Impression Cord Retraction Technique

IMPRESSION TECHNIQUES

Impression Cord Retraction Technique

Impression Cord Retraction Technique

Impression Materials
IVOCLAR VIVADENT Virtual Light Body Virtual Heavy Body 3M ESPE Penta H Heavy Body Dimension Garant L

Advantages of Soft Tissue Laser Surgery

Time savings with Multiple Simplified Procedures Reduced referrals Combined appointments for Time Savings and Patient Comfort Recommend taking a Laser CE Course

Advantages of Soft Tissue Laser Surgery

Dry and bloodless surgery Instant decontamination of the surgical site Reduced bacteremia Reduced mechanical trauma Minimal postoperative swelling and scarring Minimal postoperative pain

SoftSoft-Tissue Laser Utilization in Prosthodontic Practice

Esthetic Recontouring for C&B and Veneers Blending papilla heights Blending cervical heights Reestablish distal-buccal height of contour on upper incisors Esthetic Recontouring before Whitening Crown lengthening/soft tissue management around tooth preparations..limited by sulcular depth and challenge of circular fibers

SoftSoft-Tissue Laser Utilization in Prosthodontic Practice

Troughing for impressioning Formation of ovate pontic sites Exposure of Implants Removal of hypertrophied tissues on implants and teeth Bloodless exposure and access to subgingival decay in non-esthetic areas Hemostasis Frenectomy Limited Vestibuloplasty

SoftSoft-Tissue Laser Utilization in Prosthodontic Practice

Hygienist Uses: Treatment of periodontal pockets with currettage and decontamination Where, When, Why.other options Activated tip vs. non-activated tip Desensitizing sensitive teeth Treating intraoral apthous ulcers and herpetic lesions

Soft Tissue Diode Laser

There is minimal tissue shrinkage after laser surgery, which assures that the tissue margins will remain at the same level after healing as they are immediately after the surgery

Soft Tissue Diode Laser for Limited Esthetic Recontouring

In addition, the use of the laser can eliminate the trauma to the tissue of flap reflection and suture placement (assuming adequate zones of keratinized tissue) Knowledge of where implants have been placed allows for exposure with Laser with a clean, bloodless field

Which Laser would work best?

Soft Tissue Diode Laser

Ivoclars G-4 & Navigator Soft Tissue Diode Laser offer convenient features:

Every laser on the market has the

ability to perform incisions and excisions of soft tissue, while destroying bacteria at the surgical site. Reduced mechanical trauma to the tissue, less postoperative pain, swelling, and scarring are not unique to any specific wavelength.

Preprogrammed settings Wireless Foot control Sometimes no anesthesia Bloodless

Navigator Soft Tissue Diode Laser

Impression Technique with Laser Troughing: Your High Tech Solution

Avoid latex glove contamination Advantages and Technics for success:
Finesse Preparation margins after troughing Lowest wattage needed to work Understand gingival tissue quality Need for minor soft tissue manicure for enhancement of golden proportion and symmetry

Impression Technique with Laser Troughing: Your High Tech Solution

Sounding to Bone : Normal, High and Low Crest for laser-plasty options

Aesthetic Periodontal Surgery Considerations with Laser

Minor Crown Lengthening Lengthening all cervical areas with or without papillaplasty Esthetic blending of cervical margins Be aware of anterior/posterior blend Create Ovate Pontic Form

LASER TROUGHING
Safety steps first Activate Tip Stroking Motion At Lowest Wattage Possible Cleaning Tip Viscostat Scrub Hydrogen Peroxide Scrub Consepsis Scrub Recheck and Remove any Small Tissue Tags

Laser Esthetic Contouring

Laser Troughing

Laser Troughing vs. Cord Retraction

Combination Laser Troughing with Single Cord Retraction Technique

Impression Technique Medication Options

Probantheline ( 2 tabs of 15 mg.) for a dry field, taken 30 to 60 minutes before impression Sal-Tropine (0.4 mg. one tab one hour before appointment and one more at start of appointment depending on length of appointment needs) Peridex Antimicrobial rinses helps to manage gingival health for up to 2 weeks prior to impression appointment combined with aggressive home care.

Review: Impression Techniques

Cord Retraction vs.Laser Troughing Sequence and technics for success Use of 1:50,000 Lidocaine infiltration or Ultradents Viscostat scrub for hemostasis Thin cord for recession prevention One cord technique, with multiple turns Two cord technique, leaving in Ultradent Black 000

Impression Technique: Tips for Success

The amount of retraction cord will depend on sulcus depth and tissue biotype The use of probing for bone sounding or sulcus depth determination will also aid in determining margin placement 2 cord technique can be used most of the time since normal crest/ bone appears 85% of the time

Impression Technique: Tips for Success

Sequence and technics for success: Custom tray Customized rigid moldable crystal clear disposable impression tray (palate filled with wax) Affordable Dental Products Corp.

Impression Technique: Tips for Success

Sequence and technics for success: Use of DAM it to
block palatal flow and minimize gag reflex (Danville Corp.)

Impression Technique: Tips for Success

Sequence and technics for success:
Use of 5th Hand Black Cheek Retractor (Affordable Dental Products Corp)

Impression Technique: Tips for Success

Sequence and technics for success Baharav study found 4 minutes to be minimum optimum time for cord to create 0.2 mm crevicular width critical to quality of final impression Air blowing technique option with reinjection of light bodied impression material (but material sensitive)

Impression Technique: Tips for Success

Be sure all undercuts blocked out When cord is removed, visual inspection should show uniform width of sulcus and all margins clearly visible and grooves captured Do not remove impression with handle; break seal on sides and remove on path of insertion Recommend use of Nitrile gloves to avoid latex glove contamination of PVS materials Rinse and Disinfect impression

Characteristics of an Excellent Final Impression

Be free of distortion ( elasticity so not distort on removal, especially with long periodontally involved teeth ) Be free of debris ( blood and saliva ) No voids, bubbles folds or tears Completely capture preparations and adjacent anatomy, with very readable margins Fully set before removal for dimensional stability

Digital Impressioning
In-office systems with chairside milling are Cerec (Sirona) and E4D (D4D Technologies) Chairside digital impressioning with image transfer to Lab or Manufacturing facility are iTero (Cadent), Cerec, and LAVA C.O.S. (3M-ESPE) Systems

PROVISIONAL ACRYLIC RESTORATIONS

PROVISIONAL ACRYLIC RESTORATIONS

Utilization & Fabrication

Rationale Characteristics of a good temporary Benefits of a good temporary Failures Multiple technics are to be reviewed, including both chairside and prefabricated heat-cured Biotemps, cold-cured ethyl and methylmethacrylates, and Bis-GMA composite temporaries

Criteria for Material Selection 18 Reasons for provisional temporization prior to periodontal surgery

Ivoclar-Vivadent Telio CS C&B & 3M-ESPE Protemp Plus Features/ Benefits

Outstanding strength Long-term durability High esthetics (smooth surface, fluorescence) Easy handling (less inhibition layer) Time saving (no polishing or glaze necessary) Safe (low temperature peak)

Desired Combination of Properties for Fracture Resistance But know limitations!

High flexural strength High flexural resistance Limited deflection High tensile strength High fracture stability

Putty Matrix for Telio CS C&B Bis-GMA Chairside Provisionals

Fabricate Putty Matrix with Ivoclars Virtual Fast Set Putty Exquisite Detail!

PROVISIONAL BIS-GMA COMPOSITE RESIN RESTORATIONS

Fabrication Technique Review:
Dry teeth and with predetermined guide point trimmed, seat matrix for 2 minutes Remove matrix from mouth, trim excess film off other teeth and then gently use curved hemostat to remove temporary from mouth Remove air-inhibitor layer from temporary with saturated alcohol cotton ball Pencil margins and contacts, trim and polish

Be sure to trim only 1 mm. from margins

PROVISIONAL RESIN RESTORATIONS Fabrication Techniques with my favorites: Axis Disc # D911 HEF- 220T & Lab Bur # UC079E-040

Telio CS C&B Temp

PROVISIONAL BIS-GMA COMPOSITE RESIN RESTORATIONS

Finishing Technique Review: Tetric Color (Ivoclar) custom staining

PROVISIONAL BIS-GMA COMPOSITE RESIN RESTORATIONS

Finishing Technique Review: Polish and/or use BisCover LV when doing Laminates or custom color temps, light-cure and then coat with BisCover LV and light-cure again.

SMILE MAKE-OVERS
COMMUNICATION TECHNIQUES FOR SUCCESS AND QUALITY CONTROL
LAB RX AND OTHER EXTRA LAB GUIDES
FACEBOW MOUNTING PUPILLARY PLAN INDEX OR HORIZON INCISAL / OCCLUSAL INDEX GUIDE STUDY MODELS OF TEMPORARIES AND OPPOSSING ARCH CROSS-MOUNTED ON ARTICULATOR CUSTOM INCISAL GUIDE TABLE SHADE COMMUNICATION

Shade Communication
Digital Photography with shade guide, stump shade guide, and Black & White Clear Color Strip with A-2 X-Rite Shade Vision Colorimeter The Ladder Vita 3-D Shade Master Shade Mapping

Shade Communication
E-mail digital photos to lab with shade guides E-mail digital photos to lab with black & white holder with Lumen A-2 & Lab converting with Clear Matchsoftware

Shade Communication E-mail Digital Pictures to the Lab Including stump shade & Clear Match

Shade Communication E-mail Digital Pictures to the Lab

Gingival Shade Communication E-mail Digital Picture to the Lab with Ceramco Pink Gingival Guide

Shade Communication E-mail to Lab

Shade Communication
The Ladder A colorful shared photographic aid with detailed shade characteristics

Empress Veneer Cementation

Empress Veneer Cementation

OptraGate or Rubber Dam for isolation Light cured resin cements are the most color stable for luting veneers, ie. IvoclarVivadent Variolink II without catalyst.

Empress Veneer Cementation

Review of Self-Etch vs. Total Etch
Total Etch most widely accepted with anticipated higher bond strength Total Etch concerns with post-op sensitivity leading to patient management problems Self-Etch Primers with Light-Cured Veneer Cements without post-op sensitivity DiTolla, DDS 2005 ( one year no pop-offs )but also says if its not broken, dont fix it!For some trade-off may be worth it.

Empress Veneer Cementation

Place central incisors first Brush away all excess cement (if dont see excess, remove, add cement and re-place it) Tack with 2mm curing tip Glide Floss Wave technique with large curing tip
Clean up during gel set

Clean-up Final Cure Minor Reshaping and Occlusal Adjustments

CEMENTATION Multilink Automix

Dual Cure. Easy cleanup. High initial bond strength. High Radiopacity. Mix primer A & B for self etch and bond. Low sensitivity. metal or metal -free metal, glass ceramic, zirconia

immediate immediate shear shear bond bond strengths strengths -various substrates various substrates
Dr. Carlos Munoz, SUNY @ Buffalo Dr. Carlos Munoz, SUNY @ Buffalo
MPa

MaxCEM
40

RelyX Unicem
36

Panavia

Multilink

30

20 12 10 3.7 0 5.2 2 13.3

17.9

18.3

10.7 7.4 1.5 1.9

Immediate bond. Light Cure - dentin; surfaces treated according to instructions for use

Multilink Cement
Note that the use of Multilinks Alloy (Metal) Bond on Zirconia has been proven to increase its bond strength

Reality Check

Is it really the best thing to come down the pike? Are fees high enough to cover failures?

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Planning for Success

Complications from Crowns & Bridges
Caries 18% Pulpal 11% Porcelain Fracture 3% Prosthesis or Tooth Fracture 5% Cement Wash-Out or Loss of Retention 7% Esthetics 6% Periodontal 4%

Planning for Success

8 Studies showed 11 % of Crowns have complications 3 Studies showed C & B Failures
After 15 years 25 % After 10 years 10%

All Ceramic Failures 8%

Fractures: 3% Anteriors; 7% Bicuspids; 21% Molars

Planning for Success

Protect your China with Occlusal Guard Risk factors cannot be predicted, but data is a good guide to avoiding high risk These factors must be assessed in the early stages of treatment planning and prepare patient for realistic expectations A wise man proportions his belief to the evidence E. Hume

SUCCESSFUL CONSULTATIONS KEYS TO TREATMENT PLAN ACCEPTANCE

THREE PART PROCESS Establish value Learn patients wants and needs Determine all existing problems and help patient see them with you and understand implications of each problem Help patient understand the best solution to each problem and achieving Their Goals

Whats in it for me! Must address patients wants and needs

You Can Only Do Two Things:

Do the best you can do Commit to doing better every year

Then Reap the Rewards of:

Patient satisfaction Staff enthusiasm Personal gratification Increased success and prosperity

Please fill out Course Survey to Qualify for Drawing for Prizes thank you

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NOW LETS GET STARTED

PRO.S. MENTORSHIP
PROsthetic Seminars and Mentorship Program

Understanding and applying the principles of how esthetics and function come together will give you the tools to help produce more predictable long term outcomes

Your greatest asset can be a Mentor Keeping you motivated and getting you through the early learning curve with confidence and success Into our office for a day and back to yours for a year of support and guidance

PRO.S. and Mentorship

PROsthetic Seminars and Mentorship
Over the shoulder and by your side: The support you need to make it happen after the course is over.

Thank you. Thank you, Thank you!

Its the follow through that counts! E-mail for more info mfagin@roadrunner.com

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