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BOSTON UNIVERSITY HANDOUT
HUGH FLAX DDS
ALL IMAGES AND CONTENT ARE COPYWRIGHTED
CONTEMPORARY COSMETIC DENTISTRYPREDICTABLE PRINCIPLES THAT “FACILITATE
AND REPLICATE” THE SMILES OF OUR PATIENTS
BY HUGH FLAX DDS, AAACD, MICOIATLANTA, GA
Henry M. Goldman School of Dental Medicine
FOR HANDOUT GO TO www.HughFlax.com
Catapult Group is an organization which consists of top clinicians and educators from throughout the United States and Canada. This group of like-minded yet diverse dentist’s goal is to bring quality education to the dental community via multiple venues including; live lecture, participation, web based, and written formats.
SUMMARYContemporary Cosmetic Dentistry-- Predictable Principles that “Facilitate and Replicate” the Smiles of our Patients • Cosmetic dentistry is no longer a novelty as it was in the 1980’s……it is serious business. Patient
expectations are growing so that you must learn to master the art and science not only in the front but the back of the mouth. Fortunately advancements in technology and materials have allowed dentists and their teams to be on the same page with the patient, lab, and specialist that help you create extra-ordinary results that are predictable and profitable for the practice and often affordable for patients.
Learning Objectives:
• 1 .Learn critical factors in smile design that help you create beauty and” keep it real”
• 2. See how veneer cases can be easy to do by always doing 4 critical steps
• 3. Discover how laser technology can make your cases esthetically beautiful, biologically healthy that promote healing and improve your bottom line –even 2 months faster in complex cases.
• 4. Find out how having the ability to efficiently and effectively design smiles with composite is not a “lost art’ using minimally invasive preparation design and properly layering composite resin with simple layering of opacity, translucency and color to achieve the beautiful and believable results.
• 5. Learn updated techniques in posterior composites that are minimally invasive.
Hugh Flax DDS, AAACD MICOIAtlanta ,GAFlax DentalMember of Catapult [email protected]
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DISCLAIMER
• As a Catapult Group member we participate in multiple product reviews each year in order to stay at the fore front of the latest materials, techniques and services available, ensuring that the message we are delivering is current and relevant to today’s continuing education needs.
• Some of these products & services I will be sharing with you today.
• Today I am supported in part by:• Shofu• AMD• SDI• Lending Club• Kettenbach• Microcopy• Solution Reach• Contact EZ
DISCLOSURES
• Huge proponent of “Responsible Esthetics”
• Leading edge vs. Bleeding Edge
• Products that I mention I use all the time and like to share what is working for me (companies that are sponsoring or contributing products for this presentation only for that reason)
• Learning-sharing new and reinforcing “time-tested” knowledge and learning from each other
USA TODAY STUDY (1997) OF ATTRACTIVENESS AND SELF ESTEEM
WHAT WOULD YOU CHANGE ABOUT YOUR PHYSICAL APPEARANCE ?
• Weight
• Height
• Face
• Hair
IF YOU COULD CHANGE ANYTHING IN YOUR FACE WHAT WOULD IT BE ?
• Nose
• Eyes
• Teeth
• Chin
• Lips
• Head shape
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ABC-TV’S“EXTREME MAKEOVER” SHOW !
DIVERSITY IN CULTURE AND EXPECTATIONS
TODAY’S CHALLENGES OF ESTHETIC DENTISTRY
• ESTHETICS
• BIOLOGY
• FUNCTION
• ECONOMICS1. Expectations of patients2. Chairtime3. Minimally invasive4. Affordability5. Durability/ Reparability
TIME FOR CHANGE• Diversity of people and choices in treatment• How we build value for people and meet expectations
• The speed and volume of providing information and care
• How to fit someone’s budget-time and financial• How we perform dentistry
EXTREMECUSTOMIZATION
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EXTREME CUSTOMIZATION
• LEVERAGING TIME
• INNOVATING
• BE CREATIVE
JIM ROHN
STONE TOOLS COMPUTER MOUSE
“Innovation distinguishes between a leader
and a follower.” Steve Jobs
http://www.ted.com/talks/lang/en/matt_ridley_when_ideas_have_sex.html
You need to understand how human beings bring
together their brains and enable their ideas to combine and recombine, to
meet and, indeed, to mate. In other words, you need to
understand how ideas have sex.”
CREATIVITY
"Don't think. Thinking is the
enemy of creativity. It's self-
conscious, and anything self-
conscious is lousy. You can't try to
do things. You simply must do
things."
ESTHETICS
FUNCTION
PERIODONTAL
SUPPORT and CONTOURS
BIOMECHANICS
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INTERDISCIPLINARY CARE
3 D CT Scan Courtesy of Kai-hung Fung, MD
ORTHO LABPERIO
ENVISION THE SMILE
“Begin with the end in mind”Stephen Covey
WHAT IS ESTHETICS ?The science of beauty in nature as
an art
“Beauty is the association of many complex associations”
Charles Darwin
FACIAL EVALUATION
In repose
Middle 1/3 =Lower 1/3
Maxillary lip length : YAF 20-22 mm
YAM 22-24 mm
MIDLINE
MATCH THE MIDLINE OF THE FOREHEAD (NOSE ?)
INCISIVE PAPILLA
INCISAL and INTERPUPILLARY PLANES
Parallel to each other
Skeletal defect ? Ears?
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SMILE FRAME
The “Broadway Play”
Proportions
Symmetry
LIPS
Form
Fullness
Competence
Symmetry
Position (repose/smile)
Affect of upper incisors (length/inclination)
SMILE LINE
Plane of incisal edges
Lower lip curve
Convex-youthful
Concave-indicates disharmony esthetically (“curb appeal") and functionally (“under the hood”)
GINGIVAL SYMMETRY/CONTOUR
No excessive display
Centrals match each other
and canines
Laterals?
Edentulous
spaces ?
AXIAL INCLINATION
Long axis of teeth
Harmony-occlusally
visually
Tipping
Profile
/gingival shaping
PROFILE
Contour of facial surfaces Parallelism with adjacent
structuresEstheticsFunction
Incisors ? Canines ? Lab communication
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BUCCAL CORRIDOR
What is it ?
Factors ?
Arch width
Muscles of cheeks
Soft tissue contour
Posterior teeth
EMBRASURE SPACES/OUTLINE FORM
3 Dimensional (incisal/gingival)
Characterization
Transition
Dozens of combinations
Communication tool—several resources
-- Smile Guide (Discus)
-- Imaging systems
Image FX now called
Patient Gallery http://www.patientgallery.com )
GPS 3D Design http://dentalgps.com/gps-store/gps-software/
COLOR
3-D multi-chromicity
Translucency- degree?
color?
clarity?
“Halo”
How to communicate it
Resources: Analysis (Ubassey)
Voyage (Sieber)
Ceramic Works (Aoshima)
TEXTURE
Ultimate in
“microanatomy”
Age factors
Communicate with the patient and lab
PROPORTION / GENDERIZING
From PPAD Sept,1998 (Vol.10,No.7)
DENTO-FACIAL EVALUATION
Esthetically pleasing?
Tooth display?
Incisal edge position?
Gingival level?
Proportional width?
Maxillary lip position?
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RULECreate Reference Points
1.Display2.Length: At least 10 mm3.Width: At least 7.5 mm4.Midline: Must be vertical5.Lateral incisor: 2 mm rule6.Canine: 1 mm rule
PLAN1.Incisal length2.Gingival level3.Implant level
PLAN1.Mock Incisal and/ or Only
2.Full waxup (function)3.Test Final Mock
ESTHETIC FACTORS
• Midline• Facial thirds are ideally equal• Interpupillary line• Maxillary Tooth Position
1) Labial-support maxillary lip and balance of face2) Vertical canine position in repose—level with the lip (Misch/
Kois)3) Centrals-1-2 mm below the horizontal line drawn from canine to
canine4) Canine tip in line with ala of the nose5) Posterior occlusal plane meets labial angle forming a 90 degree
angle
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GIVE ‘EM WHAT THEY WANT !!!
“Do what you do so well that people can’t resist telling others about you”
Walt Disney
COMMUNICATE VISUALLY ANYTHING TO ANYONE ,AT ANYTIME !
JCD WINTER 2015
WHY NOW?????????
FACT: In 2009, in the USA, video content views surpassed text content views
WHY NOW???
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COURTESY CHRISTIAN COACHMAN
BOTTOM LINE
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ANALYTICAL EMOTIONAL
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Pink Esthetics WAYS TO MANAGE PINK
TRADITIONAL• ELECTROSURGERY• SCALPEL REDUCTION• OPEN FLAP CROWN
LENGTHENING• FREE GRAFTING• CONNECTIVE TISSUE
GRAFTS
INNOVATIVE• LASER REDUCTION• CLOSED FLAP GUM LIFT• TUNNEL GRAFTING
(Allen;Salama;Mahm; VISTA;Pin Hole)
• PEDICLE GRAFT• ADD WITH PINK RESTORATIVE
Macro-multiple teeth/ large areasMicro-1-2 teeth / small areas
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BIOMECHANICAL RISK ?
http://www.highlandmetals.com
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Axial—KS0; KS1 and KS1L coarseFine flame shaped
Lingual- Egg or pear shaped (coarse/ fine)
Final polish –rubber point
SMOOTH ROUND PREPARATIONS
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LumiSmile White Highlights: • 32%, 22%, 16% Carbamide Peroxide • Formulated to minimize sensitivity • Long unrefrigerated shelf life*• Flavored with real peppermint oil • Refill kits available
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IT’S NOT ABOUT THE PAINT ! ! !
IT’S ABOUT THE ARTISTRY THAT YOU DO WITH IT! ! !
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DATA ACQUISITION ACCURATE
CALIBRATED
SYSTEMATIC
TREATMENT PLANNING FUNDAMENTALS OF DENTISTRY
• Biomechanics
• Periodontal support
• Occlusal/ Function
• Habits
• Medical management
• Esthetics
STRATEGY FOR “WIN WIN SUCCESS”
CODISCOVERY—at EVERY visit
1. Build understanding
2. Verify and validate
3. Create vision AND Manage expectations
BLUEPRINT OF CONCEPTS
“TEST DRIVE”
GO FOR THE WIN !!!
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MED HX
DENTAL HX
DOCUMENTATION
Review forms/Interview
Digital photos (AACD; DSD)
Digital radiographs
Periodontal exam
Occlusal exam
Oral cancer exam
Caries / Cracks
DIFFERENT CAMERAS FOR DIFFERENT NEEDS & DESIRES
• SLR
• I PHONE smilelineusa.com Smile Lite & Smile Capture Full Set - #6500/6550-SET
Adaptor for better focus/ zoom
5000K Light and Polarizing filter for depth/reflection
• EYE SPECIAL II
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UNIQUE FEATURESEYESPECIAL C-II
• Designed for dentistry• 8 pre-set shooting modes• Dental grid lines & spot focus • Water and chemical resistant – Essential
for infection control • Durable rugged Exterior
• User Friendly• Fast autofocusing & anti-shake
capabilities• Easy to use – no photography skills
required• Light weight/can be held with one hand –
weighs only 1lb
• Special Benefits• Compatible with the Eye-Fi X2 card –
Immediately upload images onto PC, iPad, Tablet or Smartphone
• SureFile Photo management software –Keeps record of patient information
8 DENTAL SHOOTING MODESFOR EYESPECIAL C-II
Standard Mode – For standard intraoral photography.
Surgery Mode – For intraoral photography from a certain distance.
Mirror Mode – For intraoral photography using a mirror; the image taken can be reversed.
Face Mode – For shooting facial views or half-body portraits.
Low-Glare Mode – For Photographing details of anterior teeth; working models and indirect restorations
Whitening Mode – For shade comparison between before and after whitening.
Tele-Macro Mode – For photographing anterior teeth, indirect restorations and working models in higher magnification. **Attach the close-up lens when taking pictures in this mode**
Isolate Shade Mode – You can isolate the shade for optimal shade matching.
STANDARD MODEFOR STANDARD INTRAORAL PHOTOGRAPHY
Everyday dental photography – The mode that will get used most
• Ideal distance 9.4 in
• Patient will be sitting up in chair or standing
• Will likely have cheek retractors in place
• Can be taken with normal operatory lighting
ISOLATE SHADE MODEYOU CAN ISOLATE THE SHADE FOR OPTIMAL SHADE MATCHING
• Gingival shades removed
• Improves visual acuity
• Excellent case selling tool
• Ideal distance 5.5 in
• Patient may have cheek retractors in place – could be used on a model at the bench in a laboratory
CASE ACCEPTANCE
Collaborative with DSD system
(Interconsultation and Emotional Dentistry)
Matter of fact presentation of:
1. The “cards” we are dealing with (Awareness of conditions/risks)
2. What are those “implications” to short and long term goals (Consequences) and determine Concerns
3. Options—including “Doing nothing” (PRESENT AT LEAST 3)
Broad stroke description of a “progressive plan”
Technical Q & A (with Doc)
Plan the “first step”
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GENERALIZED WEAR CASE
WHEN A LASER IS USEFUL
ESTHETIC RISK?
UNSTABLE CHEWING ENVELOPES/ OCCLUSIONS
Kois Continuum #8
What pattern of wear?
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BIOMECHANICAL?BONE LEVELS?
KOIS CONTINUUM #8
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Futar® D Fast - Twice as fast
Rigid Shore-D hardness of 43
Dispensed with very little effort, saving time
Thixotropic and easy to remove
Total Set Time: 1 Min.
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Futar® Fast - The comfortable classic
• Shore-A hardness of 90
• Thixotropic and easy to remove
• Sets quickly, can also be milled and easily cut with a scalpel
• Total Set Time: 1 Min.
Hydrophilicity: clinical aspect
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WHAT ARE MY BEST COHESIVE CEMENT CHOICES?
Dual Cure Resin
GC LinkACE
3M Relyx Unicem
Bisco Duo-cement
Ivoclar Multi-link
Bio-enhancing
Glass ionomer—Fujicem 2
Bioceramic--Ceramir
“Universal” Adhesive
Definition
•Usable for Direct & Indirect (Film Thickness <10 um)
•No additional resin layer required (1-Layer Adhesive)
•Compatible with D/C, S/C resin cement/composite without DC
Activator
•Usable with TE, SE & Select-Etch
Not Sensitive to Dentin Moisture Level
Shear bond strength on dentin with different moisture level, MPa
Adhesive Technique Desiccated Dentin Moist Dentin* Over wet Dentin
All-Bond
Universal
Total-Etch 26.9 (7.1) 33.2(7.8) 48.1 (7.8)
Self-Etch 28.4 (3.0) 31.0 (3.0) 34.2 (7.6)
•Recommended procedure by IFU.
Desiccated: strong air dry 10 sec; Overwet: a pool of water on surface.
DRY WET
Dry or wet? It doesn’t matter!
Lithium DisilicateZirconia
Shear Bond Strength to Indirect Substrates using Duo-Link
(Self-Cured Mode), MPa SUMMARY of ALL-BOND UNIVERSAL:
the ONLY TRULY UNIVERSAL one-bottle dental adhesive
bonds to all dental substrates (Directs and Indirects)
can be used with Self-Etch, Total-etch or Selective-Etch techniques
hydrophilic (good wetting) before curing… after curing, it is more
hydrophobic (non-permeable & durable) than other adhesives
long-lasting (durable) bond strength
doesn’t need additional resin/adhesive layer
bonds to dentin regardless of moisture level (over-wet, moist or dry)
compatible w/ S/C and D/C resin materials without additional activator
doesn’t need refrigeration
the solvent is easily evaporated (no water residue)
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SEQUENCE: 8,9, 7,10Cuspid bicuspids each side
APPLY 2 coats thoroughly15 sec per coatDRY lightly to remove excess
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LIGHT CURE –10 seconds per tooth
Ceramir Crown & Bridge Ceramir C&B is a material that combines glass ionomer technology with the
innovative Ceramir (Calcium Aluminate – CA) technology.
The GI contributes to: Low initial pH, short duration
Flow and Setting characteristics Early strength
The CA contributes to: Increased strength and retention
Biocompatibility Sealing of tooth material interface Apatite formation Sustained long term properties, no degradation Basic end pH
RetentionValues equal to self-adhesive resins
Metal
Cement Retention (gold crown) (kg/f)
Ceramir Crown & Bridge 38.6 ± 8.5
RelyX Unicem 39.8 ± 15.3
MaxCem (Kerr) 15.9 ± 9.3
Ketac Cem 26.6 ± 4.4
ZinkPhospate 13.9 ± 4.5
0
5
10
15
20
25
30
35
40
45
Ceramir Crown &
Bridge
RelyX Unicem MaxCem (Kerr) Ketac Cem ZinkPhospate
Retention (gold crown) kg/force
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FMR PREVENTIVE MEDICINEGET TIME/FORCE OCCLUSAL INFORMATION WITHOUT RELYING ON SURFACE “PAPER MARKS” OR PATIENT/DOCTOR PERCEPTIONS
USE THE T-SCANBETTER TIMING & BALANCE
LESS WEAR/FRACTURESBETTER COMMUNICATION/DOCUMENTATION
SALAMA, COACHMAN, GARBER, CALAMITA,ET ALInt. Journ of Perio and Restorative Dentistry Vol 29 No 6 2009; 573-581
Think 3D with color and contour gums-artificial and natural
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USING TRANSITIONAL BONDING FOR INTERDISCIPLINARY CARE
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• Highly filled and durable for fracture resistance in thin areas
• The fillers are coated with a silane coupler that allows for predictable bonding to substrate (which is already enhanced by the Composite Primer)
HOW TO BOND GRADIA GUM
GC Ceramic Primer is used to bond Gradia Gum to Ceramic.
GC Composite Primer is used to bond Gradia Gum to Composite/Acrylic.
GC Metal Primer ll is used to bond Gradia Gum to Metal.
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CADDY WOMPUS JOURNEY
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BOTTOM LINE:1) No implants over 4.3 mm in the anterior zone
2) Lingualize the implant placement3) Fill the gap with 50/ 50 mix DMFB/ cortical bone4) Consider a connective tissue graft
OPTIONS:1) Do nothing
2) Remove implant (s)3) Augment the tissue and restore (single? splinted?)
and add pink
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MICROGINGIVAL PORCELAIN ENHANCEMENTS• Create a “palette” of colors/ blendsMockup
• Sandblast with Prepstart (27 micron AlO2)
• Porcelain etch with Ultradent HF (60 sec) and rinse thoroughly
• Silane (airdry for 1 min)
• GC Composite or Ceramic Primer-cure for 1 min
• Place restoration in the mouth
• Apply composite and blend
• Polish and/or glaze
WHY NOW?
• Desire to go digital with impressions—lots of choices; wanted the complete pkg.
• Confluence of more user friendliness (impressions/ design/ milling) and better material choices (esthetics; seal; strength; bonding mediums)
• CEREC-30 years experience and Sirona’s desire for “CAD/ CAM for everyone”
• Expand the breadth of options for our patients
Restorative (crowns; partial crowns; and inlays)…..YOU CAN BE CONSERVATIVE
Implant surgery and restoration ( crown down approach)
Ortho impressions ( Clear Correct; Invisalign 6/15)
Digital waxups and integration with DSD
• It’s FUN and DELEGATABLE
• Create a WOW experience-One Visit/ One Shot/ No temp
Saves time and increased case acceptance
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• EXCEPTIONAL STRENGTH FOR MULTIPLE SITUATIONS
• EXCELLENT AESTHETICS• FASTER MILLING TIME• REPAIRABLE IF NEEDED• EASIEST MATERIAL TO FINISH.
Finishing & polishing
1. Grind off the connector
2. Use medium silicone point
3. Use fine silicone point
4. Use diamond paste such as GRADIA DIAPOLISHER Paste for high
gloss
Treat with hydrofluoric acid (5%) for 60 seconds or Phosphoric acid (35-37%) can be also used for the purpose of cleaning the surface, preferably scrubbing with a microbrush for 10-15 seconds.
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Repair of Cerasmart restorations
248
1. Roughen
Slightly roughen the bonding area (restoration and exposed tooth structure) using a coarse diamond point or carbide bur
2. Silane the restoration
Apply silane coupling agent on the restoration such as Ceramic Primer
II and gently dry.
If other primer is used, followed the manufacturer’s instruction
GC G-ænial Universal Flo is recommended in order to repair the surface of Cerasmart restorations since it is based on the same technology.
4. Apply the composite
Apply the chosen restorative material and light-cure it
according to the manufacturer's instructions.
Apply a bonding agent such as G-aenial Bond on the
exposed tooth tissue, dry and light-cure following
manufacturer’s instructions
3. Bond the exposed tooth
OUR FIRST CERASMART
GC IFU
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Shake the bottle
Dispense
Apply a thin layer with a
brush
Do not air blow
Cure light-curing device
having a wavelength in
the range of 400-430 nm
for 40 sec (exceptions
Kerr Demi Ultra and 3M
Elipar 10 S)
Selective etch15/10/10
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THE BU$INESS OF MAKING YOUR PRACTICE PROFITABLE
You GotA Problem
With That ??
Your patients
can confirm
by email and by text!
Recare Reminders bring your
patients back to You!
$605,462.00 from past
Appointments
Newsletters
keep your Brand
in front of your Patients!
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for watching an online demonstration of the
Text “FLAX” to
801.201.6357
to receive a
$25 American Express
gift cardfor watching an online demonstration of the SOLUTIONREACH Platform
RECURRENT DECAY/ CRACKS PRESENT
DOCUMENTATION
DENTAL BENEFITS• Better more natural smiles—conservative (preserve enamel)
3 R’s—Relocate Replace Restore
• Prevention---better fitting bite (peaks; valleys; side of the hill) decrease stress; cracks; and wear
• Improved gum health due to less crowding
• Avoid unnecessary treatment and unneeded expense
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217 SE 136th Ave. Suite 105Vancouver, WA 98684, USA
p (360) 694-1000f (360) 694-6191
The ContacEZ IPR Strip System is an innovative interproximal reduction system that makes IPR safer and more accurate without creating sharp corners. Designed for use with Invisalign®, ClearCorrect™, eCligner, Inman Aligner™, and other clear aligner treatment systems, these strips curve and flex along the natural contours of the teeth to prevent soft tissue irritation, avoid cutting excessive enamel, and maximize patient comfort.
• Single-handed design offers optimal tactile control.
• Will not cut lips or gums and eliminates gagging.
• Flexible strip will contour the curvature of the tooth without creating subgingival ledges or sharp corners.
• Reduce binding and prevent residual crowding.
• Easy access to tight anterior or posterior areas.
• Autoclavable up to 280° (steam heat only, not dry heat), and multi-usable.
PASS ALL CONTACEZ STRIPS BACK AND FORTH BUCCOLINGUALLY ONLY
217 SE 136th Ave. Suite 105Vancouver, WA 98684, USA
p (360) 694-1000f (360) 694-6191
IPR Strip System
0.06mm│Single-Sided│Extra-Fine Diamond │ Serrated
0.12mm│Double-Sided│Medium Diamond
0.15mm│Double-Sided│Coarse Diamond
0.20mm│Double-Sided│Coarse Diamond
217 SE 136th Ave. Suite 105Vancouver, WA 98684, USA
p (360) 694-1000f (360) 694-6191
Double-Sided Optional StripsReduce enamel on two adjacent teeth.
Purple IPR Super-Widener0.25mm│Coarse Diamond
Brown IPR Mega-Widener0.30mm│Coarse Diamond
217 SE 136th Ave. Suite 105Vancouver, WA 98684, USA
p (360) 694-1000f (360) 694-6191
CleanAfter cementation, remove excess cement with an explorer. Pass a ContacEZ
Serrated Strip buccolingually in the interproximal spaces to cut and clean out any remaining excess cement.
White Serrated StripGentle Saw
0.35mm│Serrated
Blue Serrated StripHeavy-Duty Dental Saw
0.065mm│Serrated
Safely remove cement from multiple restorations without disturbing placement prior to light curing.
Cut into massive excess cement, and separate fused contacts of multiple veneers after light curing.
HEAL
IT
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• 20% more diamond cutting surface for a faster cut with less chair time.
• NeoDiamond is individually packaged, sterilized,
and color-coded with Quick Grit ID for safety and convenience.
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More patient-friendly financing helps increase case acceptance:
• More Payment Plans: True No-Interest Plans* provide patient-friendly options.
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• More Approvals: Credit policy expansion approves more patients.
So we can treat MORE patients.
More patient-friendly financing helps
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MORE Flexibility: Terms up to 84
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nearly 12% more likely to move forward
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MORE payment plansTrue No-Interest Plans*
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•Financing up to $50k; great for large cases.
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MORE of what you wantWhite glove customer service
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Independent Solo Dentists
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SmileSource.comSHADE MATCHING
CHALLENGES IN SHADE MATCHING• Lighting
• Metamerism—two objects appearing to match in one situation and not matching in others (office vs. home)
• Contrast Effects—visual phenomena that alter perceptions of color (skin tone; background –use blue/gray; large vs small teeth; crowding; successive shades)
• Reflections on surfaces
• Experience and knowledge
• Eyes
• Subjectivity of dental team and patient
• “Hit man vs. The Healer”
CREATING A WORLD DENTAL SHADE STANDARD
1927
1956
1940
1950’s
1983
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ADVANCING DEVELOPMENTS
1983
2003
1998
Dr.Hall
(Drs.Jung)
Dr.Saddon
2010
1998
Dr.Paravina
MOST SHADE MATCHING TODAY…
TECHNOLOGY FROM THE 1950’S WHAT ARE YOU USING?
The color of the tooth REALITY OF SHADE MATCHING TODAY
Courtesy of Dr. R. Nash
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SHADE SELECTION; IT’S A PROBLEM…
• Doctors are matching shades by looking at the whole tooth or incisal areas.
• Doctors are mainly buying and using the enamel shades in current composite systems.
• In a recent study 86% of dentists couldn’t agree on a shade.
• A recent SCAD poster showed that three leading composite brands didn’t match the intended Vita shade, for numerous shades.
Healthy Tooth
Decalcification and
decalcification are
equilibrium
Caries occurs
Resin filling Bo
nd
ing
ag
en
t
Direct Restoration
Secondary Caries
Pulpectomy
Crown treatment
Build up core
Crow
nCement
Bo
rde
r cari
es R
oo
t bre
ak
ag
e
Extraction
BIOLOGY
TOOTH SUBSTRATE MANAGEMENTENAMEL VS DENTIN
FUNCTIONAL RELIABILITY FOR COMPOSITES
FUNCTIONAL RELIABILITY FOR COMPOSITES
STRENGTH and FLEXIBILIBILITY UNDER MULTIPLE FORCE LOADS and VECTORS
• EFFECTS of POLYMERIZATION
1. Volumetric shrinkage
2. Shrinkage stress
• FLEXURAL MODULUS—the higher the more brittle
• COMPRESSIVE STRENGTH
• RADIO-OPACITY
Polymerisation Shrinkage Stress
0
1
2
3
4
5
6
Aura
Dentin
SonicFill Kalore Xtra Fil Surefil
SDR
Quixx Venus
Bulk Fill
Tetric
Evo
Ceram
Bulk Fill
Rok Ice Glacier
Po
lym
eri
sati
on
Sh
rin
kag
e S
tress
(MP
a)
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COMPRESSIVE STRENGTH
Radiopacity
(mm Al)
0
0.8
1.6
2.4
3.2
4
4.8
A ura F ilt ek Sup reme
X T E
Est het X HD Herculit e U lt ra Kalo re T PH3
Rad
iop
acit
y (
mm
Al)
IN THE END, IT’S ALL ABOUT THE LOOKS
Patients judge their dentists by how their restoration looks!
HUE , CHROMA & VALUE
Hue - Basic color of a tooth e.g red, blue or yellow
Chroma – Intensity of the color (hue)
Value – Lightness or darkness of the color(hue)
Opacity – ability for light to pass, translucency
Aura’s shading system• Based on natural make-up and colors of enamels
and dentin
• Linear, logical and scientific arrangement for
predictability and customizing shades
• Simple layering technique to reproduce the natural colours of teeth
• Designed to simplify shade matching for busy clinicians; minimal effort.
• Shade matching in ten seconds is recommended,
then the clock starts ticking when the patient entering the chair.
SHADE SELECTION METHOD
1. Choosing the dentin
shade
2. Choose the enamel
shade
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COLORIMETRIC PROPERTIES OF AURA DENTIN CHROMA RANGE
• Single opacity
• Single hue
• Large chroma scale, aka color intensity, (Db,DC1 – DC7) is equally spaced
• Fluorescence
Aura has a linear and scientific arrangement for
predictability and customizing shades
AURA’S FEATURESS
• Non-sticky – less uncured resin is used, creamy handling
• Easy to polish to mirror finish
• Large particles (60 microns) = high filler loading & strength
• Low flexural modulus (big bonus); better fracture resistance, less stress at composite interface means less debonding
• Lower polymerization shrinkage
Shade selection for layering technique
• Shade selection must be carried out
before isolation, ideally under day light using Aura shade guide provided
• Do not dry the teeth
• Start with Dentin shade/ bodyEnamel
• Aura’s shade guide is made from actual
Aura’s pastes.
• No shade change from pre-cured state to
cured state
Enamel shadesBased on different colours of natural enamels:
E1: most whitish/lightest, high opalescence with
some degree of translucency. Designed to emulate young enamel. Age under 20
E2: neutral in colour, less opalescence with intermediate translucency. Designed to replace adult enamel. Age 20-60
E3: tinge of yellow, high translucency & is suitable for aged enamel. Age 60 plus
FEATURES OF E1 – E3 SHADES
• Prepolymerized microfilled composite – market advantage, stronger than a standard microfill.
• Easy to polish to high gloss
• Contains opalescence (bluish glow in natural light) to match natural enamels, gives life to restoration
• Superb gloss retention without the “plucking effect” of large particles
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• College student (about to begin nursing school) very unhappy with her post orthodontic results
• Discolored teeth-white spots and yellowed composites
• Prominent upper left canine
• Inconsistent shapes and papilla
• Worn edges of teeth
Muscle tenderness and sense of not having a consistent bite, prominent canine, slight fremitus of #6-11, and general tooth wear were indicative of occlusal dysfunction
• Discolored cervical composites and generalized “white spots” were indicative of a history of decalcification. The question at her exam was whether this was still active.
• A “bioluminescence” test demonstrated a lower than optimum pH in the oral environment. Patient was put on an aggressive remineralization program using Carifree treatment rinses and tooth pastes/ gels.
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Using the Erbium laser in soft tissue mode of 2 Watts to create a better “gingival frame” prior to bonding
Surface discolorations and previous composites conservatively removed with a flame shaped diamond maintaining the outer enamel and creating room for forthcoming layer of Aura.
• Suspicious decalcifications checked with cavity detection dye
• All remaining “affected” enamel removed with the Erbium or new CO2 laser
Set at 27 micron AlO2 and 40 psi
Consepsis(Ultradent) thoroughly irrigated
over microabradedareas to disinfect surface
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37% phosphoric acid was placed over the
entire labial surface with a 30 second exposure time (since
no dentin was involved) and thoroughly rinsed
with water for 15 seconds each
A universal bonding resin was placed carefully placed using a
microbrush and thinned with an Adec warm air dryer
Each tooth being treated was cured for 20 seconds using SDI’s
Radii Plus light with its wide tip.
Aura Enamel (Shade E1) was thinly applied and sculpted using
Cosmedent’s Titanium IPCT Instrument placing the gingival half first blending the interproximal. After a 40 second cure, the incisal portion is
adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.
CURING TIMES
Actually 10mm+
Gross finishing is achieved with a thin 16 bladed ET 9
bur to clean the gingival margins and establish labial anatomy.
Interproximal surfaces were smoothed with
plastic finishing strips
Labial surfaces were polished using a series of
abrasive disks
Final gloss achieved using a flexible felt disc
and aluminum oxide paste
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59
PUTTING IT ALL TOGETHER
MARK YOUR PATH
LASE
IT !HEAL
IT
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VERIFY
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CONCLUSIONS
• Smile design and composites are a great entry point for patients who want smile “makeovers”—use the right tools (photos; DSD; and bonding materials) to create artistic success and “good business”
• Utilizing minimally invasive preparation design like lasers; air abrasion; and bevels will help to preserve tooth structure and blend composites to look more lifelike
• Properly layering composite resin with color friendly materials like Aura helps achieve the beautiful and believable results
ANY QUESTIONS ????
Thank
You
CONTACT INFORMATION
HUGH FLAX,DDS(404) 255-9080
Email: [email protected] lecture info
on cosmetic dentistry, implants and lasers
http://www.catapultelite.com/flax.php
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Laser History and Physics
1916
Einstein took Bohrs theory
of Spontaneous emission
and came up with the
stimulated emission theory
that would be the basis of
laser technology.
LASER is an acronym for :
L = Light
A = Amplification by the
S = Stimulated
E = Emission of
R = Radiation
Spectrum of Medical Lasers
110000 nnmm 440000 nnmm 775500 nnmm UUllttrraavviioolleett VViissiibbllee IInnffrraarreedd
HHeeNNee ((663322nnmm))
KKTTPP ((553322nnmm))
AArrggoonn ((551144 nnmm))
DDiiooddee 881122nnmm
DDiiooddee ((998800nnmm))
NNdd:: YYAAGG
((11,,0066 µµmm))
EErrCCrr::YYSSGGGG 22..7788 µµmm
EErr::YYAAGG (( 22..9944µµmm))
1100,,000000 nnmm
XXeeFF((335511 nnmm)) EExxcciimmeerr
XXeeCCll ((330088 nnmm))
KKrrFF ((224488nnmm))
AArrFF ((119933nnmm)) RRuubbyy ((669944nnmm)) HHoo:: YYAAGG
((22,,0088 µµmm))
--rraayyss xx--rraayyss UUVV vviissiibbllee IIRR mmiiccrroowwaavveess rraaddiioo wwaavveess aaccoouussttiicc wwaavveess
AArrggoonn ((448888 nnmm))
1100--1122
1100--99
1100--66
1100--33
11 110033 wwaavveelleennggtthh,, mmeetteerrss
CCOO22 ((99..66 oorr 1100..66mm))
Absorption
Scatter
Transmission(Refraction)
Reflection
Laser-Tissue Interaction
Laser SpectrumFOCUS ON THE TARGET What happens when tissue absorbs laser
energy? Ablation, vaporization and cutting
CellLaser energy
• Laser Light is absorbed by TARGET TISSUE and turned into heat that cuts tissue.
• The PRIMARY action of a laser is absorption in chromophores it is attracted to (e.g. melanin, hemoglobin, water, HA)
• The photothermal reaction of absorption produces a temperature rise in the target tissue until it vaporizes – and incision/excision occurs
• All dental lasers are PHOTO THERMAL.
The cell expands until it vaporizes
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Zone of Necrosis -tissue is irreversibly damaged and will
die
Zone of coagulation - most of the tissue will recover and return
to normal
Vaporized
Area
Tissue effects caused by thermal exposure Doctor’s advantages when using a laser
1. Less Hemorrhage to control
2. Less Pain - Reduced need for prescription drugs for pain
3. Less need for post operative bandages…lymphatic help seal
4. Less need for local anesthesia….saves time for many procedures
5. Patients appreciate the technology and will pay more
6. Fewer post-op complications …..reduced microbial colonization.
Cosmetic Restorative Clinical Applications
Soft Tissue Procedures
•Gingival Recontouring
•Gingivectomy
•Frenectomy
•Troughing
•Fibroma Removal
•Hemostasis
Possible Soft Tissue Dental Lasers
CO2 Er:YAGEr,Cr:YSG
G
Nd:YAG Diodes
• Soft tissue (hard as well with Solea
• Gas-based• Used for surgery
• Hard tissue• Erbium crystal• Hard tissue cutting• Cavity preps• Very expensive
($80K+)
• Soft Tissue• Neodymium crystal• Perio / LANAP• Soft tissue• Very expensive
($100K)
• Soft Tissue • Semiconductor diode• Excellent for soft tissue• Affordable 3k-5k• Portable• Easy to use• Low Maintenance
AMD LASER
Laser Gingival Troughing
Gingival troughing is one of the most common procedures that can be mastered out of the gate by most new diode laser users.
Advantages of using a laser vs. packing cord
Eliminating packing cord – time saver
Fast and easy perfect impressions
Little to no post-operative pain and discomfort
Initial Trough Impression Provisionals
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Laser Gingival Troughing
Continuous wave .8 W (anesth)/ 1.6 W pulsed (topical)
Initiate fiberDrag/ Angled toward tooth in
short segments slightly into sulcus (90 sec)
H202 or Expansyl
Frenectomy
A diode laser is an ideal instrument to complete a frenectomy– no more scalpels or sutures needed!
Advantages of using a laser vs. traditional modalities
Cut and coagulate at the same time
No bleeding
No sutures
Little to no post-operative pain and discomfort
Laser Implant Recovery
1.8W Continuous Wave mode, initiated tip, may required anesthetic)
Move slowly, use more energy as needed,
and be sure to cool the tissue and site with lots of H20.
Oral Lesions (Apthous Ulcers) A diode laser is an ideal tool to treat aphthous ulcers and
herpectic lesions.
Laser is used in NON-CONTACT mode, where the tip of the laser not initiated as the goal is for the energy to penetrate into the lesion.
Advantages of using a laser vs. traditional modalities
Reduce pain and discomfort
Quicker healing than corticosteriod treatment or other treatment modalities
Delayed reoccurrence of the lesion
Pre-op Immediate Post-op 3 days post op
Soft Tissue Laser Comparison: Diode vs. Hard Tissue (HT)
Both diode lasers and HT lasers are used today to manage soft tissue.
Diode lasers are more precise than HT lasers as diode laser energy is transmitted through an optical fiber that can reach areas where a HTlarge articulating arm cannot.
Diode lasers are great at coagulation and hemostasis as the wavelength is absorbed by melanin and hemoglobin, the HT laser wavelength is absorbed by water making it more difficult to achieve coagulation.
Diode lasers are compact and weigh less than 5 lbs whereas HT lasers can weigh up to 40 lbs and are often over 3 ft high.
Diode lasers are all electronic and optical, with very few moving parts; making diodes more cost-effective, compact and reliable than the much larger, more cumbersome, and more expensive CO2 laser.
Optical Photomicrograph of a Human Tooth
ErYSGG Cut A
The combination of the YSGG laser and
the water spray created hydrokinetic
energy, which in turn produced a
precise, clean and straight cut.
Er-YSGG vs. Laser EnergyComparative Clinical Evidence
SEM of the cut tooth.
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Erbium Lasers vs. Air AbrasionMagnification (x1000)
Air abrasion causes smear layer and
debris on enamel.
100 µm
Scanning electron micrograph of enamel cut
with the air abrasion instrument. The
surface shows smear layer and debris.
(x1000)
Er, Cr: YSGG cuts enamel precisely with NO
smear layer, no micro fractures.
100 µm
Scanning electron micrograph of enamel cut
with Er, Cr: YSGG HydroPhotonic™ system
The structure is compact with no column
displacement and no modification of the
intercolumnar distances. Notice no smear
layer or denaturated tissue structure.
(x1000)
Bonding surface quality for enamel
Cutting Hard Tissue with High-speed Dental Drill
100 µm
Notice smear layer surface
structure and microfracture of
approximately 10 microns in
width. (x200)
10 µm
This SEM shows detail of the
microfracture at a higher
magnification. (x2000)
*All of the above slides were performed at a magnification
of x200 and x2000 on a Jeol SEM model JSM-840.
The studies were performed at the BIOLASE Technology research and development laboratory by Ioana Rizoiu, M.S., at
the MIFAS, independent Southern California analytical laboratory specialized in optical microscopic high resolution SEM
(scanning electron microscopy) and also at the University of California Los Angeles school of dentistry in collaboration
with professor Lewis R. Eversole, D.D.S., M.S.D., M.A.
High-speed dental drill causes smear layer
and microfractures
10 µm
Scanning electron micrograph of enamel cut with
YSGG Hydrokinetic™ system. This surface
shows hydroxyapatite columns (and
interprismatic substance specific to this enamel
structure) free of any mechanical or thermal
damage. (x3500)
ENAMEL
*All of the above slides were performed at a magnification
of x3500 on a Jeol SEM model T-20.
BOTTOM LINE:
CO2 (9.3) and Erbium lasers create clean and precise cuts on enamel -
No smear layer, crystalline structure preserved
Cosmetic Restorative Clinical
Applications
Hard Tissue Procedures(for adult & pediatric patients)
•Desensitization for bleaching
•Cavity Prep - Classes I-VI
•Caries and Restorative Material Removal
•Roughening & Etching
•Enameloplasty
•Bony recontouring
Clinical Paradigm Shift
Micro dentistry (conservative care)
Minimally invasive soft/hard tissue treatment
Little to no need for anesthesia
BE GENEROUS TO YOUR PATIENTS !!(as if the clinical benefits weren’t enough)
Give them comfort
Give their teeth strength
Give people courage and hope
Give them beauty...mimic nature
Give people a message
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MAGNIFICATION AND ILLUMINATION ARE CRITICAL
IN WORKING WITH LASERS
XV1™ Loupe + Light First & only cable-less headlight
Counter-balance design
Capacitive touch controls
Supports all Orascoptic™ telescopes
EyeZoom™ First & only adjustable magnification loupe
3x, 4x and 5x magnification powers
Maintains working distance at each magnification power level
Co-engineered by Konica Minolta®
Laser Analgesia
Proposed mechanism of action
Reducing the action of the sodium potassium pump at the cellular level thereby slowing or even stopping nerve conduction in the pulpal tissues long enough to “painlessly” ablate enamel and dentin without the use of anesthesia in most cases
Lasers in Dentistry (Miserdino and Pick)
Quintessence Publishing 1995
Chapter 19 Modern optics and Dentistry
page 287
“ For example, radiation scattered in enamel and dentin can be entrapped by these natural waveguides and transported to the pulp chamber”
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TREATMENT PLANNING FUNDAMENTALS OF DENTISTRY
• Biomechanics
• Periodontal support
• Occlusal/ Function
• Habits
• Medical management
• Esthetics Thank you Graeme Milicich
DIAGNOSIS and STRATEGY OF TOOTH PRESERVATION
Diagnosis
Determine risk and treatment with CAMBRA System (Featherstone et al)
Remineralize-with Low Risk
Remove areas of decalcification and preserve vital tooth structures-especially enamel with High Risk
*
•Featherstone, JD., S. M. Adair, Anderson MH, Berkowitz RJ, Bird WF, Crall JJ, Den Besten PK, Donly
KJ, Glassman P, Milgrom P, Roth JR, Snow R, Stewart RE. Caries management by risk assessment:
consensus statement, April 2002. J Calif Dent Assoc 2003; 31(3): 257-69
• Young DA, Featherstone JDB, Roth JR, Anderson M, Autio-Gold J, Christensen GJ, Fontana M, Kutsch
VK, Peters MC, Simonsen RJ, Wolff MS. Caries management by risk assessment: implementation
guidelines. J Calif Dent Assoc. 2007 Nov ;35 (11):799-805.
Classic Caries ModelWe must remember caries is a
BACTERIAL INFECTION Cavities are basically a consequence of an
uncontrolled Mutans Streptococci infection
Transmittable
Tooth to tooth
Parent to child
Demineralization of enamel rods that is reversible until the protein matrix collapses in Striae of Retzius
A more contemporary view
THE US
Bacteria Diet Saliva pH?
Bacteria
(Biofilm) Diet SalivapH
Genes
THE USUAL SUSPECTS
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Smooth surface dentin caries
slow onset
Acid attack
Ca2+ and PO4 2-
RemineralizationNo bacterial
involvement
in the dentin
caries
Decalcified
or
hypocalcific
enamel
Chamber
within
fissure
complex
Demineralizing
dentin
Extremely narrow fissure in
almost direct contact with
dentin
Note the inverted, non-cavitated
caries presentation
The Reality of Patient Compliance
Food choices
Temptation
Compliance to
protocol
Sometimes this is
all we are doing
BIOLUMINESCENCE (using CariScan)
KaVo DIAGNodent laser
®
Milicich GW, Rainey JT:
Clinical Presentations of
Stress Distribution in Teeth
and the Significance in
Operative Dentistry.
Pract Periodontics Aesthet
Dent 2000:12(7)
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THE PERIPHERAL RIM
*
The
marginal
ridge is just
part of the
peripheral
rim of
enamel
Rainey’s Ridge
“There are the solid
sections of enamel
that comprise the
inter-connecting
enamel web of the
occlusal surface”
J Tim Rainey. Clin
Pediatr Dent 21(1) 9-13,
1996
The Basic Occlusal Restoration
Strong dentinal bond
eliminate shrinkage
fluoride remineralization
GIC
FLOWABLE
Glass ionomer
Composite
PREOP
AFTER: STRONG,HEALTHY
CLASS 2 RESTORATION
20 yo College Student
No Hx of decay
Missed 2 CC Visits
No Diagnodent Reading
Cari-Free 6200
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WITH ANESTHESIA
USING SEPTODONT
INFILTRATION
START WITH MESIAL
CONTACTS FIRST
6.5mm V3 Tab-Matrix with sub-gingival extension
Tab can be bent 90˚ for
contra-angle placement
Side holes for
easy removal
Holes designed to fit with
positive-grip Pin-Tweezers
The only matrix band
with marginal ridge contour
Hole to fit with positive
grip Pin-Tweezers
Interproximal contour for a better
gingival seal and V-shaped
concavity to protect the papillae
No 1 2009
FIRST LAYER OF
THE
“SANDWICH””
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Paste viscosity of GICs expressed in gF
0
50
100
150
200
250
300
350
400
Riva SC
HV
Riva SC
Fast
Chemfil
Rock
Fuji IX Fuji IX
Fast
Fuji IX
Extra
Ketac
Molar
Ketac
Molar
Quick
Paste
vis
cosity (
gF
)
ERGONOMIC MODIFICATION OF FIRST LAYER
Brand Workingtime
Initial settingtime
Final finishing
37 degrees C
Riva Self Cure 1:40 4:10 6:00
Riva Self Cure (Fast) 1:05 2:30 4:30
Riva Self Cure HV 1:30 3:00 5:00
Fuji IX Regular 2:00 4:30 6:00
Fuji IX Fast 1:15 3:35 *3:00
Ketac Molar (Regular) 2:15 4:45 N/A
Ketac Molar Quick 1:40 3:30 N/A
Chemflex Regular 2:00 2-3 N/A
ChemFil Rock 3:20 4:30 6:00
GLASS IONOMER COMPARISON—
TIMING IS EVERYTHING
PLACEMENT RADII PLUS—using since 2008 Excellent power and width/ Easy to charge
Exceptional ergonomics for positioning the head with a tacking tip, as well as, bleaching/diagnostic tips
Lightweight and cordless
Warranty 5 years-highest in the industry
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BEAUTIFYING INCISAL EDGES-QUICK AND EASY
CONSERVATIVE,GENTLE,AND QUICK
T-4 tip
WHAT IF YOU TO REMOVE A VENEER?
SETTINGS:
4.5 W 20 Hz
15 % H20 35% Air
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If we have
Better diagnosis
Better understanding of anatomy
Better decay removal
Understanding of occlusion and how cracks develop in teeth
HOW COULD WE IMPROVE?
Health Tooth
Decalcification and
decalcification are
equilibrium
Caries occurs
Resin filling
Bo
nd
ing
ag
en
t
Direct Restoration
Secondary Caries
Pulpectomy
Crown treatment
Build up core
Crown
Cement
Bo
rde
r cari
es Ro
ot b
reak
ag
e
Extraction
How can this get better?
Can we enhance the bond strength effects of lasers?
Can you improve on stability and usability of glass ionomer?
Make teeth and restorations more resistant to acids when patient compliance decreased
Create a continuous supplement of fluoride
More plaque resistant
Able to enhance pulp preservation
BETTER DENTISTRY THROUGH CHEMISTRY
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How to tackle
Can you improve on stability and usability of glass
ionomer?
Make teeth and restorations more resistant to acids
when patient compliance decreased
Create a continuous supplement of fluoride
More plaque resistant
What’s A GIOMER?
GIOMER products are characterized by their Surface Pre-Reacted Glass
(S-PRG) filler. S-PRG filler have a glass core that is pre-reacted with a
poly acrylic acid solution. This means that unlike GI that require light
curing and water absorption for ion transfer to occur, GIOMER’s filler
are protected from water sorption and material degradation by a surface
modified layer.
13 YearPhotos
University of Florida8-Year Vs. 13-Year Results
8-Year results as published in JADA 2007:16 of 26 Class I, and 25 of 35 Class II restorations were observed.
• No failures
• No secondary caries
• Maintained aesthetics
• No post-op sensitivity noted
13-Year results as presented during IADR 2013 poster session:19 of 26 Class I, and 22 of 35 restorations were observed.
• Retention rate 66% (27 of 41)
– 52% of retained noted as excellent
– 41% of retained noted minor changes
• Secondary caries rate 3.27% (2 of
61) restorations noted
• Overall positive results and low secondary caries attributable to Giomer technology
8-Year: J Am Dent Assoc. 2007 May;138(5):621-7
13-Year: 2013 IADR Poster Presentation, Gordan et al.
Mineral Trioxide Aggregate (MTA) High biocompatibility
Hydrophilic
Highly alkaline pH of 12.5 (Bacteriostatic)
Excellent sealing ability
Low solubility
Parirokh M, Torabinejad M Mineral trioxide aggregate (MTA). a comprehensive literature
review—part I: chemical, physical & antibacterial properties. J Endodo. 2010;36:16–27
Able to enhance pulp preservation
Able to enhance pulp preservation
Cannon M, Gerodias I, Vieira EM, et al. Effects of Different Pulp Capping Techniques on Hard Tissue Bridge Formation,
European Academy of Pediatric Dentistry. June 2006, Amsterdam, Netherlands.
Mineral Trioxide Aggregate, Comprehensive Literature Review, Journal of Endodontics, March 2010.
Gandolfi MG, Suh B, Siboni F. Chemical-physical properties of TheraCal LC pulp capping material. Presented at: International
Association of Dental Research (IADR). March 18, 2011; San Diego, CA. Abstract #2521.
Gandolfi MG, Siboni F, Taddei P, et al. Apatite-forming ability of TheraCal LC pulp capping material. Presented at: International
Association of Dental Research (IADR). March, 2011; San Diego, CA. Abstract #2520.
Gandolfi MG, Siboni F, Taddei P, et al. Chemical-physical properties of TheraCal LC, a novel light-curable MTA-like material for
pulp-capping, International Endodontic Journal, 2012.
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• Only one coat is required
• No agitation required
Apply and let stand for 10
seconds
• Light force to dry/spread material
• Take care not to splash
Gently air-dry for 3 seconds
• (5 seconds LED)Light cure for 10 seconds
halogen
Phosphonic acid monomer enamel
Carboxylic acid monomer dentin
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Fluoride/Ion Release/Rec
harge
Anti-Plaque
Pre/Post-curing color
stability
Light diffuse material
Chameleon properties
Non-sticky Excellent
flow
Good ergonomics
SOME REAL PERSPECTIVE
Erbium YAG
CO2CO2
Types of dental lasers used in 2016
CO2
Er:YAG
Er,Cr:YSGG
Nd:YAGDiodes
• SOFT TISSUE ONLY
• Gas-based
• Used for surgery• Expensive
($40K+)
• HARD TISSUE/SOFT TISSUE/BONE/ENDO/P
ERIO
• Solid-state – uses an Erbium crystal
• Hard tissue cutting• Cavity preps
• $50K+
• Solid-state – uses a Neodymium crystal
• Soft tissue surgery
• Perio / LANAP• Soft tissue
• Not common in ortho• Very expensive
($85K)
• Semiconductor diode• Excellent for soft
tissue
• Lots of brands• ~25K installs in USA
• Affordable ($2K-$20K)
Er,YAG
Introducing You To The LiteTouch
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LITETOUCH EDU
LiteTouch Uses PERIODONTICS • Effective and unrivaled pocket debridement: Bactericidal effect (disinfection) • Excellent surgical precision: Precise & selective granulation tissue ablation avoiding unnecessary damage of
healthy tissues • Effective and selective calculus removal • Faster healing of surrounding tissue and bone: Minimal postoperative swelling and discomfort, leading to
fewer follow-up visits
PEDODONTICS • The preferred method for treating children: No fear factor; shorter procedures; less noise; no vibrations • Preventive Dentistry: Precise and delicate treatments; minimally invasive; enables microsurgery (pits and
fissures) that preserves healthy tissue • Friendly equipment: Well-accepted by kids • Ideal for hard or soft tissue crown lengthening either open field or closed through the sulcus • Improves treatment of periodontal disease by sterilization of the pocket, granulation removal and
stimulation of the crestal bone
AESTHETIC DENTISTRY • Precise manipulation: Gingival re-contouring, smile design & depigmentation of natural melanin deposits • Excellent for debonding porcelain veneers: Allows dentists to reuse veneer while maximally preserving
tooth substance • Anesthetic free treatment makes patient management easier on staff, doctor and patient
DEXCAM CARIVU
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Light-microscopic view of the Er:YAG lased dentin
showing heat-denatured layer observed in red with
the thickness of approximately 30 µm (Masson’s
trichrome stained)
TEM image of the Er:YAG lased dentin
demonstrating amorphous and nonfibrous subsurface
layer (☆) (demineralized, UA/LC stained). The
resultant heat might superficially denature the
dentinal collagen fibers.
Excerpta Medica, International Congress Series 1248. 1st ed. Elsevier Science B.V.:
Amsterdam; 2003. 161-166.
The characteristic changes of the superficial layer of lased dentin actually demonstrate the increase of the mechanical properties and acid-resistance.Unfortunately, laser-irradiation decreases resin-bond to dentin.
Information provided by Professors Akira Senda and Fujitani Morioki Aichi Gakuin University
Micro-FTIR spectra of the non- and lased dentin (CO2 laser, 69.0
J/cm2) revealed that the laser-irradiation eliminated the amide peak
wavelengths (box) and increased the crystallinity of dentin (arrow).
Jpn J Conserv Dent 42(5): 860~877, 1999
Jpn J Conserv Dent 55(6): 411~423, 2012
Er:YAG was done at Hiroshima Univ. (former university for Morioki), CO2 laser work was carried out in our department of Aich Gakuin University.
• Only one coat is required
• No agitation required
Apply and let stand for 10
seconds
• Light force to dry/spread material
• Take care not to splash
Gently air-dry for 3 seconds
• (5 seconds LED)Light cure for 10 seconds
halogen
Phosphonic acid monomer enamel
Carboxylic acid monomer dentin
Fluoride/Ion Release/Recharge
Anti-Plaque
Pre/Post-curing color
stability
Light diffuse material
Chameleon properties
Non-sticky Excellent flow
Good ergonomics
RADII PLUS—using since 2008
Excellent power and width/ Easy to charge
Exceptional ergonomics for positioning the head with a tacking tip, as well as, bleaching/diagnostic tips
Lightweight and cordless
Warranty 5 years-highest in the industry
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DO IT OFTEN!IF YOU DON’T USE IT, YOU LOSE IT!
Practice
Always try new things as you climb up the “learning curve” Unconscious
Competence
ConsciousCompetence
Conscious in compentence
Unconscious
Incompetence THE LEARNING CURVE
“Good-to –great organizations avoid technology fads and bandwagons, yet
they become pioneers in the application of carefully selected technologies…used
technology as an accelerator of momentum not the creator of it”
WHAT’S NEXT?
Evidence based research (co-op?)
Better delivery systems and wavelengths
Specialty acceptance
New standard of care
Public awareness to increase demand
Penetration into the dental market
CONCLUSIONS
Minimally invasive restorative care
Avoid lengthy recovery times from gum surgery (less invasive.....no stitches !)
Give the dentist more control of their cosmetic cases (no referrals and better
artistry !)
The best part: Patients are happier by completing the "smile makeover“ cases 2-3
months faster (much better customer service!)
If you want to learn more:
Dental Clinics of North America—Cosmetic Dentistry UpdateApril 2011 Vol. 55 No 2
A FINAL THOUGHT…….
“We are not creatures of circumstance;we are creators of circumstance”
Benjamin Disraeli
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CONTACT INFORMATION
HUGH FLAX,DDS(404) 255-9080
Email: [email protected] lecture info
on cosmetic dentistry, implants and lasers
http://www.catapultelite.com/flax.php