I'm dr. Joshua Austin sitting in this week for dr. de tola who is eating babies with dingoes
in Australia that's terrifying and I'm make him strong on this week's case the week a doctor goes
digital and analog and it's a good thing he did both and in the news we visit texas his birthplace
home of amazing barbecue and a stupid criminal all that and more on today's chairside live
howdy welcome to episode 146 of chairside live i am dr. Joshua Austin sitting in for
dr. Mike de tola while he is playing keyboards on the new minute work tour in Australia Megan
how are you I'm doing alright rockin rollin you know how it goes yeah your hair's looking
good Thanks a little bit better we that we had one appointment to try to fix it didn't
go as planned but now my hairdresser who's my normal hair dresser who didn't do this
tragedy is coming back from maternity leave so i have an appointment at the end of august okay
so it'll just stay tuned people work up we're gonna go back to normal i was curious why you
would choose to do something drastic to your hair why your regular maternity girl or why
your regular hair stylist is out on maternity leave that would be similar to like a patient
going into their dentist for veneers as soon as their dentist went on vacation
right in someone's garage yeah you know it's really it's why is the sky blue why is the
grass green why did I choose to do that all questions to ponder interesting yeah well
we have a great case of the week this week where a doctor took a digital scan of a case
and then took a PVS impression and it's a good thing he did let's go take a look at that now
on today's case of the week we're going to discuss a doctor who did a digital scan wasn't quite sure
about part of it and then took a PVS impression to confirm the margin and so he sent both of those in
and we're going to take a look at those right now so what you're looking at right now is an
occlusal view of the digital scan and one thing I noticed when I look at this as compared to say
this screenshot is how smooth this is compared to this and part of that has to do with the scanners
so this was done with an internal scanner that produced an STL file that was then uploaded and as
they convert that into the three shaped software that that we use here it caused you know some of
this sort of visible distortion but it's it's really just you know it doesn't look quite as
smooth and it makes it a little bit harder to read you know versus here this is a scan of an
actual stone model where the die has been trimmed and whatnot so this is a little bit smoother but
most scans come out looking like this as compared to this that's not necessarily a bad thing it just
doesn't look quite as smooth and so the doctor was a little unsure of the margin and so when
you look at this you know it's pretty easy to see the lingual margin kind of right in here as
we come around the distal margin my guess is where is where that was was a little bit fuzzy for him
and so what the lab did is they they went ahead and made a 3d printed trying crown for this this
was going to be an emacs case and then they they tried it on the stone model and so if we look at
the stone model here you know this is die trimmed and whatnot and on that stone model the margin
was a little bit short so scan the model and and decided to make a new crown from the model if you
can look here you see how clear this margin is here versus how it is on this digital scan and
so that that made it that made the life of the technician a little bit easier in in making that
crown when we move on here there's a couple other things that we see here is a nice view from the
the palatal or from the lingual of this of this preparation and you can see we have something
going on here on the distal of this canine and then a really nice flattened plane here on the
mesial of this premolar and whether or not this damaged was cause I ate Regina kalid during the
preparation of this crown or if this is previous damage the biggest problem that we have here is
it's going to be very difficult for the technician to make a nice good contact here in approximately
between the crown on this tooth in this tooth and so what's going to happen is number one
we're going to have a nice sharp point contact if we have any contact at all and that's going
to trap food that can be unaesthetic it can be a decay problem for the patient as as they have
a plaque trap there it would have been very easy at the time of preparation for the doctor to fill
this in with some composite I you know up until a few years ago I would have said just just normal
composite but now we have some of these very low vikas low viscosity flowable materials like show
like beautiful by shofu which is a non slumping flowable that that would be really easy to just
kind of flow in here and just really bring this contour back out same thing over here so that the
technician can have a nice interproximal contact it's going to make the patient's going to like
this crown a lot better without worrying about getting broccoli or asparagus or spinach stuck
in there every time they eat and you know if you have a good interproximal contact there's less
chance of getting your current decay you know down here at the margin as plaque just sits there and
the patient has a hard time cleaning that out you can see it's not quite as as sharp here as it is
in the digital scan this is the the scan of the model but you can see definitely that we have a
nice negative area there and that's just going to be impossible to get a nice interproximal contact
on the prep is very good the prep is nice we got plenty of reduction all the way around
a nice thick margin which makes it easy to do a goodie max here but really this is going to
be really hard to do to do a good contact here so you know spin the two or three extra minutes that
it takes to build this out a little bit here and here and it's going to make the technicians life
easier it's going to make the patient's life easier it's going to make your life easier
you know when you go to deliver this and then you know subsequently when you see this patient
on recall you know you're not staring at that every time and you're high Genesis and digging
stuff out of there you know for the next for the next few years here's another image of the
digital scan this time from the buckle and you can see here you know not only is this going
to be a functional issue with getting a contact here this could be an aesthetic issue you know
if you look at this this is going to be produce a nice negative space here you know that that's
not going to be all that that appealing and it's going to always show plaque and always show food
food particular Zand and whatnot in there so here it is a scan of the actual model you can see how
much smoother this looks and again same thing here nice negative space there so you know investing in
in a few minutes of taking some composite and filling in these contact areas here and we can
really get a much better result on this crown but again this is a nice case nice preparation
just with a little bit of some ancillary things by fixing the contacts on the adjacent teeth we
could be a lot better good on the doctor on this one for recognizing the fact that he couldn't
quite see the margin all that well on the scan and deciding hey let me take an impression too
and then that really gives the the technician a chance to make sure that they get a crown right
on the first time thank you for that dr. a you're welcome now let's go to a segment we call your man
this week's viewer mail comes to us from dr. Chris pilotto and he writes dear dr. de tola
today my first case of minimal prep veneers went in I've done many cases before but they were full
prep and until I had seen you on chairside live in one of the Glidewell videos I never gave much
credence to minimal or no prep veneers anyway my patient and I were very pleased with the outcome
I appreciate you taking the time to produce such high quality education for dentists keep up the
good work I'm inspired to do more of these best regards dr pilotto well Chris I am again sorry
that I am the one sitting in here to answer this question and not dr. de tola he's in Australia
searching for that perfect shayla so when you talk about no prep veneers I think the key just like
anything is case selection the best cases tend to be the cases that have multiple die estamos and we
have multiple multiple diamas you can really sort of make a big difference on that without prepping
anything in approximately there's always going to be a little bit of prep even on nope revenues
even if it's just roughening the enamel getting that fluoride rich surface of the enamel off so
we can get a better bond and sometimes on no prep veneer cases we still need a little bit of prep
here they're on a line angle so you know really it probably an honesty is more minimal prep you
know full prep veneers have their time in place and that's probably a much more likely scenario
for most veneer cases but when you do have the right case for a no prep veneer or minimal prep
in your case it can go very very well I think the key is to do a diagnostic wax up and and that can
be done here either digitally or with with with real wax you can do it in your office any number
of ways to do that but that's really going to be the key to help you figure out how to do that but
I'm glad that case went well for you and hopefully you'll find some more of those cases in the future
because I think it's a great way very conservative way to give people dentistry that they want so
Meghan I think we have something for Chris we do of course always Chris it is your lucky day
because we've got two thumbs up two thumbs up and I'm going to find that as dr. michael de tola so
this will be a complete forgery nice i love it little it's illegal but we'll take it very good
and i think we have a brook cir polishing and adjustment kit so you send it out to you so get
on your crisper for right nin Thank You Megan do we have any news yes a Texas man is behind
bars after police allegedly caught him stealing from a dentist office officers responded to a
burglary report and found the 21 year old suspect inside the building with lots of cash and dental
equipment Collins was arrested and charged with burglary of a building which is a felony he was
also charged with forgery and misdemeanor theft of property both from outstanding warrants from
two different counties now what terrifies me about this is you're from Texas here a newport beach at
the lab are you afraid that it might have been your practice no I think I know about it by now
and I can tell you how I know it's not my practice when they said there's lots of cash okay cuz utter
I don't know none of my patients pay with cash it's very rare for there to be cashing if it is
it's 50 bucks or hundred bucks it's lots of cash yeah and you specifically said lots of cash I did
so I wonder and by the way now if I was Robert which I'm not if I was thinking hmm I'm gonna
go on a little heist here right dental office not my first choice if you're going to a dental office
I would assume that you're looking for like the drugs that we would use to sedate people
or vicodin or hydrocodone any of those types of things i would i would see as being a target now
I know that dental equipment is costly but I'm and most of it is heavy too right so like if he had
a bunch of it in his possession so I'm assuming maybe he was carrying it in a bag or whatever I'm
a gunnysack like the cartoons like what like what could he possibly be stealing immediately maybe a
laser or something like that or hand pieces but he's got a fence that stuff and so I don't know
how he would know what are the expensive you know pieces of equipment that are you
know light and inside sorry right yeah maybe so I don't know interesting thing but he's got a fence
all that stuff and so you know I think people are going to know when he takes it to the pawn shop
whatever right you know okay this is a dental laser like he's not going to look like a dentist
I'm assuming and so I don't know what what is that um well it's uh I really know what it is
right right thank you how much can I get for it but you know I don't think anybody ever accuses
these people of having grand master plans when they rob a dental office I just think it's like
I mean there's a reason why there's that show world's dumbest criminals you know what I mean
it's like just I think that anyone who is choosing to steal is not you know thinking logically but
it's like come on put a little thought and do it and he got caught on premises you know he
got caught at the office so means he's not very fast you and he had two different warrants out
from two different course he did of course he did of course he did and so justice has been served
for the 21 year old dental thief maybe he should pick a different type of business to rob next
time like a dry cleaner or you know he can steal the dry cleaning chemicals and Huff them sounds
like an episode of Breaking Bad you got another story I do new research reveals at the Megalodon
the largest known shark to ever have lived had teeth with built-in toothpaste the study found
that the teeth were heavily comprised of fluoride whereas modern sharks only a florid on the enamel
of their teeth Megalodon teeth were almost eight inches long much longer than those of any living
shark today they also had a revolving jaw that replaced teeth as they were lost a feature today
shark still have however the fluoride containing teeth disappeared a shark's evolves to only have
fluoride on the tooth surface now extinct the massive creatures thought to have roamed the ocean
from around 16 22 million years ago Megalodon is that named after you yes that is my own dinosaur
yeah creature yeah I don't think of sharks at dynasty no well my producer James told me it was
the moon Colorado employ he must be yeah he must he must be what I find interesting here they said
it's like having built in toothpaste it's kind of nothing like that at all right um so I didn't like
that analogy but I do what they said don't shoot the messenger I do find it interesting that the
shark has you know the entire tooth made out of fluoride which would help it against cavities and
things like that and help it stay in the mouth forever for a creature that only needs a tooth
for like 15 minutes because it's got another one behind it it's like it's like being huge and bulky
and strong and beautiful at the same time you know so it's a triple G yeah what if we as humans had
teeth that just replace themselves ya de business yeah we'd be we'd be out of it we there would only
be oral surgeons to help kind of extract those teeth as they as they needed to move out so that's
a good thing yeah I'm glad I'm glad that isn't the case you know shark's tooth paste is basically
like those you know this little when you see shark week and they have the shark bites the camera and
you see those little like parasites that live in the shark's mouth that clean off everything
that's kind of what I am for from like tatola I'm sort of just like the little fish that swims next
to the great white and I just sort of eat the scraps that he you know doesn't so yes that's
what i consider myself that's good yeah but I so I think this is interested in actually there's
been a ton of stories lately ton not really but a few stories lately of people especially young
kids who've been like walking along the beach and they'll find these Megalodon teeth and it
makes me want to find a Megalodon tooth because it's named after me so yeah like I would imagine
there's a those fetch a pretty penny in the sort of antiquities market sure you think a year seen
the show now getting the name of oddities I think the name of the show is not well they sell weird
like body preserved body Parker yeah that's way yeah it's very strange kind of a creepy feeling
but to when you watch the show but maybe that would go or some unlike the animal black market
yeah strange weird well thank you for that Megan yeah that about does it for this week's episode of
Charis I live for myself dr. Mike tatola Megan strong producer James the rest of the CSL crew
thank you for your time and your continued commitment to quality dentistry we'll see
you next time super super shark with super teen I got it I got it together we got it I got it I
got it I got it I got it I got it again are you forgotten it because you did oh no okay dancing
picked it right up here okay how I remember everything help and I do wear sunscreen because
I don't want to get wrinkles and sun decanter backs Sun campaign can add you enjoy the Sun
like that yeah son cancer skin cancer there's like little ice weird little powdered donut fairies or
over here just nibbling on many little Donuts all day long except you're not writing on the
prompter you're not believing me cheeks in the news come on people sorry it's my first time
no well my producer James told me it was and he's from Colorado and polish so I believe him