hello and welcome to chairside life i'm your host megyn strong in today's episode we have an
exceptional solution for common clinical dilemma now what would that be well what do you do when
you need the strength of a pfm but you want the aesthetics of an all ceramic dr. Mershon has the
answer she uses breakfast or anterior watches she uses this impressive restorative material on a
non-symmetrical anterior case where she needs to match the contralateral natural dentition if you
haven't seen brooks your interior in action yet now's your chance so take it away dr. Marsh on
hello and thank you again for taking the time to watch today's clinical presentation on this case
I'm going to replace three old p FM's with Broxson interior crowns explain my reasons
for the material selection show you how I achieve gingival harmony between central's and then I will
talk about my criteria in choosing the impression tray these pfm crowns have been in place for a
couple of years and as the gingival recession took place around number eight the low value around the
margin can be noted we can also note the gingival inflammation especially around number nine on
number seven open margin was also visible on the x-ray there is also a gingival disharmony I will
try to correct with laser I start by evaluating the gingival tissue thickness in the simplest way
using a metal periodontal probe into the circus because we know recession of periodontal tissue
is more common with P FM's and this risk increases in patients with teen biotype this technique will
help me assess the gingival biotype it can be noted that this patient has a tick gingiva biotype
I begin cutting off the Crown's by making a vertical opening with the tapers your cut
bar and extend this opening across incisal edge I will also go over the lingual since these grounds
have a very thick lingual metal colors I want to make sure I separate the metal all the way to the
gingival margin and great care should be taken not to Nick the gingiva there was no difficulty
in cutting this grass off I could see clearly the cement interface so no risk of damaging
the tooth but we can inadvertently damage the gingiva you can use a retraction instrument and
get the tissue out of the way but I didn't hear and you will see I slightly Nick the gingiva on
facial of number 9 but in this case I knew I need to do a focused laser pre countering to bring the
gingival architecture of number 9 in harmony with number 8 grams came off pretty easy when I is the
christensen crown remover to expand the vertical opening we can see there was some stain on number
seven where there was an open margin but the preps have a fair amount of tooth structure left and
there is no decay because denting color of these preps were not dark I selected peroxyl interior
for the final restoration this material can be moved down to point nine millimeter thickness
and I am able to do less preparation when teeth are not discolored in the end with this case
we hope the restoration will have an increased translucency that allows the light to pass through
so we get popular and gingival margin that are nice and pink unlike with metal base restoration
another reason for selecting a material like Broxton interior is that cad/cam offers superior
margin fit also I have the ability of cementation like with any other pfm but without the risk of
metal margin showing up if in the future the patient experience recessions again I am packing
now ultra pack double zero cord from altered and I usually do this to provide a vertical gingival
retraction of 0 point five millimeter and then drop the margin to the new gingival level we can
see these margins are already more sub gingival than I would like them to be and you can clearly
see how I nicked the gingival number nine because there was a lot of bleeding I am using here the
Picasso laser to do a salt alert deployment and remove the inflamed tissue on number nine I had
the laser set on basic at point eight continuous wave for 20 seconds making sure I am short of the
pocket depth I use a diamond burr from accidental to smooth the margin then I use the laser to bevel
the gingiva note how the nicht tissue went away I'm not going to impress at this time we will
temper eyes and let the tissue here for about two weeks biotin card were used to improve patient
smile during this healing phase the potential of biotin CAD is that if the patient likes them they
can act as a template for the final restoration for more tips on this step and how to sit your
bio temps in 15 minutes check out my assistant episode on chairs I life note how the gingival
embrasure were open to avoid impinging on the papilla and allow room for patient to floss he
is after the tissue has healed with the bottoms in place for two weeks at this time the bottoms
were removed and the margin perhaps were finalized after packing double zero court there is not much
to be done other than rounding sharp angles or incisal edges and providing a smooth margin with
a fine diamond / for this case i use to ultra pack code from ultradent as my second cord to
provide horizontal detraction to keep the cord in place dry and provide pressure on the tissue
I use anatomical compr caps I like anatomical compr caps because they are pre-cut for mesial
and distal areas to avoid pressing too much on the popular and allow the cotton to reach the
facial and palatal margins we keep them in place for about seven minutes before removing the court
to take the final impression we use here a triple tray from clinician choice my criteria for using
this tray is four times when I want to impress no more than one to three units per quod such in this
case I like it because it is rigid and it has a teen web not plastic mesh like other trays and
it locks in the occlusal registration without interfering with patient closing comfortably
after I guided the patient into centric closed position my assistant makes sure patient stays
there during the full setting time if the patient has failed to close all the way but
the impression of the working and opposing sides are satisfactory we can still use the impression
if a separate occlusal registration is taken when that happens then we instruct the technician to
mount the models with the registered bite it is important for a product such as braxin interior
to take a picture of the prep with a stamp shade in place and send it to the lab in this case since
I felt like the underlining preparation will not change the outcome of the final color of
the restoration I only took the shade of the surrounding dentition when we want to change
the shade of the final restoration if prep is for example slightly darker then it is important to
have a picture with the stamp shade as well if the prep is too dark or if there is a metal post
then Broxson interior will not be indicated as the translucency of this material will pick up
on the dark underlining structure this is at the final delivery appointment after the temporaries
were removed and perhaps were cleaned we note that tissue has healed beautifully we proceed with the
cementation of brock's our interior crowns using Sara mere cement from occidental because the color
of this preps were unnatural denting and because Brock's interior comes in all 16 Vita shades we
see how these braxer crowns were able to blend in nice with the surrounding the Titian pre-op we
noted how the health of the soft tissue affected eight and nine appearances pre determining a
slight change in gingival architecture of number nine especially in high smile line patient like
in this case we can see post cementation how the trend of the soft tissue is characterized by an
ideal symmetry there is a correct parallelism of the gingival line and the incisal edge position
after removing the excess cement I'll check the occlusion and fanatics to make sure there will
be no interferences I'll check for F sound and confirm the incisal edge is in ideal position
and there is no lisp when I check for s sound when we look at the gingiva possum entation we
can see we increase the aesthetic result at the same time maintaining adequate biologic
integration of the new restorations because Brock's interior is a more translucent econia
it allows the light to pass through so we get popular and gingival margin that are nice and
pink like you will get with all ceramic materials patient was very impressed with the result and
she would like to change other old P FM's and get more work done to restore the posterior area stay
tuned for a future episode thanks again for watching thank you for that dr. mershon and
if you'd like to learn more about this exciting restorative material visit www ental com well
that about wraps it up for this episode of chairside live on behalf of everyone here at
Glidewell laboratories we thank you for watching and I'll meet you right back here next time
you