hello and welcome to chairside live I'm your host Megan strong thank you for joining us today
dr. Bai is presenting part one of an exciting case that you can't miss I mean it and in this
portion today you're going to get to see dr. Bai prepare teeth number eight and number nine for
bio temps stick around and you'll see the final impressions and delivery of the restorations but
first let's start at the beginning of the work on these crucial anterior teeth take it away dr. Bai
welcome back to another episode of share side live my name is dr. herb I and I'm here at
Glidewell dental laboratories at the Gladwell International Technology Center and I had just
recently had a patient come into the operatory with the chief complaint of teeth number 8 & 9
and a complaint was that the patient did not like the restorations any longer originally the
patient and elective restorations to begin with but his treatment options were very limited at
the time he's had crowns placed on teeth number 8 & 9 and as you can appreciate in the clinical
situation these teeth are quite bulky and on the radiograph you can see that there are some open
margins so the crowns initially did not fit quite that well to begin with so my concern
was - once I removed these crowns to evaluate what's underneath and obviously tooth number 9
has a an existing root canal so I want to make sure that I can provide her type of restoration
that can block the darkened dentin underneath the restoration of tooth number 9 and I was also want
to make sure that we don't have any darkness coming through the gingiva on tooth number 9
as well so as I proceeded I took the preliminary impression for the bio temps and I sent it down
to the laboratory and the process for fabricating the bio temps has obviously become more digital so
everything is converted into a digital file our technicians will fabricate the master cast and
once the master cast is in a solid format I will go ahead and utilize a desktop scanner to scan the
cast and the opposing and also a bite registration so once all that information is digitized then we
can go ahead and digitally design the bio temps which we call bio Tim's CAD or CAD cam assisted
fabrication of bio temps so in this situation our technician is digitizing everything including the
bite in that last scenario and then the technician can move forward with the design of the bio temps
so utilizing the software the first thing we do is mark the occlusal plane and also we'd like to
mark the more origins of where the restorations are and just like crown prep and approximately
we're going to be a little bit higher than we are going to be facially and lingually with
our margins so our technician will go ahead and mark the interproximal location of where the bio
temps will end up and what's that location is completed we can go ahead and do what we call a
virtual prep what I really like about the virtual prep is that it creates a minimum thickness that's
uniform all the way around the preparation of the tooth structure and that way you can get
a restoration a bio temp back that's uniform in thickness and the other reason that I really liked
the uniform preparation is that it's extremely thin so you get a thin shell back and but you
have more options of being able to seat this restoration on the preparation because you can
minimally prep the teeth if that's what's required so in this scenario you can see our technician is
going through the digital wax up obviously the advantage is that we can visualize exactly where
the teeth are going to be and in relation to the preparation and we can also take a cross-section
of our restoration and measure the thickness and in certain situations if we need to we can add a
little bit more thickness to those areas so a lot of control with digital wax up and digital
fabrication of the bio temps once we have the digital file the next step is called nesting is
essentially the technician placing the bio temps within the block digitally so that the milling
machine knows exactly where the restoration is going to be and that information can then get
transferred into a physical machine with the milling process in place so once the nesting
is completed we'll have our technician place the milling block inside the milling machine and once
the file is transferred over to the milling machine then the milling of the bio temps can
start and literally within minutes we can have a product that is very close to completion so as you
can see here the milling is completed and the bio temps is now removed from the block obviously in
a normal situation you wouldn't use a two-unit bio temp and an entire block so this was for
demonstration purposes only usually there are many different units that are nested within the same
milling block as you can see that is the milling block is fairly large for just two bio temps now
there is a little bit of artwork involved in fabricating the final product so the technician
will remove the bio temps from the milling block and proceed with staining and glazing
and once that's completed they'll send the final product back to the dentist and in this case the
technician sent it back to the operatory and in the second visit I was able to bring the patient
back and I wanted to make the patient nice and comfortable with some anesthetic before proceeding
so I went ahead and anesthetized and removed the previous crowns and this is the situation with
initial crowns removed and then I'll go through and I will prepare the teeth to receive bio temps
and eventually the final restoration now this is the step where I'd like to evaluate the teeth once
again I remove the final restorations and you can tell that tooth number nine has a darker dentin
shade than tooth number eight and at this stage I can go ahead and select the restorative material I
had a good idea going into it because I already knew that the tooth was looking out treated and
removing them will also help me evaluate regardless what I want to do now is fit the
bio temps and this is the bio temp CAD product and as you can see here without any adjustments
I'm able to seat the restoration in place and I want to check and make sure that I have the
proper amount of reduction before realigning it so you can see here from the side views that I have
not relined the bio temps yeah I just seat them on top of the tooth preparations and then once
I know that I can seat them completely and I'll check the bite and the fit then I'll go ahead and
utilize an acrylic material to realign the bio temps so in this situation I'm actually using
tough temp for the realign and once the temporary material is placed inside the bio temps and I'll
seat it on top of the restorations I sometimes remove a little bit of excess material so that
my trimming and polishing time will be reduced obviously you want to take care to not wipe off
some of the excess from the margins so that you can capture the margins properly so once the
material is set I'll go back into the laboratory and remove the excess temporary material and I
want to make sure that my margins are as crisp and clean as possible so I'll use diamond disc
and some lab burrs to make sure that I have enough opening and approximately between teeth number 8
and 9 and also nice and clean margins so once my temporaries are completely fabricated and
finished I can go ahead and apply some palace seal to provide a final glaze and then I want
to deliver at the bio temps to the patient with some temporary cement now what I'd like to do
is try them on first before I place the cement so I want to try them on and make sure that they fit
properly then I'll take them back off and dry them and then load them with temporary cement before
delivering it in the patient's mouth once the temporary cement is completely cured what I like
to do is make sure to remove all the temporary cement obviously leaving some temporary cement
behind can cause some tissue inflammation and anesthetic case like this that is really something
that you want to move away from in any case it would not be a good thing to leave the temporary
cement but especially in a case where I'm treating a patient in the ascetic zone and I'll go through
and I'll double-check with some floss I like to tie a knot in the floss and run it through to
make sure that in approximately I didn't leave any temporary cement also in the interproximal
space between teeth number 8 and 9 I like to use super floss and remove any temporary cements and
what I like to do is also give a package of super flush to the patient because it's really important
for him to clean this area while the tissue is healing and while the lab is going to fabricate
the final restorations so there you have the bio temps in place and within a week the patient comes
back for some pictures and you can appreciate how the soft tissue has already healed and then we can
move to the next step and the selection in fabric of our final restoration now for us the next step
is going to be to bring the patient back and it is an extra step what I want to do is have the
tissue heal completely before capturing the final impression and having our final product so I look
forward to having you back here to view part two of this two-part series for this case for the
material selection and progression of delivering final restorations for this case thank you again
for joining me for this chairside live episode and I hope to see you soon and then your future
thank you for that doctor bye and stick around to the completion of that case and upcoming episodes
and thank you for watching that's all we have for today's show so bye on behalf of everyone here at
global laboratories we appreciate you tuning in today and I'll meet you right back here next time
you