise
◼ Head and Neck aches
◼ Tooth sensitivity
◼ Ear problems, ringing, buzzing, fullness
◼ TMJ locking history or other
◼ Orthodontics history
OCCLUSAL & INCISAL WEAR
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WEAR FACETS
Pot Holes
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GINGIVAL RECESSION & ABFRACTION LESIONS
ABFRACTION LESIONS• Sometimes it presents as single teeth due to excursive interferences or as a
pivot, fulcrum or “teeter totter” tooth.
• Other times there are more in a quadrant and there is severe wear to the occlusion.
• Other times it maybe on the facials of anterior teeth, where there is wear on the incisal edges or wear facets on the linguals, however little to no wear on posteriors.
• Occlusal guards should be fabricated along with an occlusal analysis in CR on models.
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Flowables?
Microleakage and missing fillings from high occlusal loads on teeth can cause large cervical stress concentrations resulting in disruption of the bonds between the hydroxyapatite crystals and the eventual loss of cervical enamel and dentin.
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ABFRACTION LESIONS & CLASS V RESTORATIONS
LATIN WORDS, AB – “AWAY”, FRACTION – “BREAKING”
• Pathological loss of tooth structure caused by biomechanical loading forces.
• Static and cyclic flexural overloading of tooth structure ultimately leading to fatigue and failure of tooth structure away from the point of loading.
RESIN MODIFIED GLASS IONOMERS(RMGI)• Light cured
• Dual cured
• High flexural strength
• Lower compressive strength than conventional G.I.
• Good polishability
• Excellent wear
• Hydrophillic
• Fluoride release
• No microleakage
• No adhesives
• Acid resistant layer
• Reduces sensitivity
• True chemical adhesion
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GC FUJI AUTOMIXLC
• Resin bonding is mostly due to the intertubular dentin.
• Deep preparations have less intertubular dentin.
• More moisture present due to odontoblastic tissues and fluid
• Higher risk of post-op sensitivity
• Use a New Advanced Adhesive and Flowable
• Glass Ionomer (GI)
• True adhesion to tooth structure
• Bonds to moist dentin
• Less technique sensitive
• Fluoride release
• Decreased gap formation and cusp deformation
• Coefficient of thermal expansion is similar to dentin
• No post operative sensitivity
• Use on dentin & cementum
• Base out deep areas
• Place resin/composite on top of GI
Replacing Existing Restorations & Decay
Dentin Bond Strengths of Simplified Adhesives: Effect of Dentin Depth. Compendium June 2006, p.340-345
Using Cavity Liners with Direct Posterior Composite Restorations. Compendium June 2006, p.347-351
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RESIN MODIFIED GLASS IONOMER RESTORATIONPost-Op Photo – notice unlike typical class V composite RMGI restorative material.
Typical treatment involves the placement of a #00 retraction cord on each tooth followed by a shade selection. Roughen tooth structure with air abrasion. Place cavity conditioner on all areas to be restored for 10 seconds, then wash and dry.
Restorative Therapy- Case TIP
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Mix RMGI and syringe into place. Utilize hand instruments to shape and remove gross excess. Cure each tooth for 20 seconds. Remove excess and contour using a handpiece with fine diamond burs. Teeth should be isolated from saliva.
Restorative Therapy- Case
After contouring the restorations can be coated with a self etch adhesive coating, and cure for 10 seconds.
Restorative Therapy- Case
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Ten year post-op photos show the integrity of the material is still
excellent. Note the lack of marginal microleakage stain often
present with composite restorations.
Restorative Therapy- Case
RESIN MODIFIED GLASS IONOMER
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Fig. 15 – Graph representing the mean annual failure rates
per adhesive class, determined according to a systematic
review of Class-V clinical trials of adhesives during the
period 1998–2004 [2].
Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent
Mater (2009), doi:10.1016/j.dental.2009.11.148
Deep Preparations◼ Bonding Agent, Flowable & a Layered NanoHybrid Composite
◼ Conventional Glass Ionomer, Bonding Agent & then Composite ◼ Fluoride Release
◼ High compressive strength
◼ Hydrophillic
◼ Insoluble
◼ True chemical adhesion
◼ Minimizes microleakage
◼ No sensitivity
◼ Acid Base Resistant Zone
◼ Decreased gap formation & C Factor
◼ Coefficient thermal expansion similar to
dentin
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• Bioactive material
• affinity to tooth structure. when placing a glass ionomer a weak acid or conditioner is used to aid in releasing calcium and phosphate ions from the tooth structure. These calcium and phosphate ions combine into the surface layer of the glass ionomer and form an intermediate layer called the interdiffusion zone. This bond layer can be very strong and significantly reduce the microleakage that would occur at the margins of the restoration.
• Very good fluoride and ion release helps remineralize tooth structure in the remineralization–demineralization process that naturally occurs in the oral cavity.
• They chemically bond to enamel and dentin.
Why Glass Ionomers?
• They produce good marginal integrity.
• They shrink only one ninth the amount of composite material.
• They are fluoride-rechargeable.
• There are no free monomers in the material.
• The cavity preparation can be bulk-filled, making the materials easy to place.
• They exhibit excellent biocompatibility.
Why Glass Ionomers?
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GLASS IONOMER SANDWICH
•Class I, II, III & V posterior restorations
•Open & Closed Sandwich
techniques
•Composite replacement •Amalgam replacement
•High caries risk patients
•Pediatric patients •Geriatric patients •Special needs patients
•Long term resistance to microleakage
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RESIN TO DENTIN HYBRID ZONE
GLASS IONOMER INTERFACE
Inte
rfac
e A
na
lysis (TE
M)
CARDOSO et al. J Dent 2010
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EQUIA FORTE™HT is a complete system that is an ideal solution for posterior restorations:
•Class I, II, III and V posterior restorations •Composite replacement •Amalgam replacement •High caries risk patients •Pediatric patients •Geriatric patients •Special needs patients •Buildups•Long term provisionals/Emergencies**
EQUIA FORTE HT
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EQUIA FORTE HTCaries control/quadrant dentistry
(Class II, III, V & core buildup)
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Resin modified glass ionomer materials placed in abfraction lesions have been proven to have better longevity than traditional composite resin restorations.
When dentin is missing on occlusal loading restorations, use conventional glass ionomers to replace it. It is the best dental material available today that virtually mimics dentin. No adhesive is required, and sensitivity is non-existent. Like dentin, conventional glass ionomers have a very high compressive strength, ensuring it will withstand long term mastication forces and a capping composite can be placed on top of it to replicate enamel.(Equia Forte HT-GC America is my go-to buildup material unless only two walls remain in my preparation)
TIP
CENTRIC OCCLUSION DENTISTRYOR MIP
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Red Blood Cells 2 – 5um
200-500nm
Human Hair 60 –120um
6,000 – 12,000nm
?
SHIMSTOCK & ARTICULATING PAPER
What do you use…..
.…and why?
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SHIMSTOCK & ARTICULATING PAPER
• Parkell Accufilm II is 21µm for dentistry
• Great Lakes articulating ribbon 12µm
• 8µm Almore Shimstock foil
• 8µm articulating paper??
What do you use…..
.…and why?
8µm articulating paper
Available in blue
And red too!
Mark the bite before prepping teeth!!
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TROLLDENTAL-8ΜM ARTICULATING PAPER
TIP
G-AENIAL BULK INJECTABLE –
AVAILABLE SHADES
A1 & A2 shades available
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• Injectable high strength nanoparticle composite with ideal viscosity handling and adaption characteristics that may be used as a one step application for bulk filling up to the occlusal surface without the need for capping or veneering with another composite
G-AENIAL BULK INJECTABLE
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WEAR RESISTANCE
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Minimally Invasive
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Selective Etch Enamel Only
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• Bis-GMA free / Radiopaque
• High Strength & Wear Resistance
• High density uniform dispersion nanofiller technology
• Sculptable
G-aenial BULK
Injectable“operates like a flowable but
performs like a restorative”
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• Verify bite• Shimstock
• Over Impression
• Preparation
• Bite Registration• Dead soft Delar Wax
• Firm, Hard Bite Reg
• Shimstock
• Facebow
• Full Arch Impression
• Provisional
• Lab Articulation
Indirect Restorations & Bite Registrations
PDL & OCCLUSAL RECORDSThe range of PDL width: 0.15mm ~ 0.38mm
• Average PDL width by age:
o 11 ~ 16 years old: 0.21mm
o 32 ~ 52 years old: 0.18mm
o 51 ~ 67 years old: 0.15mma
• The PDL width decreases with age.
• The PDL width is thinnest around the middle 1/3 of the root.
• Tooth with more function has bigger PDL space
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Occlusal Testing Hold
Drag
No Hold (None)
SHIMSTOCK
• Holds• Means that when biting firmly in C.O. the shimstock can not be
pulled out
• Drags• Means there is resistance on the shimstock but it can be pulled
out slowly
• No Hold• There is no resistance what so ever when pulled between
occluding teeth.
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BUILT IN ERRORS!Thickness??Rotation?? Rocking??
Function & Failures
• Closed Bite Trays (most common)
• Lack of rigidity may cause distortion
• Spring back after impression potential
• No cross arch stabilization
• Thin spots or perforations can cause distortion
• Impression material shrinks towards bulk
• Unable to recreate excursive movements
• Potential for errors & adjustments extremely high
Impression Trays
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QUAD TRAY EXTREME (CLINICIAN’S CHOICE)& BITE REGISTRATION
PEER REVIEWED
The Catapult Group rated the Quad-Tray Xtreme as better than, just as good, or tied with other available closed bite trays.
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QUADRANT & DISPOSABLE ARTICULATORS
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Bite Registration & Occlusal IndexingTIP
LITHIUM DISILLICATE (EMAX)
• Simple
• Fast
• In Occlusion
• Minimal or No Adjustment
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CEMENTATION
REASONS WHY OCCLUSION IS SO IMPORTANT
1. You are changing bite pressure by not having adequate occlusal pressure
2. You can cause more damage to other teeth from occlusal forces
3. You can cause tooth movement and shifting in the dentition due to pressure.
4. You can cause a jaw positional change that upsets the TMj.
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Disposable Articulators
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Semi Adjustable
not on Hinge Axis
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Semi Adjustable
not on Hinge Axis
is a zinc-oxide non-eugenol, automix temporary cement with a unique polycarboxylate resin
The addition of polycarboxylate optimizes adhesion, soothes the tooth, and provides an
excellent seal, while allowing the material to be easily removed from the tooth preparations
when desired.
Cling 2 (Clinician’s Choice)
30 second working time, 60-90 second set time
Good adhesion, easy removal
Low film thickness
Excellent marginal seal
Biocompatible – protects the gingival tissue
Resists forces of mastication
2 year shelf life
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Utilize an accurate preliminary over impression
Maintain over impression
Check contacts and occlusion
Place temp cement only on margins
Do not fill temp with cement
Or vent holes
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TRY-IN / NO ADJUSTMENTS…
• A few steps makes a big difference
• Patients notice the difference.
• Do you want to be like everyone else?
KEY TO ADJUSTMENTS
• Full Arch Impressions
• Facebow
• Bite Registration
• Semi Adjustable Articulator
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ASAP INDIRECT + POLISHERS(CLINICIAN’S CHOICE)
CERAMIC ADJUSTMENT
• Jiffy Ceramic Polishers (Ultradent)
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OCCLUSAL RECORD/BITE REGISTRATION
Fast Setting Rigid PVS
Or
Wax
MODEL ARTICULATION & EQUILIBRATION
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INCISAL PINS
Selection Process
◦ Open Bite Trays
Plastic-full or quadrant
Metal-full or quadrant
Custom Trays
Non-perforated or perforated (metal or plastic)
Rigidity can eliminate tray distortion and rebound
Spring back after impression is possible with plastic
Cross arch stabilization
Ideal occlusal stops for proper model articulation
Able to recreate excursive movements if mounted on a semi or fully adjustable articulator.
Potential for errors & adjustments are low
IMPRESSION TRAYS
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STOCK TRAY SIZES
Impression Trays
DIFFICULT FOR IDEAL FIT
Impression Trays
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IMPRESSION TRAYS
• Custom trays create more ideal placement
• Thinner material creates less distortion
• USE TRAY ADHESIVES for all open bite trays, not just custom trays.
• Only negative is time
Selection Process
Custom Tray
HEATWAVE TRAYS BY CLINICIAN’S CHOICE
• 4 upper & lower trays
• 60 sec. @ 158°F
• Fast, efficient
• Virtually custom
• 30% less impression material used
Impression TraysTIP
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Impression Trays
HeatWave by Clinician’s Choice
Impression Trays
HeatWave by Clinician’s Choice
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Large Volume Mixers
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Dry all teeth in arch
Place tip in most difficult area first
Keep tip on margin and immersed in material
Go around entire margin first
Next go to adjacent teeth
Then do coronal aspect of teeth
Double Mix Single Impression is the most accurate
Syringe Placement
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Special offer from GC America!
Buy 3 G-aenial Sculpt® refills or G-Premio BOND™ products, Get 1 FREE!
Please reference Promo Code #2424 to take advantage of this special offer! Offer good from 4/1/2020 through 6/30/2020.
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Customize Teeth
Checking Occlusion is the Key to Aesthetics
Interferenc
es
Case Example: #1B
Checking Occlusion is the Key to Aesthetics
WHAT, WHY, HOW, APPLY
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What is the perceived problem?
WHAT IS THE ACTUAL PROBLEM?
WHAT
Can we find the true cause of the problem?
WHY
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◼ Aesthetics
◼ Occlusion
◼ Excursives
◼ Restorations
◼ Wear
◼ Solutions
HOW DO WE FIX THE PROBLEM? What
options are available to fix the problem?
HOW
APPLY
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TMJ SIGNS & SYMPTOMS
• Wear facets
• Pot holes
• Abfractions
• Gingival recession
• Mobility
• Occlusal & Incisal wear
• Linea Alba
• Tongue scalloping (Crenations)
◼ Muscle hypertrophy
◼ Muscle tension/tenderness
◼ Muscle rigidity
◼ Limited opening
◼ Guarding on CR closure
◼ TMJ noise
◼ Head and Neck aches
◼ Tooth sensitivity
◼ Ear problems, ringing, buzzing, fullness
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Case Example: #5
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Silginat - Kettenbach
Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
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Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
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Wear Facets & Interferences
Mounted and Equilibrated
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Custom Incisal Guide Table
GC Pattern Resin
Duralay
Sil-Tech (Ivoclar) -
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▪ Slow unperceivable changes
▪ Diagnosing once it’s a problem
▪ What about prior signs & symptoms
◼ Round, Brachyfacial often
◼ Limited smile appearance
◼ Worn teeth or deep bite
◼ Enlarged Masseters
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POSTERIOR INTERFERENCE (PREMATURITY)• Centric Occlusion
• Natural growth patterns
• Orthodontics
• Dental work
• Trauma
JOINT REPOSITIONED AND
STABILIZED (CRSTABILIZED)• Splint Therapy
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What happens to a Condyle when there
is an Occlusal Prematurityon a 2nd molar?
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A Veneer Case?
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CHANGE!
• Larger amounts of tooth augmentation can create potential shifts in bite
pressure on teeth, CR-CO slides, and excursive interferences.
• Material properties must become more resilient to increased wear and
pressure demands.
• Higher risk of post operative complications due to occlusal modifications,
jaw positioning, and/or adhesive techniques and materials.
• A different approach to typical Restorative Dentistry
Not a veneer case!!
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What did the patient’s teeth look like
prior to veneers? Did she have any
symptoms? Braces? Dental work?
Trauma? Etc…
Case Example: #10
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BUILD IN STRENGTH, RETENTION, AND
CREATE A GUARD
• Patient needs to understand limitations
• Sign off on doing short cut and wear an
occlusal guard
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Simplified Provisionals**
Siltech Putty Matrix
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Duplicate waxup model in stone
Scribe a 0.5-1mm line with a sharp instrument into the
model where the tissue and tooth come together.
Provisionals (Bead Line Technique)
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Duplicate model with a fast setting polyvinyl impression material.
I have used light and medium body washes with a heavy body tray
material.
Provisionals (Bead Line Technique)
Provisionals (Bead Line Technique)
The scribed line creates the Bead Line in the over impression of the cast.
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The Bead Line in the over impression creates pressure along the tissue
and preparation margin. This causes a thin cut or separation of the
acrylic flash from the provisionals for easier clean up.
Provisionals (Bead Line Technique)
Typically the excess acrylic can be removed with fingers, a spoon or discoid instrument. Minimal
to no effort is required to remove excess flash. If a void or a margin is exposed simply fill the
void with a flowable. Etching and a bonding agent are not required as the flowable will adhere to
the air inhibition layer of the temporary acrylic and you do not want to adhere to the tooth.
Provisionals (Bead Line Technique)
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The Bead Line Provisional Technique creates less work and risk of damaging tissues and tooth
structure. Typically the process takes 5-10 minutes to make provisionals. Consepsis (Ultradent)
can be placed on the teeth and dried prior to fabricating provisionals.
Provisionals (Bead Line Technique)
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
Scribe a 0.5mm-1mm groove into tissue & a little on tooth
Cosmetic Provisionals (Bead Line Technique)
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PROVISIONALS
• Utilize an accurate preliminary over impression
• Maintain over impression
• Check contacts and occlusion
Provisionals
-Visalys (Kettenbach)
-Inspire (Clinician’s Choice)
-Luxatemp Ultra (DMG)
-Pro V (Bisco)
-TempSmart (GC America)
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Cosmetic Provisionals (Bead Line Technique)
Cosmetic Provisionals (Bead Line Technique)
No Polish Necessary if you use a good model
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Cosmetic Provisionals (Bead Line Technique)
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
Minimally Invasive Veneers…. Why? Benefits??
Waxup
Mockup
Preparation
Provisional
Bonding to Enamel
Material Options
Minimal Prep Case: 3
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Beadline Provisional Mockup
Mockup
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Depth Cuts
Photos for Laboratory Technician
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Provisional Restorations
Final Restorations
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Provisionals Mimic The Final Restorations
LuxaTemp Ultra (DMG)
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Promo code: 50OFF5 Offer expires: 5/31/2020
20% OFF!Dr. Todd Snyder: 20SNYDER
1-800-247-3368 • www.bisco.com
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Cementation Material Options
Restoration Placement? Bonded
Margin placement Moisture Control Technique Sensitive Materials
Self Adhesives
Bonding agent (TE or SE) & luting resin
Cemented Margin placement
Moisture Tolerant Retention Required
Materials RMGI
Calcium Aluminate
Resin Modified Calcium Silicate (RMCS)
Cement Selection
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CEMENTATION CONSIDERATIONS
ISOLATION
PREP DESIGN / TAPER / AXIAL WALL HEIGHT
RETENTION OF RESTORATION (FIT)
RMGI moisture tolerant, needs good retention
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GC FUJICEM 2
BIOACTIVE CONSIDERATIONS
ISOLATION IMPORTANT BUT LESS CRITICAL
PREP DESIGN / TAPER / AXIAL WALL HEIGHT
RETENTION OF RESTORATION (FIT)
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Zirconia Restorations- Tryin
- Sandblast
- Clean w/ phosphate
scavenger
- Rinse- MDP Ceramic Primer
- Tooth etching is not necessary
- No bonding agent necessary
- Theracem (Bisco)
Phosphate Scavengers
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Ceramic Primers w/ MDP
Theracem (Bisco)
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Cement Selection
Cement SelectionJournal of Esthetic & Restorative Dentistry March 2015
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(If Sandblasted by Lab)Try-in
Sandblast
Decontaminate
Rinse
Prime
Cement
Try-in
Decontaminate
Rinse
Prime
Cement
Zirconia Cementation
Sandblasting ZirconiaSize: 50 micron Aluminum Oxide
Pressure: 40 PSI or 2.8 Bars
Time: 20 seconds
Angle: 60º
Distance: 2 cm
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DUAL CURED OR LIGHT CURED
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RESIN CEMENT COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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COSMETIC CASES….
COSMETIC CASES….
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PROVISONALS
PROVISIONALS
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CERAMIC TRY-IN
• Make sure it is etched properly from lab
Try-in
Decontaminate
Rinse
Prime
Cement
Silanes
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TRYIN APPROVAL
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SELECT HV ETCH IS A 35% HIGH VISCOSITY PHOSPHORIC ACID
ETCHANT AVAILABLE WITH BENZALKONIUM CHLORIDE (BAC)
AND IS DESIGNED FOR PIN-POINT ACCURACY.
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• Light-Cured Dental Adhesive
All-Bond Universal is a universal adhesive it can be used with direct and indirect restorations and is
formulated to be compatible with light-, dual- and self-cured materials. The versatility of All-Bond
Universal makes it an indispensable part of any dental practice.
• Unique Benefits:
• Not moisture sensitive use on wet, dry or moist tooth structure
• Impressive bond strength to ALL substrates
• Use with ALL direct and indirect restorations (<10 micron thickness)
• Ideal chemical balance for both total- and self-etch adhesion from one bottle
• Compatible with ALL resin cements (no additional activator required)
• Virtually no post-operative sensitivity
• Clinical Significance:
• All-Bond Universal offers the flexibility for total-, self- and selective-etch procedures
• All-Bond Universal is compatible with all light-, self- and dual-cured resin composite and cement
materials for all direct and indirect procedures
• All-Bond Universal works with dual cure resins, NO activator is required
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CHOICE 2 VENEER CEMENT (BISCO)
- Light-cured luting cement designed for cementation of porcelain veneers.
- Color stability.
- Corresponding try-in pastes (sold separately)
- Choice 2 is specifically formulated for color stability (Delta E <1.2**) resulting in high esthetics
-Highly filled resin cement enhances the overall strength of the restoration
-Low film thickness ensures veneers are completely seated
-Corresponding try-in pastes confirm shade selection prior to cementation
-Choice 2 cement will not change (shade shift) over time, a problem that can occur with dual-cured systems
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LITHIUM DISILICATE & SILICATE, LEUCITE, FELDSPATHIC &
ZIRCONIA RESTORATIONS
- Dual Cured
- Quick Clean Up
- High Conversion
- Low Film Thickness
- Radiopaque
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FINAL RESTORATIONS
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Veneer Finishing System
Send CONTACEZ to 24587 to request a sample.Using the code SNYDER20 on their website will get attendees 20% off their next order!
ContacEZ Restorative strip system
• NEW Gold Narrow Strip 0.10mm single sided medium diamond grit Sub Gingival Trimmer w/ Blank Clear Gateway
• Black Diamond Strip 0.06mm fine diamond single sided
• Orange Serrated Diamond Strip 0.05mm extra fine diamond single sided
• White Serrated Strip 0.035mm
• Blue Serrated Strip 0.065mm
• Gray Final Polishing Strip 0.05mm ultra fine diamond single sided
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ContacEZ IPR Optional Strips
• Clear IPF Single Sided Opener 0.10mm med-fine diamond
• Cyan IPR Single Sided Widener 0.12mm med-coarse diamond
• Purple IPR Super Widener 0.25mm
coarse diamond
• Brown IPR Mega Widener 0.30mm coarse diamond
Example-Centric Occlusion
▪ Anteriorly positioned condyles
▪ Occlusion is not ideal Appears to have canine guidance
Weak centric stops and limited number
▪ Patient okay for a few months
Now has joint pain, noise, muscle pain, teeth are sensitive
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Centric Relation
▪ Joint in proper position
▪ Occluding only on second molars
▪ Restorative dentistry & orthodontics (aligners too)
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Normal Disc Reducing Non-ReducingNormal
Remodeling DJDRemodeling
Adolescent
Facial GrowthDecreasedInterruptedNormal
Bones
Disc
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Aesthetic Opportunities:
Developing Beautiful Smiles
Case #24 (Complex Occlusion)
Developing Beautiful Smiles
Assessment:Joint NoiseFacial Muscle PainPoor OcclusionInvisalign Done/RetentionAnterior WearWants to Keep Appearance
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Cause & Effect Diagnosis• Functional Wear on Anteriors
• Masticatory Muscle Pain
• Headaches
• Jaw Relationship / TMJ Disorder
• Obstructive Sleep Apnea (OSA)
• Combination
Aesthetics & Occlusion
Supplemental Tests:Sleep StudyCone Beam CT (CBCT)Airway Evaluation
AIRWAY VOLUME
-50mm2 and below have an association with OSA
Aesthetics & Occlusion
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TMJ EVAL/Diagnosis
CBCT-Pathology-Jaw position-Bone Appearance-Active DJD/Remodeling
Aesthetics & Occlusion
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Aesthetics & Occlusion
Orthotic: Superior Repositioning Appliance (SRA)
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Nociceptive Trigeminal Inhibition Tension
Suppression System (NTI-tss)
Jaw Position
NTI type appliances
Jaw Position
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NITE BITE
• 5 minutes to make a Nite Bite appliance for relief of most TMJ
discomfort
• Fast fabrication
• Force distribution
• Minimal opening
SRA FABRICATION:Try-in
Check Bite
Adjust Posterior
Shallow Ramp
Trim Trough
Occlusal Reline
Passive Centric & Hold
Mark Depth of Fossa
Trim Excess
Polish
Aesthetics & Occlusion
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Aesthetics & Occlusion
Aesthetics & Occlusion
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Aesthetics & Occlusion
• Patient wears just at night the first 2-5 days
• Understands they will wear 24/7
• Patient comes back for evaluation every 2-4 weeks
• Passive reline to achieve equal contacts
• Once the bite is stable follow for another 2-4 weeks
Aesthetics & Occlusion
Orthotic: Superior Repositioning Appliance (SRA)
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Aesthetics & Occlusion
Aesthetics & Occlusion
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Aesthetics & Occlusion
Occlusal Analysis
Aesthetics & Occlusion
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Aesthetics & Occlusion
Aesthetics & Occlusion
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Aesthetics & Occlusion
Aesthetics & Occlusion Impression Trays
HEATWAVE BY CLINICIAN’S CHOICE
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Aesthetics & Occlusion
The Nuts & Bolts of VeneersAesthetics & Occlusion
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TISSUE AND MOISTURE CONTROL
Aesthetics & Occlusion
A laser is more precise, causes less pain, and
prevents bleeding better than traditional tools used
on soft tissues. The highly focused laser light
cauterizes nerve endings, coagulates blood
vessels, sterilizes the surgical site, and increases
the speed of healing. Instantly cauterizing nerve
endings greatly reduces pain during the procedure
and after. Healing times can be as low as a few
days where traditional surgical approaches can take
several weeks.
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Simplified Provisionals
Aesthetics & Occlusion
Provisionals (Duplicate models)
Scribe a 0.5-1mm line with a sharp instrument into the
model where the tissue and tooth come together.
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Aesthetics & Occlusion
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Aesthetics & Occlusion
• Verify shape
• Display at rest
• Protrusive
• Excursives
CEMENTATION OPTIONS• Glass Ionomers
• Resin Modified Glass Ionomers
• Self Etch Resin Cements
• Bonding Agent w/ Resin Cement
• Calcium Aluminate
• TriSilicate Cement
Aesthetics & Occlusion
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CERAMIR (CALCIUM ALUMINATE CEMENT BY - DOXA)• Alkaline pH 8.5
• Moisture Tolerant
• Self Sealing
• Apatite Formation
• Insoluble
• Stronger with time
• Semi / Translucent
• Biocompatibility-Excellent
• Bioactivity-Apatite formation
• Sealing Quality-Excellent
Aesthetics & Occlusion
Aesthetics & Occlusion
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Aesthetics & Occlusion
Aesthetics & Occlusion
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Aesthetics & Occlusion
Aesthetics & Occlusion
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Aesthetics & Occlusion
Pre-op
Post-op
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Review Patient with Problems-Sleep Study Questionnaire-Sleep Study?-Cone Beam CT (CBCT)
-TMJ Diagnosis (Beamreaders.com)-Airway Evaluation
-Superior Repositioning Appliance (SRA)-Reline as needed.
-Hinge Axis-Diagnostic Model Workup-Discuss Options with Patient
Aesthetics & Occlusion
Questions?
Aesthetics & Occlusion
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Lecture Handout
www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers
Digital Handouts
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