hello everyone and welcome to chairside live I'm your host Megan strong and thanks for
tuning in today we've got a great show for you dr. Bai has a fantastic implant case for
us where he's going to explain the fundamentals of implant placement we're talking step by step
protocol so if you've just started placing implants or have you been toying with the
idea this presentation will help equip you with the tools and confidence then
registered dental assistant will Schmidt is discussing an ever important topic shade
taking but first let's get started with implants dr. buy picked a straightforward
case to ease you into the idea of placing your first implant because it's all about
case selection in those first several implant cases okay enough talking dr. buy take it away
hi everyone and welcome back to another case of the week I want to share this case with you
and if you're incorporating implant dentistry into your dental practice cases like this would
be ideal to start out with and repetition with cases like this will lead you to expanding your
knowledge base and your comfort level you can expand what you're doing within your practice
so for this case the patient presented with plenty of interproximal space plenty of bone so that we
can do the proper diagnosis and move forward with the implant placement so the first visit
the patient comes in and we evaluate periodontal status obviously the caries and make the diagnosis
and and provide some treatment for the patient and the patient has to be periodontal e sound for us
to move forward with implant dentistry also I go through a series of evaluation of the radiographs
and the cone beam CT scan so that I know how much bone I have and I can go ahead and place
the implant in the proper position so once I have the diagnosis down I bring the patient back and
provide some anesthetic with local infiltration and once the patient is nice and comfortable
with the anesthetic I can go ahead and provide a full thickness flap reflection so that I can
access the bone in this scenario I do a full thickness flap I reflect a full thickness flap
and I want to make sure that I have the access to the cortical plate of the bone but once I reflect
the flap I'll go through and remove any residual soft tissue I want to make sure that I have full
access to the bone as you can see here so step one have access and be able to visualize where I
want to place the implant and step two is to go ahead and create my initial osteotomy with the
start drill the start drill basically allows me to follow up with additional drills in order to
deepen and widen my osteotomy so that I can place the implant what's really important for me is when
I'm placing the implant I want to go ahead and check with a parallel pen to make sure that my
osteotomy is in the right direction as you can see here I might be tilted a little bit to the
distal or the mesial and one way to really confirm that is to take a radiograph to make sure that I'm
away from the vital structures and I'm not tilted in the direction that I don't want to be tilted
in after the first start drill I'll go ahead and move to the second start drill before going into
the shaping drills now the shaping drills for the hon implant system are designed so that the shape
of the shaping drill is the shape of the implant and you don't have to worry about depth because
it's built into the shape of the drill you just placed the drill to the bone and you can predict
how deep it is by where you place the drill into the osteotomy and again I want to use my parallel
pins usually at the next step in order to see whether I'm in the right direction and whether
I need to change the angulation it's really important to move up in the drill sizes and
give yourself a chance to correct the angulation if you are off angled so that's something to keep
in mind and it's a very systematic process you don't just go from the start drill to the final
shaping drill you want to move up in width and length of the drill so that you know you have a
chance to correct angulation if you run into any trouble so moving up to the different drill sizes
I get to the final drill and in this situation it is a 4.3 by 11 1/2 millimeter diameter implant so
my final shaping drill is going to match the shape of my implant once I finished osteotomy
with the final shaping drill I'll go ahead and place the implant you have the option of placing
the implant with the torque wrench or you can use the the surgical handpiece but you don't want to
use the same rpm as you're creating the osteotomy so you'll want to drop the RPM down to 25 to 30
so that you have a lot more control with placing the implant once the implants in place you can
place a cover screw or a healing abutment and in this situation I wanted to place a healing
abutment that goes through the tissue the tissue heals around it after i suture everything and
then I can come back if when I want to take the final impression I can come back and remove the
healing abutment and place my impression coping and take the final impression also once I finished
the procedure and place the implant it's fairly simple to place two interrupted sutures in this
situation we used interrupted chromic sutures the tissue was approximated fairly well and
as you can see here the implant is in place and now the patient goes through a period of
osseointegration before I bring the patient back for the final impression I want to thank you for
your time and I hope you enjoyed the case of the week and if you're incorporating implant
dentistry into your private practice cases like this would be ideal and build your skill level
and your confidence thank you for that doctor bye and you can look forward to more implant cases on
future episodes to help you get your feet wet but now let's meet up with will he's talking
all about shape taking and picking the perfect shade let's learn his secrets take it away we'll
thank you so much Megan so today I'd like to address and answer a question that Gladwell
technical advisors field from doctors and staff more often than any other subject when contacting
the lab for support the most common question above all involves tooth shade what is the best shade
taking method what if my patient wants to bleach or has already bleached more importantly how do we
properly communicate our patients to shade to the laboratory doctors grab your staff for this one
because I know everyone is going to benefit what do shades consist of and why is it so important it
should be as simple as matching a tab to a tooth and writing it on a lab slip but it really isn't
we aren't simply trying to communicate a single hue or color as it is more commonly referred we
are also attempting to distinguish the shades chroma this is the level of saturation in your
hue as well as the shades value the level of white or dark overall let's look at the Vita classical
shade guide for instance although it is the most popular shade guide used in dentistry it does not
communicate all three of the ideal parameters to select shade specifically the shades value I like
the Vita classical guide and it is a great tool to use to assist us in our decision making process so
I'm going to ask you to do something a little off the wall I want you to take all the tabs out of it
and rearrange them contrary to the alphabetical order in which it is set up when talking about
shades on the Vita guide any professional knows that b1 holds a brighter hue than a1 or a2 the
new arrangement of your tabs when replacing them should be from left to right B 1 a 1 B 2 D 2 a 2 C
1 C 2 D for a 3 d 3 B 3 a 3.5 B 4 C 3 a 4 and C 4 now that we have them in descending order we could
assume that it would be easier to reach a shade decision well probably not now that the free space
between shades has decreased we are mathematically less likely to perceive the slight difference
between neighboring tabs so where do we go from here shade guides are now being designed with
ease of application in mind the groundbreaking 3d master shade guide system allows the value of
a hue to be selected by first grouping colors and then choosing the value in each specific
color group like a drop-down menu I like to call this method tabbed browsing another option is the
Vita bleach guide although this guide has only one additional shade tab than the Vita classical guide
the colors are spread out on a broader spectrum exactly twice the coverage as the classical guide
this makes it less complicated for our eyes to notice the difference true to its name however
this guide is best used for patients who are involved in chair side or take home whitening
procedures the Vita linear guide first groups then separates tab groups according to value before hue
and chroma are taken into consideration now the Vita ez shade advanced digital shade guide takes
much of the legwork out of shade acquisition by eliminating the need for proper lighting
in the operatory as well as keeping results in a memory bank to be reviewed at a later time
so which systems and methods are the best to use when communicating with your dental tech Gladwell
receives shade information from practices over a vast range of shade guide brands so we are
well equipped to translate the instructions that are sent in to the result that you have
in mind we receive the majority of our shade instructions through Vita branded products for
this reason I'm focusing today's discussion more towards these guides however don't feel limited
to using what is popular to get your message across as long as your specific instructions
are communicated with transparency to your dental tech most shade matching issues can be avoided no
matter what system you utilize well let's move to the operatory and talk about some details let's
first talk about the best conditions for choosing your ideal shade before starting the shade taking
process I need to know if my patient has been bleaching or is continuing to bleach we recommend
at least 7 days since the last bleaching treatment has been administered however a full two weeks
would be more ideal due to rehydration and bounce back now I'm a firm believer in the buddy system
when taking shades why because no two sets of eyes will see the same thing proper illumination of
the site nearby colors of your patients clothing lipstick skin and hair even objects nearby in the
room will make us things differently so I'm sorry gentlemen but you are ten times statistically
more prone to colorblindness than your female colleagues additionally we are more prone to
vision deterioration as we get older so enlist the help of your assistant grab a staff member
even hang your patient a mirror and let's get a collective opinion on the shade to proceed with
when acquiring shades from my own patients the first thing I look for is a good pre procedural
shade I sit my patient upright and remove any artificial light sources especially the patient
lamp if a digital shade guide is available I like to start with it to get a basic idea of the shade
I am looking for and then use that data to narrow it down further with shade tabs when utilizing the
digital shade guide most should prompt you to scan the gingival third the body and then the
incisal for a well-rounded reading make sure to then compare your handheld shade tabs to the teeth
that are involved as well as the opposing and the adjacent teeth try to avoid covering up the tooth
being prepared and casting a shadow on it rather place the shade tab beside the tooth as well as
incisal to incisal compare shades with the lips at rest in a smile and then retracted if the body and
incisal of the teeth have clear shade variances make it a point to photograph the differences
and orient the shade tab accordingly so now that our preparation is complete we have opened up one
more shade parameter that I haven't discussed yet this of course is our prep shade also known
as the dentin shade or more commonly as the stump shade don't forget to pronounce that extra letter
F at the end I hear so often the preparation being referred to as a stump when in reality
the stump is a German language term meaning blunt or unsharpened avec lar makes a couple
great prep shade guides that have become more of the standard in dentistry worldwide these guides
are known as the stump material and natural dye material guides the main difference between these
guys is similar to the difference between the Vita classical and 3d master guides the natural
dye guide has a wider shade spectrum making it easier for the eyes to pick up the differences
it won't be a problem to use a standard Vita shade guide or similar system as as the system use is
clearly notated in the photos and on the RX form we have now collected enough data and photographic
evidence to complete our lab prescription and submit for fabrication think of these photos
as a secondary rx form and don't hesitate to draw specifics on them to get your message understood
I like to point out things such as halo effects decalcification spots and any
abnormal variances that will aid in a lifelike restoration being fabricated
moving to my rx form is important that exact details about the shade are presented here to
start I leave a space and write see attached photos plus I highlight that area if necessary
in the space provided on the form to write the shade it is important to note eight this shade
as well as the exact guide you acquired this shade from getting into this habit will be especially
beneficial when you are using a bleaching guide due to the large amount of bleaching
guides available to choose from but also when using plastic denture tooth specific guides or
less popular shade guide brands there is no such thing as providing too much information on the
prescription form the majority of shade related phone calls that Gladwell technical advisors
place or answer is due to a lack of important shade dialog between the practitioner and the
laboratory well I appreciate you tuning in to this very important segment for all the doctors
watching I want this to be a good refresher course and a motivator to get you excited again about
acquiring and communicating shades for all of my dental assistants watching today I hope that this
sheds some light so to speak on the reasons why we choose the right tools at our disposal and the
most effective way to speak to the lab from start to seat thank you for watching back to you Megan
well that about wraps it up for this episode of chairside live on behalf of everyone here
at globulin laboratories thank you for watching and I'll meet you right back here next time
you