hello everyone and welcome to episode 158 of chairside live we've got a great lineup for
you today first we're going to take a look at an exciting obsidian veneer case and then yours
truly is heading up to the operatory where I'm gonna hop in the chair up dr. ana-maria murse on
but first let's explore the near case using our obsidian lithium silicate ceramic material this
high-strength monolithic ceramic is more than just strong it's also beautiful let's see it in action
in this next case patient was unhappy with her gummy smile her teeth and her facial profile after
carefully planning the solution to her problem with our in-house oral surgeon dr. Peter shear
her treatment included aesthetic crown lengthening by gingiva Tommy and austech t'me to reduce the
amount of gingival display and also genioplasty to correct her facial profile after all options
were presented patient also agreed to ten prep veneers using our obsidian lithium silicate
ceramic to demonstrate what the possibilities were for improving patient smile a cosmetic resin
markup was performed chairside at the consultation appointment using the diagnostic wax up I did the
mock up using a body wash impression matrix and after injecting laxative material I placed it
in the patient mouth after the patient had the opportunity to look at her smile the decision
was made for ten obsidian veneers that will have the Central's longer than the laterals after the
gingiva was allowed to hear from the surgery another pre valuating set of temporaries was
used that took in consideration the gingival repositioning I used this set to place facial
depth at here I use a depth cut bur from brass Lord USA that provided a 0.3 millimeter depth
gingival a 0.5 millimeter at the middle turd and point 7 millimeter in size away providing
a preparation that follows the three different planes once I was done with the depth cut I marked
the horizontal grooves with a pencil and used the curette to flick the metrics off to finish the
preparation a eight five six zero one two round and the diamond bur was also used from brass ler
this temporary mock-up prevents any unnecessary entry into the tooth and helped me keep the
preparation on the enamel and precisely control my facial depth cut before final impression patient
where the temporary for an additional week great care was taking to open the gingival embrasure
so not to create any damage to the papilla at the final impression appointment almost always after
the removal of the temporary there will be some area that needs to be cleaned up and so using the
white stone will remove any residual from the area where the temporary was spot edge using
the double core technique to expose the tooth apical e will definitely aid in the help of the
technician to see the tooth below the margin so that the technician will have a better idea on
how to counter the margin and blend the Obsidian material into the existing tooth counter before
taking the final impression I use grip strip to carefully separate the interproximal so that the
technician could see the margins after removing the second cord I use capture veneer poli-sci Lock
same impression system here I'm syringe in medium body on the prepared teeth while my assistant was
loading up the tray a full arch in precision material was filled with capture heavy body the
impression was left to set in the patient's mouth for three minutes also a hard bite was taken with
capture material in order to better communicate the shade to the lab also stamp shade was taking
available in a Vita classic and bleaching shades obsidian material has great optical properties and
it can be pressed or produced via CAD cam here is the final cementation appointment obsidian press
veneer were tried in with water to ensure color and to ensure that everything fits at this point
the patient got a chance to look in the mirror and approve her new restorations after cleaning
the prepared teeth with preppies pumice from whip mix g5 was put down as an antibacterial and
desensitizer agent and because the preparation was on an amo I could use an a deck air to dry
to prevent any contamination a and B primers was right to get the tooth ready for the resin cement
prior to cementation the intaglio surface of each veneer was treated with hyper clean for 20 seconds
before loading the veneers with multi-link also mono bond plus was applied for 60 seconds in terms
of isolation I use scatter rolls and metric bands the veneers were placed in two sets at the time
and hold into place using wooden sticks applying light pressure on the facial and the incisor to
ensure correct sitting for this case I thought was easier to bond the veneer in place starting with
the posteriors to get them out of the way then I went back to the two centrioles and work my way
towards the cuspids prior to the final cure I use small amount of glycerin liquid strip from I've
Eclair to ensure that there will be no oxygen inhibiting at the margins once the veneers were
talked and waved into place the matrix was removed to allow the removal of excess cement I used an
explorer to cleave off the excess and a little saw to separate the cement from the interproximal area
with an average biaxial strength of 397 mega Pascal's obsidian lithium silicate ceramic
exceeds the strength requirement for all ceramic restorations making this material a good choice
for this case because the veneer were extended posteriorly to the maxillary premolars patient
bite and lateral exclusion were checked and final restorations were evaluated for phonetics after
all the necessary adjustment a rubber cap was used to polish the final restoration overall this
obsidian smile makeover exceeded our patient expectation all right now it's time for you
to come with me as we head up to our operatory to meet dr. Morrison and watch as she uses our
camouflage Nano hybrid composite on me come on let's go all right so we made our way up
to the operatory and I'm here in the chair of dr. ana-maria Mershon and they're gonna do some work
on me today but I'm not worried because she's got some extensive experience you've been at the lab
for nearly 20 years can you tell us a little bit about your history here I got hired in 1995 as a
dental technician in the bio temp department and worked there for a few years after which I decided
to become a certified dental technician so for that I had to work in porcelain and ceramic and
after that I think was 16 years after working in the lab I decided to apply to dental school and
I got accepted all right about the time I gave birth to my son and I came back about two and a
half years ago just came back home because I grew up in this company and I wanted to come back and
give back to everybody great well awesome well I'm excited to be in your chair today because
I know I'm in good hands can you tell everyone a little bit about what we're going to be doing
today so sure we're going to replace a felling sealant that over time developed secondary decay
probably because of improper isolation or maybe saliva contamination we're going to remove the
caries and replace the felling sealant that you have in your mouth and we're going to use our
very own camouflage Nano hybrid composite although this material was developed having the technician
in mind to add aide in their fabrication of inlay only encountered bridges today I would like to see
how this material behave in oral environment and how I will be able to recreate nature using the
camouflage composite alright great let's get started one relatively small cavity deletion
in another wise intact arch classifies Megan as a patient with low risk for dental caries using
local anesthetic with vasoconstrictor I am getting Megan ready for the procedure and to receive the
rubber down I like to use the rubber Dam because it controls the soft tissue and increases my
visibility access I think is essential to have a dry field to prevent the cavity from contamination
by the oral bacteria and be able to attain the best marginal seal for the adhesive restoration
here I'm using caries detector dye that helps stain the collagen that had become denature by
the curious process although this is a simple class on preparation it is this type of shape
of preparation that can be challenging the shape of a class one preparation is described as having
the highest configuration C factor and it is the most susceptible to the effect of shrinkage stress
a porcelain round bar in a slow speed handpiece will carefully remove all the stained infected
soft dented the cavity is acid edge where 37% phosphoric acid to first edge the animo than
the dentin after rinsing and carefully drying the cavity opti bond so low plus from cur would
use for direct bonding application of my material of choice universal camouflage composite because
class one restoration comes with an increased c factor the developing curing contraction
stress of bonded surfaces can increase too in my attempt to control the shrinkage and decrease the
c factor I like the cavity to receive small composite increments I use small incremental
buildup of universal camouflage composite and with proper lighting and by the ability of
camouflage composite to be placed in small two millimeter increments the effect on clinical
success can be improved universal camouflage composite has a flexural strength of about 134
mega Pascal's because of its flexural strength I think that camouflage composite is a material that
can exhibit an ideal combination of aesthetic strength and ease of manipulation in the oral
environment well that about wraps it up for this episode of chairside live on behalf of everyone
here at gladwell laboratories we thank you for watching and hope you'll come back next week
you