hello and welcome to episode 164 of chairside live I'm your host Megan strong thanks for
tuning in and here's a sneak peek at what you can expect on today's show dr. chi is
taking a conservative same-day approach he's using our highly aesthetic obsidian
lithium silicates ceramic material on tooth number 19 check it out
for today's case we're gonna work on tooth number 19 that has an existing do amalgam
restoration and a distal lingual cusp fracture what we're going to provide for the patient is
a conservative only restoration by removing the amalgam and any recurrent decay and preparing
that for an indirect off ceramic only that we're going to fabricate chairside we're gonna scan it
with the 3m true definition scanner design it on the iOS fast design software and mill it out
with the TS 150 milling system the material that we're going to utilize will be the obsidian CAD
which is a lithium silicate material and it offers a unique blend of strength about 385
mega pascals of flexural strength and also very very nice aesthetics with natural translucency
that allows it to blend in with the surrounding tooth structure obsidian is also utilized in our
revolutionary obsidian pressed sand metal restorations which are now the strongest
Pia films ever fabricated since glass ceramics are more prone to chipping during the milling
process obsidian CAD is milled out in a slightly soften pre crystallized state and that ensures
that it maintains its structural and marginal integrity and I'll show you how we can utilize
the required crystallization cycle in the porcelain oven to add some stains and glaze
to enhance the aesthetics let's take a look at the case alright this patient presents with a
large amalgam restorations on tooth number 19 with the distal lingual cusps that had sheared
off and this is actually a situation that I see fairly often and I will utilize a digital
process to help restore this patient's problem so after taking the shade which we determined to
be an a 3.5 I'll start the process by removing the retentive areas of the amalgam restoration
and the restoration just easily pops right out and after that evaluating the rest of the the cavity
to determine if there's any recurrent decay in this situation just a little along the gingival
floor and after that since we are going to mill an indirect restoration i just want to ensure
that there aren't any undercuts and that the proximal walls of the cavity are divergent due
to the proximity of the pulp i placed a thin layer of victor bond just for added insulation so here's
the completed preparation again with divergent walls without any undercuts and we can begin the
scanning process no retraction was necessary with cord because the margins were kept super gingival
for the preparation scans ensuring that all of the surfaces are captured occlusal buccal and
lingual rotating almost to 90 degrees both on the buccal and lingual to ensure that those areas are
captured well and on to the opposing scans where we also want the functional areas along with the
entire buccal surface because that will align during the bite scans in this situation with
the patient biting together once the three sets of scans are completed they are sent wirelessly
to the iOS fast design software where after I set the path of insertion the margins are
placed and the pre-planning of the design is done where I can set the design and rotate it
and just kind of fit it into the tooth number 19 and the software does an incredible job of
restoring the missing part of that tooth not a lot of work is done except the only thing I did here
was to broaden the contacts a little bit more and setting the value of that contact in this case I
find 60 microns of proximal contact to be ideal and the last part of the process is to set the
sprue location because the distal lingual cusp was missing I place it right in that area so to
avoid the contact and the margin so after about a 12 minute milling cycle here I utilize a slow
speed handpiece with a diamond bur to remove the sprue and afterwards I'll place it on super peg
material which is a putty material that will help stabilize the restoration onto the firing peg and
also during the heating cycle in the oven it helps to prevent any type of dimensional
shrinkage or changes to the restoration so here I'm placing a very thin layer of glaze material
into the restoration and what this does is it will of course give a very nice luster to the
restoration once it's fired and also and help seal up any potential micro fractures in the
restoration some of the stains that I place right into the primary Anatomy a little bit of mahogany
to help create some added depth to those areas and some white on to the Custis and marginal ridges
to add some value to those areas not a lot of stain there's not a lot of work that needs to be
done and it's placed into the porcelain furnace after about a 20 minute cycle the restoration
is completed it is crystallized and also staining glaze the glaze material fuses to the restoration
and the stains are also set in place and the Peck material comes off very very easily so this is the
first time trying in the on lay in the patients tooth here I utilize the Optra stick by avec lar
to help carry the restoration to the tooth and once it's seated in place I'll verify that the
margins are nice and sealed and also that the proximal contacts were set properly I really
haven't had to adjust any proximal contacts because once I set it on the software it is
perfect pretty much every time so even though I'm using a self-adhesive resin cement I will place
an additional layer of in this case it's Scotch bond bonding agent and internal studies here at
Glide wall we have determined that an additional bonding agent has increased bond strength quite
dramatically to dentin and in our studies it has increased the bond strength to dentin four
times even though in this situation I am using a self-adhesive resin cement the restoration itself
is acid etch with hydrofluoric acid 5% for about 20 seconds after tat curing for about two seconds
that aids in the removal of any excess cement removing any cement interproximally with some
floss material and even though it is a dual cure cement I do set it into place with an additional
light cure of 20 seconds per surface and here I'm using some composite polishers to go right
along the margins to help smooth out any areas of excess cement that may be left over and I'll
finish that off after checking the occlusion finish off any rough areas with an aqua brush
which is a bristle brush that helps polish any rough areas of the restoration and here is our
completed case within a two hour appointment I was able to restore this patient's lower first molars
form function and aesthetics the patient left very satisfied getting their problem resolved
in a single appointment and that's one of the great benefits to utilizing chairside digital
dentistry and of course I was very pleased to be able to offer this solution very effective
and efficient solution for this patient and that's it for this week's case of the week we
hope you enjoyed watching the on lay fabricated for this patient utilizing a digital workflow
in a single appointment we hope you enjoyed the case of the week for this all a restoration it
took approximately an hour to complete after the preparation chair aside CAD cam is an
amazing technology that allows us as clinicians to provide extremely high quality restorations
for our patients within a single appointment thank you for your time back to you Megan thank you for
that dr. Qi obsidian never ceases to amaze me all right now let's check in with will Schmidt who
I hear has a patient in the chair it's coming up next in a segment we call across the chair
so today I'd like to focus on bio temps bio temps are a great addition to your practice as simple as
taking an impression and allowing the laboratory to fabricate your temporaries so that you don't
have to these are especially great for combination cases where we can do crowns bridges veneers and
things together I've grown to love them over the years I think they are a great addition to your
practice it's as simple as taking impressions sending it to the lab and having them fabricate
your temporaries for you so on the date that you prep you can simply realign and place those right
in the mouth so today I would like to talk specifically about posterior bio temps as
you can see here the models that we're gonna use are all set up the lab has gone ahead and done a
rough preparation of these models that way I can have a basis of how these bottoms are gonna fit
before I rely I always like to try my bio temps on the model just to make sure there aren't any
interproximal reductions that need to be done and they have been fabricated properly the laboratory
is also going to provide me with a couple plastic stent so that I can try these in the mouth or even
on the models to make sure that my bio temps are going to fit my preparations before the realign as
well I will go ahead and trim the reduction stent and actually try it in the mouth to make sure that
my doctor's preparations have enough room first of all in the occlusal plane but also within my bio
temps go ahead and snap that in on the bicuspids a nice passive fit it looks like I do have enough
reduction to go ahead and place these bio temps I will give them just one dry try in first without
realign without anything else just to make sure that they will sit in there side by side you are
going to feel them rocking at first but we just want to make sure that they're gonna fit in there
and there's nothing that is obviously wrong with them before we go through with anything else I
like to go ahead and realign without using in the etch any Bond luxe attempt exact attempt some kind
of acrylic temporary material right into the bio temp and also try to fill up as much as you can
a little excess is okay because we can trim that up later I also like to put a little bit just on
my glove so that I can check to see outside of the mouth how close who are until it sets for today's
purposes I'm going to show you two different kinds of posterior bio temps for 18 and 19 I pulled this
out as one unit and I'm going to trim it as one unit then we're going to go ahead and break it
apart and show you what it's going to look like as two separate units my margins look good everything
else looks good there's no bubbles or anything I can go ahead and use this realign as my final very
important thing and I do this right after I bring those realign bio temps out before trimming is I
go through and I make sure that there isn't any excess realign material or acrylic on the teeth
if you don't do it right then chances are you're going to forget and then the patient's going to
feel high spots that aren't your bio timpz but simply excess material within the mouth I like to
trim chairside right beside the patient or use my laboratory just to make sure there aren't any more
of those little pieces of cotton excess acrylic anything that's going to disrupt the tissue or
cause any discomfort as I keep a good fall chram with my fingers at all times the most important
thing to keep that drill nice and steady we'll go ahead and smooth everything out to begin with
and then we'll go in and get these embrasures I like to use a nice long thin diamond flame bur in
order to get these embrasures and let the tissue breathe we make sure to open those embrasures up
really well that way the tissue can breathe the patient can floss underneath with a floss threader
if they need to no food or anything is going to get caught in there and more importantly I can
get all of the excess temporary cement out from in between those teeth this is really going to come
into play when we take these off eventually and the patient's tissue is not irritated underneath
and bleeding when we're trying to submit in our permanent restorations you can see here on the
lingual as I'm looking the only space that I can see here in between the gingiva and that
preparation looks to be where my retraction cord from my final impression was placed just moments
ago other than that my margins look good I always make sure that I can't in fact fit an
instrument through those embrasures if I can fit that instrument through there the patient
can fit floss they can remove any sort of food or any contaminants away from there making sure my
contacts are good with my natural teeth checking my occlusion and adjust if necessary smoothing
out my contacts I'm making sure I'm not actually touching my contacts so that they're not light and
checking once again as you can see there aren't any hot spots in my occlusion the occlusion is
nice and spread out and on the bicuspids as well this to be a successful reduction I've gone ahead
and separated these two units and also check the contacts in between I like to show that we can
also do separate units as well as single units depending on what you want to achieve with your
patient while placing temporary cement I like to put just a little bit on the flat surface
put just a little more around the edges of the integrity of that temporary that way when you put
the temporary on all the excess is going to move out from the sides and not get stuck underneath
and cause your temporary to be high place back in the mouth on the dry preparations go ahead and
check to make sure a little bit has extruded from the sides and all the patient to bite on a cotton
for the appropriate time clean up any excess temporary cement and we should be good to go
on this patients follow-up appointment number 19 has had a root canal treatment however number 18
is still a vital tooth we have gotten this patient and neset eyes for this appointment but I want to
show just a couple different ways we can remove these temporaries in this case the temporary that
is on the root canal treated tooth is probably not going to be too sensitive to me removing it with
a four set for patients who are having a little sensitivity or the forceps just not working I like
to use a little trick where I will take a spoon excavator and carefully at the margin put just a
little bit of a leverage pressure in order to pop that right out nine times out of ten the patient
doesn't even know that that temporaries gone so I hope that gives you a helpful insight on posterior
bio temporaries specifically these crowns we did today it was a pretty easy straightforward case
and we finished up with some of city and Presta metal crowns that look just amazing thank you
for watching back to you Megan thanks will and for all you dental assistants watching if you
have a question or comment for will write to us at chairside live at Glidewell dental comm
well that about wraps it up for this episode of chairside live and don't forget to earn while
you learn this free CD chairside live courses at Glidewell dental comm on behalf of everyone
here at glial laboratories we thank you for watching and I'll see you back here next week