hello and welcome to chair side life I'm your host Megan strong thank you
for tuning in today in this episode dr. burner Shawn is presenting a combination
crown veneer case on teeth number 7 through 10 she's placing Brooks Airy interior for
its strength and durability and its aesthetic appeal dr. Mershon is also
demonstrating how to avoid common fight registration errors and a unique way to
see multiple restorations all at once let's check it out take it away dr. Murray Shawn
hello and welcome back for my new chairside life episode I find today's case most interesting
because it deals with the restoration of a facial trauma for the outcome I will sit and bond for
bronzer interior restorations simultaneously using a carrier tray while running on a slippery
swimming pool deck at age 11 he lost his footing and landed face first onto the concrete rim
catastrophically fracturing his central incisors three of his anteriors teeth had to undergo root
canal treatment the treating dentist at the time built them up with composite not until age 22 did
his previous dentist decided to finally crown 8 and 9 after which he was still not happy with his
smile this led him to seek me out for treatment number 7 in fact had not yet been restored with
a crown but was treated simply with an endo and built up composite causing it to show dark when
smiling or talking the facial ceramic of number 8 has started to share off over time the sharing
of the veneer ceramic created an unreflective matte appearance upon further evaluation it
was noted that natural vital tooth number 10 intrinsically retains Krays lines increasing
the risk of fracture together with the patient it was decided that a veneer could be added to the
cosmetic treatment to balance out the smile and further protect the tooth anytime I see fractured
teeth or chipped restoration in the aesthetic zone my go-to material is a highly translucent
monolithic zirconia such as bronzer interior I proceed with the removal of the old restorations
using the zero caliber to cut to this by layered all ceramic restorations my treatment plan
involved crowning 7 8 & 9 with Broxton interior as well as placing a bronzer veneer on number
10 I chose this material in particular because this monolithic form of zirconia can endure the
rigors of an intraoral restoration better than the aesthetic core materials with veneering porcelain
especially perfectly because there is no ceramic layer too cheap or delaminate as was the case with
number eight to prepare number seven for a full crown I use burrs from the reverse preparation
kit by access dental for the preparation of the veneer on number ten I use a bur logic set from
brass ler USA both set include calibrated verse to ensure precise depth when cutting into the
enamel incisal e or facially for number ten using a three band depth limiting diamond bur
and sinking it into the tooth following the two planes on the labial aspect I can create
a tapered facial reduction this tooth was in edge to edge relationship so to increase the resistance
and retention form I am reducing the enamel to engage the incisal edge and slightly overlap it
palatal e using that limiting burs I can ensure that I don't lose their normal entirely this is
important as I know I will encounter lower durability when bonding Abraxas veneer to
dentin to position the finish line interproximally I use a tapered diamond and a fine grid diamond to
smooth the facial and interdental areas rounding any edges this will avoid incorporating stress in
the final restoration for an accurate impression I always use the dual core technique followed
by gingival compression with comfort caps I have chosen medium and heavy body capture venial poly
silicon impression material as my assistant will removes the second chord I follow right behind
him with the medium body and then quickly filling the sulcus and all around the preps while he is
loading the custom impression tray today I would like to take a moment to talk about how I record
the bite when I don't use a triple tray because I didn't prepare the canines I verified that the
teeth are all in maximum in Turkish patient position before taking the bite record the
impression material I prefer is from the capture system because it is a non compressible silicone
material and has no recoil when the models are articulated together when I captured by the record
for a limited number of restorations and have not used a triple tray I only extrude the silicone
over the teeth that have been prepped and then have the patient bite together until all other
teeth are in occlusion this way I know that my bite record will provide the lab with the correct
vertical dimension of occlusion additionally if I don't guide the patient to close on the back teeth
then the patient will naturally seek contact on the anterior teeth by sliding the mandible into
a more forward position if this record is taken with the mandible slightly in a forward position
when the lab articulates the models it will show a decrease in occlusal clearance as we can compare
in these photos the models are articulated with the silicone record material placed only on the
prepared teeth versus a full art record note how there are spaces between canines and less
in size of clearance for the veneer on number ten and when the bite is placed only on the prepared
teeth will allow the patient to more easily locate the MIP ensuring contact on the canines
and more clearance in cisely during the delivery appointment and after the bio terms were removed
the restoration were tried in checked for margin accuracy contact and occlusion then the teeth and
restorations were prepared for sealing staying true to my purpose here at Glide well I continue
to pursue the advancement of Dentistry through research and development to find new ways to be
faster and more predictable I can use this case as an example where I challenge myself to develop
a speedier sealing process I use this dental spatula repurposed into an instrument meant to
carry all final restoration to sit simultaneously during the bonding procedure transparent silicone
vitalist raishin material was placed on the flat side of the instrument to secure the crown and
the veneer into the correct position once the silicone had set all of the restorations were
removed simultaneously and loaded with multi-link cement after an easy detachment from the tray
using the next Laura I Vera five complete sitting of the restorations using wooden sticks after
tack curing for two seconds the excess cement is removed and a strip of this ring gel is extruded
and light cured once more to prevent the formation of oxygen inhibited layer the same process could
be achieved with a digitally fabricated tray now being demonstrated on the model the crowns
or veneers can be safely nested into the correct position into this tray once the looting cement
is loaded all the restoration would be carried and safely seated in the mouth as you can see sitting
it here on the model this tray uses a palatal and an occlusal stop to ensure optimum placement it
is translucent so it allows the choice to cure diluting material if the sitting is correct or
provide easy removal to facilitate cleanup and verification of the correct insertion I hope you
enjoyed this presentation in which with a minimum number of restorations I was able to completely
transform this patient's smile the light reflection gives the bronzer interior material a
natural appearance and since it is in a monolithic form there is no risk of shearing of the veneer
ceramic from its core a possibility that exists with bilayer materials the patient was excited for
his new smile and we were just as pleased with the result thanks for watching thank you dr. Mershon
well that about wraps it up for this episode of chair side life so on behalf of everyone here
at clever laboratory thank you for watching and I'll meet you right back here next time
you