hello and welcome to chairside live I'm your host Megan strong thanks for being here with
me today here's what's going on in this episode dr. justin qi is doing a smile makeover and boy
it's pretty dramatic he placed ten veneers from number four through thirteen using the
new ruksar aesthetic he placed these veneers to close Dyess tamata and reshape the patient's
worn natural dentition let's hand it over to dr. Justin Chi to see his smile makeover
for this case we have a 41 year old female who's chief complaint is her worn and unaesthetic and
to her teeth there is attrition from 6 through 11 and also died a stamina between 5 & 6 6 & 7 and
10 and 11 the plan is to enhance her smile with veneers to increase the size close the spaces
and also to go much lighter she wants to aim for a Hollywood BL one shade using the next evolution in
our surco Nia restorations brookster aesthetic it's a special higher translucent monolithic
zirconia that elevates the aesthetics and strength from the current generation brookster anterior the
strength goes from 650 mega Pascal's to over 900 mega Pascal's I begin the preparation directly
through the mock-up by preparing through the mock-up I'm able to ensure the final restorations
have the appropriate material thickness while reducing tooth structure only in the areas that
require it I'm using the head of a 850 oh one four bur to create three depth cuts along the
incisal edges of each tooth for the facial depth cuts I first ensure that the tip which
is 0.8 millimeters in diameter begins the depth cuts at the margins and then gradually connects
to the incisal I place five depth cuts on the facial three near the center and one along each
line angle the depth cuts are then marked with a lead pencil so I have an easier time identifying
when I've blended the unprepped areas down to the ideal depth once the death cuts have been marked
I switched to a larger 850 o 1/8 bur to expedite the finishing of the preparations now it's just
a matter of ensuring the finger projections at the incisal edges and the facial surfaces have
blended together through the depth cuts resulting in a smooth and continuous surface throughout the
preparation any time we lengthen teeth with veneers a flat incisal edge preparation is
preferred for ease of fabrication smooth path of insertion and a great adaptability of the
restorations to the preparations the incisal edges have a slight angulation from lingual to facial
for the teeth adjacent to the Dyess tomahto the preps must be extended farther in approximately
to allow room for the final restorations to create the desired emergence profiles and
contacts when we prepare teeth the axial clues 'el or axial facial line angles typically result in a
sharp angle since the birds we use create flat planes it's good practice to round these over
to minimize the amount of internal stress placed on the final restorations to ensure
the labial incisal transitional line angle is smooth and rounded I use a coarse Venus Supra
polisher along these aspects at 5,000 rpm all of the finished margins terminate at the free
gingival margins of each tooth I typically use a dual core technique but wanted to try
something a little bit different since all the prep margins are at the free gingival margin
right ecwid interval I'm going to place only a size one retraction cord along all of the
teeth to help displace the gingiva slightly for our final impression once the retraction cord
has been allowed to sit for five minutes we'll remove the cord and then begin flowing capture
like body PVS material along the margins and into the sulcus you can see with just one cord and how
the tissue has been displaced enough to visualize the margins once the Lightbody has been applied
i'll now slowly adapt the anterior triple tray filled with heavy body material to the preps once
the impression has been taken will then get the patient ready for their provisional restorations
for the Provisionals I'll use a shrimp rack technique using the same putty matrix that we
use for the initial mock-up I first spot at each tooth with Kearse 37% phosphoric acid followed
by a thin coat of 3m Scotch bond Universal which will like your for 10 seconds now I'll fill the
putty matrix with tough temp basic row material and then slowly seat that over the teeth to
minimize the inclusion of any air bubbles with the scalloping created on the putty matrix it's quite
easy to remove the excess from the facial with an explorer or scaler now we're onto the final
delivery and we need to ensure that the temporary material is completely removed the temps can be
somewhat tricky to remove since they were bonded in here I use a slow-speed carbide round burr to
facilitate the removal of the bonded acrylic and ensure we reach the preparations beneath
very gentle pressure at a speed of 2,000 rpm will do the trick I finished cleaning the preparations
with a prophy cup and pumice pass at a very slow speed of about 2 or 3,000 rpm now it's time we
try in the final Brookshire aesthetic veneers in place once the margins and contacts are verified
we can now begin the bonding sequence I use a total edge technique first fetching the preps
with 37% phosphoric acid etching numbers 11 through 13 followed by 7 through 10 and then 4
through 6 breaking them apart to ensure we aren't over etching any teeth once the teeth epinet thin
layer of glue m'as used as a den sensitizing and antimicrobial agent I allow the glue man to sit on
the teeth for at least a minute allowed to soak into the teeth and then remove any excess with
a dry micro brush with gloom it's important to avoid allowing the material to come into contact
with a soft tissue as it can be an irritant to those soft tissues after glue mo I then scrub
a layer of 3m Scotch bond universal for at least 20 seconds per tooth to ensure the resin monomer
is effectively infiltrate any exposed that no tubules and into the enamel matrix these veneers
have already been err braided with aluminium oxide at the lab after we try them in we need
to now prepare these surco native veneers for bonding to ensure we have a pristine and tagged
surface foreboding we scrub IVA clean for 20 seconds in each veneer to remove any salivary
phosphates that may have adhered during the Tryon phosphate groups have a very high affinity for
zirconia and can compromise bonding IVA clean is a special formulation that effectively removes
these unwanted layers once the restorations have been washed and dried we then use mana bond plus
which is an MDP containing primer that is the special coupling agent needed to bond zirconia
restorations to resin now I see each restoration with curse and x3 Universal resin cement I like
using this cement for its handling properties and the fact that it's light cure to set since it's
a light cured cement it offers unlimited working time allowing me to see all of the restorations at
the same time when all of the veneers are in place I use orange wood sticks on the facial and incisal
to ensure that they're fully seated against the preparations once they're fully seated I
tack cure along the margins to hold the veneers in place and to allow for easy removal of the
gel cement the final brookster aesthetic veneers successfully created a fuller more youthful smile
that the patient was extremely thrilled about with the proper planning with the diagnostic wax if
transitioning from patient acceptance preparation to final restorations can be done quite seamlessly
thank you for joining us on this episode of chair sight life back to you Megan thank you for that
doctor chief well that about wraps it up for this episode of chairside live on behalf of everyone
here at Glidewell dental thank you for watching and we'll meet you right back here next time
you