hello everyone and welcome to episode 157 of chairside live I'm Megan strong and we're glad
you're tuning in today because we're celebrating the launch of Brooks our now the latest addition
to our line of Brooks are solid zirconia products Brooks are now is the first in office milling
solution that can deliver zirconia crown in about an hour doctoral by and dr. Chi will present their
most recent Brooks are now cases they will scan design mill and cement a solid zirconia
crown in a single appointment with no need for centering staining or glazing let's take a look
hello and welcome to this week's chairside live episode I'm here live from the Glidewell
International Technology Centre so what we have here is a operatory that's equipped with the
latest technology including a chair side scanner right here we have the 3m chairside scanner
intraoral scanner and dr. Qi is working on one of our patients in the operatory the patient's
here a lot of them are our employees so they get the benefit of having dental work completed here
and we get the benefit of product development and testing out a lot of different products today's
product is the brookster now and I want to go over some of the treatment workflow that we go
through besides utilizing the intraoral scanner and prepping the tooth chairside once we capture
the impression digitally we'll go ahead and move over to our dental laboratory which is connected
to the operatory so why don't we go ahead and go over and take a look at what we can utilize
in the dental laboratory in order to fabricate a final restoration so what we have here is a
dental laboratory that's within and operatory that's within an even bigger dental laboratory
and in this room were equipped with the TS 150 chairside mill this mill is capable of milling
out different types of material one of them being the case of the week for this week the Brooks are
now what usually happens is after we take the intraoral scan of the tooth that's prepared we
send the information over to this computer that's equipped with the fast design software the fast
design software allows the clinician to design the restoration the final restoration and send
it over to the TS 150ml once the information is over through the mill there is a kiosk here
while we go through four different steps and we press play and essentially the mill does the rest
of the work once we retrieve the restoration from the mill we can if we would like we can
go ahead and do some staining after the mill for the brookster now we actually don't need
to do any standing we can go ahead and polish and deliver within 45 minutes of the start of
the mill time so why don't we go ahead and take a look at this week's case of the week I think
you're going to really enjoy it the case that we're going to work on today is number 19 that
was previously in Adana CLE treated and restored a few years ago with a cast metal restoration so
ever since the restoration was placed the patient was not very pleased with the aesthetics of it so
we are going to replace it with a Brooks er now material where we're going to be able to scan
digitally scan the impression design it right here in the operatory and mill out a restoration
within the same appointment and there's a little bit of an open margin limb distal so we'll be
able to provide a better fitting restoration and something that is very highly aesthetic all right
so the first part of this procedure of course is to remove the old restoration in this case on a
mandibular first molar on the mesial-buccal brief area so one of the greatest challenges that dental
laboratories face when restoring full-coverage indirect restorations is a lack of occlusal
clearance so one of my favorite products is an occlusal clearance tab and they come in different
thicknesses this one in particular is one and a half millimeters which should be sufficient
for a full coverage zirconia monolithic zirconia restoration and so for the clearance tab when the
patient bites down all the way into centric if the tab doesn't pull through then that indicates there
is an additional need for reduction go ahead and open please here you can see on the preparation
the areas that are marked in red that I will reduce a little bit more to provide space for
the material the axial surfaces I like to use and the paper diamonds who provides the proper paper
and reduction and for a full contour zirconia were shooting for about one millimeter on the
axial surfaces there's a little bit of a gouge here on the prep then I'm gonna use a build-up
material to fill in for these CAD cam restorations we really want to try to have the preparation as
smooth as possible so I'll just fill that in and blend that into the rest of the preparation
so once the axial surfaces are reduced you want to ensure you have a clear finish line and I like
to ensure that I can trace along the axial line angles along the shoulder of the margin to ensure
that I can see that there are no undercuts because that's very important whenever we were milling
these CAD cam restorations so even though we are taking a digital impression the fundamentals
of good dentistry must be followed for indirect restorations and that is proper tooth preparation
and sufficient gingival retraction to ensure that you can see the margins in the digital impression
we've first placed a triple zero core to first displace the gingiva vertically so here we're
placing the second chord of size two and this will help displace the gingiva laterally away
from the margins and we'll let this sit for a few minutes so once the retraction chords are
placed will place a copper cap on top of the chord and we'll have the patient bite down on
the copper cap for about five minutes so we're gonna go ahead and take the digital impressions
using the 3m true definition scanner so the first set of scans will be of the preparation and the
adjacent teeth you want to ensure that you capture the contours of the adjacent teeth because that is
what the software will use to create the initial design proposal it's also good for yourself to
analyze and know exactly how wide buccal lingual e mesial distal e to design the restoration for
the second set of scans we're going to capture the opposing dentition so for the third set of
scans we're going to acquire the bite registration and that's simply scanning the buccal surfaces of
the prepared area and the opposing teeth ensuring that you capture the teeth adjacent to the prep
the teeth opposing the prep and it's also good to get the gingival margins on both sides because
that is what the software will use to stitch the two previous models the prepping the opposing
together and this will be sent to our chair side design workstation so once the prescription is
filled out the case is sent wirelessly to the design software on the margin page you can see
if you provide sufficient tissue retraction you should have a very clear finish line in this case
whenever you fabricate restorations chair side you or your assistant is now the one responsible for
marking the margins so digital dentistry really does make you a better clinician by allowing you
to see your preparations immediately you do need to ensure that you can see your margins
clearly now I may proceed on to the next step which will be indicating to the software which
direction the buccal surface of this design will face it's just a matter of bringing this arrow
directing that to the buccal now I can move on to the next step where the software is going to look
at the adjacent teeth and determine the ideal position and size and shape of our design for
this particular case here I'm able to move the design buccal ingly or up and down it's pretty
much just pre-planning the position of this design there's not a lot that really needs
to be done here because the software intuitively takes into account the adjacent teeth and decides
what the ideal shape buccal lingual position musial distal position will be for this case
as far as the contacts goes we have an option right here where we can edit the contacts to
whatever specifications you like so right here on the occlusal surface I can see some areas
that might be high and I can dial in any value and this is in microns any value for the contacts that
works for me once I determine a value that works for my restorations I can pre-select it and then
by a click of a button the software automatically will adjust all of the occlusal contacts to that
desired value so once the software prompts me to load the material I'm gonna go ahead and
retrieve the BER and the milling block from the drug store now box here's our a2 shade
and go ahead and seat the block into the milling unit so while the milling process on is underway
for number 19 one of the greatest benefits to having an in-office CAD cam system is you can
provide other dentistry for the patient while the restoration is being built so in this situation
we are going to replace the amalgam fillings on tooth number 18 so now after about 40 45 minutes
the milling unit is completed and I'm going to open the cover and remove the restoration from
the milling chamber never finished number 19 Crum so after the sprue is removed I'm going
to apply a diamond polishing paste in this case I'm using the die Sheen fine version and also
a soft bristle Robinson brush get a little bit of the paste on to the on to the Robinson brush
and apply this to all the axial surfaces after trying in the restoration it's important to clean
out the internal surface especially if you're going to bond this restoration and here we are
going to conventionally cement it but to clean it out you can either use a sandblaster what
using aluminum oxide or in this case we're using Ivo clean which actually attracts the
phosphates from the saliva and removes them from the internal aspect of the restoration
with the IVA clean you allow it to interact for about 20 seconds and then clean out the excess
once I seat the restoration I ensure that the margins are sealed we're going to allow a couple
minutes for the cement to fully cure so one of the advantages of using a conventional cement
is the ease of cleanup once it is fully set you can easily tease the excess cement off of the
restoration so today we were able to provide a same-day restoration in the Brookshire now
and taking advantage of an office cat hem system delivering the crown within the same appointment
this patient presented with tooth number 19 with the crown that was dislodged for quite
some time for a couple years actually and he had requested a same visit crown for the restoration
for this tooth so when we put him through the comprehensive exam and deemed that tooth number
19 indeed needed a crown I went ahead and provided the patient with some local anesthetic and now I'm
preparing the tooth to receive a chairside milled Brooks er now crown and usually what I like to do
is go ahead and provide a nice sham for margin I want to make sure that I have enough occlusal
clearance and once I have the dynamics of the preparation completed initially I'll go ahead
and pack my first cord which usually will drop the tissue level by a half a millimeter
sometimes a millimeters so I actually don't finish my margins until I pack the first cord
and I'll go back around and make sure that I have nice clean margins equal gingival and
to the point where I can capture a interaural digital impression and here what I'm doing is
providing a functional cusp bevel and an occlusal view of the tooth you can see that we have nice a
chamfer margins and enough preparation to receive a share side milled crown for the 3m intraoral
scanner what I'll do is I'll go ahead and powder the teeth that I want to capture in the intraoral
impression and quite literally it takes about 25 to 30 seconds to capture the impression of the
prep tooth also to capture the opposing tooth under bite registration the computer program
automatically puts the bite together for us and what we have is the digital information where
we can transfer to the fast design software so here I'm sitting in the laboratory that's
connected next to the operatory at the Gladwell International Technology Center and what I can
do is using the software I'll go ahead and design the crown usually there are just a couple of steps
that the software takes me through to select the margins of the crown the design of the crown is
automatically provided with the freedom to move the two structure around to make sure that I'm
not over contour in different areas so once the proposal is complete we can transfer the data to
the TS 115 mill and I'll go ahead and load the mill what the Brooks are now blocked in this
situation we utilized a pre sintered ruksar block and I'll go ahead and secure it in the mill and
with the press of a couple of buttons to load the program I can go ahead and start the milling cycle
and Midland process for us to have a final crown now when this crown is completed a milled we can
see that it is almost to the point where I can go ahead and remove the sprue and do some polishing
and go ahead and fit the crown on the tooth and make sure that I'm within that parameters where
I'm not I precluded and I have proper mesial and distal contacts once it's determined that I can
go ahead and deliver the crown I'll go ahead and deliver and remove any excess cement and usually
what I like to do is once we clean up the cement I'll go ahead and check the occlusion once more
and after the tooth has been deemed to be in good occlusion I'll go ahead and take a radiograph and
as you can see we have nice margins so this was what I would like to call an acceptable
restoration it's a brookster restoration that smelled in around 45 minutes and the patient
has a benefit of having a strong crown in the posterior section of the jaw of the mandible
and he'll be in good function for years to come well I hope you enjoyed the case of the week for
this weekend hope to see you next week for another case of the week thank you dr. Bai and dr. Chi for
sharing your cases with us and we invite you to further explore this chairside restorative
breakthrough and consider the difference it can make in your practice for more information visit
you