The Team Approach to Effective Laboratory Communication – We are equal partners – Our goal is to please the patient (aka the Real Boss) – Win-Win Respect • Treat me as a partner, not an underling Respect • Treat me as a partner, not an underling • Stop by my lab to meet my team Respect • Treat me as a partner, not an underling • Stop by my lab to meet my team • Don’t insult me by telling me I am too expensive * Respect • Treat me as a partner, not an underling • Stop by my lab to meet my team • Don’t insult me by telling me I am too expensive • When something does not work, do your part to help remedy the situation Respect • Treat me as a partner, not an underling • Stop by my lab to meet my team • Don’t insult me by telling me I am too expensive • When something does not work, do your part to help remedy the situation • Don’t degrade me to your patients *
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The Team Approach to Effective Laboratory Communication
– We are equal partners
– Our goal is to please the patient (aka the Real Boss)
– Win-Win
Respect• Treat me as a partner, not an underling
Respect• Treat me as a partner, not an underling
• Stop by my lab to meet my team
Respect• Treat me as a partner, not an underling
• Stop by my lab to meet my team
• Don’t insult me by telling me I am too expensive *
Respect• Treat me as a partner, not an underling
• Stop by my lab to meet my team
• Don’t insult me by telling me I am too expensive
• When something does not work, do your part to help remedy the situation
Respect• Treat me as a partner, not an underling
• Stop by my lab to meet my team
• Don’t insult me by telling me I am too expensive
• When something does not work, do your part to help remedy the situation
• Don’t degrade me to your patients *
I Need to Send It Back to the Lab ‘cause the Lab Screwed Up AGAIN
• If lab screws up why are you sending it back to THEM?
Tell Me What You Want
And I’ll Give You What You Need
Everything the Lab would Love to tell you, but is Afraid to Ask For!
• Give me a readable impression
It has been reported that 89% of impressions
surveyed had 1 or more observable errors
J Prosthet Dent 2005;94:112‐7.
You Want Me to do What?
You Want Me to do What? You Want Me to do What?
Cord plain or impregnated
Hemostasis/Retraction Hemostasis/Retraction
•Dry, no liquids to affect bonding
•Easy to dispense without tangles
Cord plain or impregnated
Comprecap
Comprecap w hemostatic agent
Hemostasis/Retraction Retraction Manufacturer
HemostaticAgent
Comments
Expasyl KerrAluminum Chloride
Clay-based. Gray-green color. Place material into sulcus for 1-2 minutes, 30 seconds after rotary curettage. Remove material by rinsing with water. Dispensed in cartridges using Expasyl gun
dispenser. Comes in Original and Strawberry flavor.
Traxodent PremierAluminum Chloride
Clay-based. White color. Place in sulcus for 2 minutes, compress with cotton cap, and remove material by rinsing with water.
Syringe dispensed.
Retraction Capsule
3M ESPEAluminum Chloride
Blue color. Extrude material into the sulcus with extra fine tip, let dwell for 2 minutes, remove by rinsing with water. Uses standard
composite compule dispenser.
Magic Foam Cord
Coltene None
Expanding vinyl polysiloxane material extruded from 50mL impression gun. Blue color. Place around prepared tooth,
compress with cotton cap, remove from mouth in minimum 5 minutes, maximum 10 minutes.
Access Edge CentrixAluminum Chloride
Clay-based. Light green color. Place in sulcus for 2 minutes, apply 2 minutes of compression using cotton caps, rinse with
water to remove. Uses standard composite compule dispenser
GingiTrac CentrixAluminum
Sulfate
Vinyl polysiloxane material extruded from 50mL impression gun. Light green color. Intraoral setting time is 2 minutes. Apply pressure while setting with cotton compression cap. Also
available in unit-dose MiniMix syringe without the need for 50mL impression gun.
Dryz ParkellAluminum Chloride
Clay-based. Light green color. Place in sulcus for 2 minutes, apply 2 minutes of compression using cotton caps, and rinse with
water to remove. Syringe dispensed.
Gingival Retraction System
Gingi-Trac
Taking Perfect First Impressions
• Preparation to marginal gingiva
• Pack cord and re-prepare apically to cord
• Remove cord and place Gingi-Trac
Taking Perfect First Impressions
• Remove after 5 minutes and evaluate
• Repeat until no bleeding (1-5 times)
Cord plain or impregnated
Comprecap
Comprecap w hemostatic agent
Electrosurgery
Diode Laser
Hemostasis/Retraction
Diode Laser
Picasso Lite Odyssey
Impression Materials
• Panasil
• Imprint 4
• Splash• Aquasil Ultra Cordless
Panasil Panasil
Panasil Imprint IV
Splash
Aquasil Ultra
Lift body out-Insert plastic end
Aquasil Ultra
Un-screw cap & insert loaded tip
Aquasil Ultra Aquasil UltraInfection Control
Barriers available
Grip & Cap Autoclavable
Aquasil Ultra
2 mm
3 mm
Aquasil Ultra
Size Color Work Time
Mouth Removal Time (MRT)
No. of Teeth
Fill Amount
Single Light Purple
35” 3’00” 1 ‐ 2 .7 mL
Multi Light Blue
1’00” 4’30” 3 ‐ 4 1.6 mL
Everything the Lab would Love to tell you, but is Afraid to Ask For!
• Give me a readable impression
• Give me enough room
Ain’t no way
Everything the Lab would Love to tell you, but is Afraid to Ask For!
• Give me a readable impression
• Give me enough room
• Give me the option of asking for a new impression or new preparation
Let’s start over
Let’s start overEverything the Lab would Love to tell you, but is Afraid to Ask For!
• Give me a readable impression
• Give me enough room
• Give me the option of asking for a new impression or new preparation
• Give me pictures of the prep, adjacent teeth and the desired shade
Uses of Dental Photography Laboratory Communication
““Singular SuccessSingular Success””
Uses of Dental Photography Laboratory Communication
Root fractureRoot fracture
Uses of Dental Photography Laboratory Communication
Uses of Dental Photography Laboratory Communication
Take photos and send to labTake photos and send to lab
Print JPEG
Uses of Dental Photography Laboratory Communication
““Singular SuccessSingular Success””
Everything the Lab would Love to tell you, but is Afraid to Ask For!
• Give me a readable impression
• Give me enough room
• Give me the option of asking for a new impression or new preparation
• Give me pictures of the prep, adjacent teeth and the desired shade
• Give me a guide of desired incisal edge, midline, angulations, position of the anterior teeth & preferably impression of temps
Looks
Longevity
versus
Common Public Perception of a Crown
Sticks out like a headlightDoesn’t matchToo opaqueBlack line at gum
The All-Ceramic Restoration
• Increased translucency and vitality
• Supra-gingival margins possible
• Does not contain metal
• Potentially best esthetics
All-Ceramic RestorationAdvantages
PFM vs All-Ceramic Crown
PFM Crown
All-Ceramic Crowns
• More exacting and extensive preparation (except pure Zr)
• Often exacting cementation procedures
• Post-operative sensitivity
• More prone to fracture
• Often higher lab bill (not pure Zr)
All-Ceramic RestorationChallengesChallenges
• All Zirconia
• Porcelain fused to Zirconia
• Monolithic Lithium Disilicate
• Lithium Disilicate w/ cutback
• Pressed Ceramic
• Feldspathic
All-Ceramic Restoration Materials-2015
• Esthetic expectations
• Specific tooth
• Occlusal habits and trauma
• Amount of tooth preparation
• Color of underlying tooth structure
• Periodontium biotype
• Type of core or post
• Bonding vs conventional cementation
• Cost
• Patient cooperation
All-Ceramic Selection Factors
Cardoso JA, Almeida PJ, Fischer A, Phaxay SL. Clinical decisions for anterior restorations: the concept of restorative volume. J Esthet Restor Dent. 2012; 24:367-83
Feldspathic Porcelain
• Potential for best esthetic results
• Primary use-Laminate Veneers
• 60-70 MPa flexural strength
• Must be meticulously bonded
I want an extreme makeover
Retracted View
Lateral Views
8 Teeth Prepared for Feldspathic Porcelain Laminate Veneers
Select desired shade before beginning preparation
Bonding Porcelain Laminate Veneers
DO NOT USE:
Self-Cured Cements (Contain elevated levels of Tertiary Amines which may yellow)
Self Curable Cements which you can add a dual-cured catalyst (May yellow)
Dual-Cured Cements (May Yellow)
Cement Do’s and Don’ts
Dr Nasser BarghiUTHSCSA
Delta “E” Values for Veneer CementsStored at 500 C
Bonding Porcelain Laminate Veneers
DO NOT USE:
Self-Adhesive “Cem” Cements-lower bond strength-(12-15 MPA vs 24-36 MPA) Rely X Unicem
Smart Cem
Bis Cem
G Cem
Mono Cem
Cement Do’s and Don’ts
Bonding Porcelain Laminate Veneers
DO NOT USE:
Self-Etching Primer (Poor enamel bonding) MUST ACID ETCH ENAMEL
Cement Do’s and Don’tsBonding Porcelain Laminate Veneers
DO USE:
Fourth Generation Total Etch multi-bottle
Fourth Generation Total Etch 2 component
Fifth Generation Total Etch
Universal Bond Total Etch Mode
Cement Do’s and Don’ts
All-Bond Universal Bond
All-Bond III (ACE TE)
All-Bond II One Step Bond
Bonding Porcelain Laminate Veneers
DO USE:
Light Cured Only Resin Cements
Cement Do’s and Don’ts
Choice 2 (delta E<1.2)
Bonding Porcelain Laminate VeneersTreatment of Porcelain Surface
Only glass beads should be applied under pressure to internal surface of laminate
If not etched apply 9% HF for 90 seconds
Bonding Porcelain Laminate VeneersTreatment of Porcelain Surface
Wash thoroughly
Ultrasonic in Et OH or apply 32-27% phosphoric acid to remove hexafluorosilicasalts on surface if over-etched
Over-etched
Bonding Porcelain Laminate VeneersTreatment of Porcelain Surface
If not silanated dry & apply silane-wait 90 seconds (BEST to silanate when received from lab
Silane to Porcelain
Condensation Reaction
Porcelain
-H2O
Bonding Porcelain Laminate VeneersTreatment of Porcelain Surface 2 Forms of Silane
Pre-Hydrolyzed Silane + Acid Non-Hydrolyzed
O
OSi
OH
HO
HO
Bonding Porcelain Laminate VeneersTreatment of Porcelain Surface Tryin with water soluble gels
Clean in ultrasonic or apply phosphoric acid wash and dry thoroughly
Apical Zenith distal to midline-electrosurgery (2003)
Retract gingiva with cord packer during margination
Completed preparations
Select stump shade
Bis-acryl temporary
Blend margins but avoid touching tooth
Blend margins but avoid touching tooth
Temps seated
Impressions taken at another appointment since
electrosurgery
Models
Restorations seated on model
Restorations on Soft-Tissue Model
Temps on Seating day
Scrub with pumiceWash and dryTry-in each laminate individuallyAdjust tooth if internalAdjust laminate if contactTry-in all laminates together
A1 tryin paste
Clear tryin paste
Milky White tryin paste
Immediate Smile
Bond Bridge first, then seat laminates
Before
After
Laboratory prostheses fabricated by Valley Dental Arts Stillwater MN
Lithium Disilicate (E-Max)
• Strength and translucency
• Posterior crowns-monolithic
• Pressed or CAD produced
• Anterior crowns-w/ layered porcelain
• 360-400 MPA flexural strength
• Better to be bonded unless >1.0mm thick
• Best esthetics
Single Central Incisor Crown•2-5 Appointments•Higher Fee
Lithium Disilicate (E-Max)Endodontically Treated
Old Bonding
Lingual View
Remove facial compositeRemove AO compositeRemove most stainUse perio probe to remove subgingivalBond bleach white compositePrepare toothPhoto w/stump shade
Make custom temp for lab
•Make quick bis-acryl
•Laminate prep on facial
•Add composite and custom stains
Send photo and temp to lab
OR Make custom shade tab for lab
•Core Shade
•Add tints
•Overlay with IncisalShade for value
Send photo and tab to lab
Pre Operative Smile
Post Operative Smile
Laboratory prosthesis fabricated by Valley Dental Arts Stillwater MN
Monolithic E Max CrownsLoad to Failure*
*Data from Ivoclar/Vivadent
Selecting Bonding Agent w Duo-Link
Bonding Agent Clinical situation
AllAll--Bond SE (light cure) + DuoBond SE (light cure) + Duo--Link (Light Cured)Link (Light Cured)
Vital tooth
AllAll--Bond TE (light cure) + Duo Bond TE (light cure) + Duo Link (Self Cured)Link (Self Cured)
Endo tooth, post & core
9%HF 60s
Li2Si2O5
Dentin______
CoreResin Cement
Sila
ne
Bonding to Lithium Disilicate(Retentive)
15 MPa
Li2Si2O5
Dentin______
CoreResin Cement
Sila
ne
Adhesive
Bonding to Lithium Disilicate-(Non Retentive)
35 MPa
DuoDuo--Link UniversalLink Universal
•Increased radiopacity
•2 shades‐milky white & translucent
•Dual curing
•Completely cures w/o light exposure
•Easier cleanup
DuoDuo--Link UniversalLink Universal
•Usable with Universal, total etch, self‐etch bonding agents
e Cemente Cement•All‐inclusive kit
•Dual and light cure
Temporary Crown
Bonding Technique
Place Divots with 330 bur
Anesthetize if vital
Seat Pointed Forceps-Easy back and forth
Be gentle: slight rock, then pull straight up
(Optional) Roughen surface w diamond for immediate dentin sealing