hello and welcome to chairside live I'm your host Megan strong thanks for joining
me in this episode dr. justin she is with us today in the chair he has a patient with a
fractured pfm on tooth number 31 so what's the plan well he's getting that patient in
and out in just one appointment using the convenient Gladwell dot IO solution
he uses the eye tarot element scanner fast design software and fast mail to deliver a
Bruckner now crown in the same appointment so don't blink or you might miss it let's watch
for this case we have a failing pfm restoration on tooth number 31 as you can see we have a fractured
porcelain on the lingual and we see this often because the feldspathic veneering porcelain
that's often used for P FM's typically is very weak somewhere around eighty to a hundred mega
Pascal's of flexural strength and that is often what we see in dentistry the non-functional costs
that shear off and in this case unsupported lingual porcelain material on this restoration
sheared off exposing the metal substructure so we're gonna go through and replace this for
the patient in a same-day process utilizing the Glidewell dot IO chair sight system and this is a
great system that brings the best innovations and materials and milling technology right into your
office so we're gonna start off by removing the old pfm I like to use a carbide 5:57 we're gonna
make the initial cut on the buckle and occlusal and I'm able to get the crown remover within
there because if the pliability of the material it's able to wiggle off relatively easily once
we make those cuts and at this point it's just a matter of cleaning up the prep refining the prep
ensuring that we have enough reduction and the preparation follows some guidelines that we'd
like to see for CAD cam restorations or CAD cam preparations which is enough reduction and smooth
rounded internal angles I like to use the one and a half millimeter prep check tab to ensure that I
have enough room not only for the restoration but also to get proper contours and Anatomy for this
restoration and that additional articulating paper strip that I put between the prep check tab and
the preparation that will help show and reveal where on the preparation I may not be reduced
enough then here I'm placing a triple zero cord this helps to displace the tissue more apical e
exposing more of the margins and I'll take a 856 oh one for burr now round in a tapered diamond bur
to refine the margins drop those a little bit more apical e and this helps to create a deep chamfer
on the preparation I like a deep chamfer on the margins that helps to create a nice base it helps
to create a smooth rounded internal angle on the preparation once the preparation is complete then
I'll follow the triple zero chord with a larger size 2 chord this orange chord here the second
chord is larger to help displace the soft tissues away laterally from the preparation to help expose
the margins even more we'll leave the cord in for about five minutes and once that's set for
5 minutes then we'll remove it to scan the actual preparation with the glide will dot IO system we
have a partnership with a line technology with their I Tarot element scanner it's a very easy
to use color scanner as you can see it uses sort of a video capture too as I sweep along
with the camera and see the information is added immediately you get immediate feedback on what's
missing where you're capturing the information so we're go through a process of three scans one of
the opposing and after preparation and since it's like a point-and-shoot camera we sweep along the
occlusal then we rotate to the buccal to capture those aspects and then also the lingual to ensure
that all the undercuts and everything are added on then the third set of scans the final set
will be of the bite registration which is taken with the patient closed completely in centric
it's always a good idea to practice this with the patient beforehand especially when they're numb
to ensure that they are biting down correctly and asking them to bite down with a little more force
typically will help ensure that they are fully down in centric so typically takes about two to
five minutes for me to scan all the information that's required of this sort of digital triple
tray for these for this particular scan it was right about three minutes and what's great about
these digital impression systems is the ability to actually see they have a feature where you
can see the clearance the occlusal clearance and if there's any additional reduction that's needed
it is easy to go back and modify the preparation right then and there and go back to rescan and
it's nice to actually just rescan the area that was modified you don't have to redo all of your
scans for the impression once the scans are completed we're now sending the file off the
digital impression over to our fast design software the fast design software will begin
at the margin step where hopefully if there's enough tissue retraction this step is relatively
quick so by doing a double core technique or whatever retraction process or procedure you
like to go through it's a it's going to be extremely important to save time during this
margin marking step once the margin is completed that's the start of our crown we move on to the
design part of the software and fast design will create a beautiful proposal based on the adjacent
teeth and the opposing dentition there's really no modifications required to the actual design
there are certainly tools available to move the restoration rotate and even move specific
parts to drag and change shapes change contours change cusp positions but I like the way that
the proposal came out so all I need to do is set the contacts at this point so I set it to
my preferred settings for the occlusal contacts you can see we're at a negative 200 by default I
just bump that up to a greater negative negative 220 and that is to provide some additional relief
from this static stone digital model because the teeth don't really compress the way that it does
intraoral II so we have to create a little bit of relief digitally so that once it's seated in
the patient there's minimal to no reduction or additional occlusal adjustments required for the
proximal contacts I like to set those at 20 that's a positive 20 microns of contact that's how much
it's coming into contact with the adjacent teeth once the contacts are set here you can see with
the opposing models in place we can evaluate the cusp fossa relationship and create the type of
occlusion that would be ideal for the patient advance to the next page where we get a little
preview of the restoration within the block and then fire that design off to the fast mil software
now I'm loading the brookster now block into the fast mill and this is the only monolithic fully
centered zirconia material available for CAD cam systems and fully centered means it's already at
that extremely strong thousand mega Pascal's of flexural strength and because as it's fully
centered this unique shape to the block helps to minimize the amount of time it would take
to mill out a restoration once the milling process begins you can see there is a heavy
water spray to ensure that that burr stays cool during the entire milling process so after about
35 minutes we have our Brookshire now restoration completed and the mill also goes through a process
of minimizing the sprue size to help cut back on the amount of finishing that's required for
the restoration before delivery I am applying some low fusing stains to this this step is completely
optional because with Brooks are now since it's already in that fully centered state it's ready
to go but it is monochromatic typically you can just polish this with a diamond polishing paste
to create a nice shine on it and deliver this for the patient but the dental technician in me
often does take this optional step to increase the chroma and match the adjacent teeth just a
little bit more and this oven cycle was about 10 minutes with low feeding stains and glaze
to help enhance the appearance of the restoration but here's our finished restoration our finished
Brookshire now and I will deliver this with a resin-modified glass ionomer cement I typically
will use three M's rely excluding Plus which is their resin-modified glass ionomer it works well
because it's easy to remove the excess cement and we have a very strong restoration that can
be held in place without the need of bonding the restoration in so here's the final restoration we
have a very strong crown that we replace for this patient we were able to successfully replace the
defective pfm with this same-day brookster crown using the glide wall dot IO chairside system if
you're interested in learning more about the system please visit gladwell dot IO that's
dot IO not dot-com gladwell dot IO to learn more about the technology and materials available for
you and your patients benefit thank you so much for your time back to you Meghan thank you for
that dr. Qi well that about wraps it up for this episode of chairside live so on behalf of everyone
here at global dental thank you for watching and I'll meet you right back here next time