hello everyone and welcome and episode 162 of chairside live I'm your host Megan strong and
we've got a great show for you today dr. Bai is going to discuss digital dentures
he's talking about fabricating an immediate denture using CAD cam software then we've got
a great new segment featuring our in-house registered dental assistant will Schmidt
but first up let's meet with dr. Bai he's got the scoop on a case where he's fabricating a
digital denture see how going digital can make a big difference let's take a look
welcome back to the operatory here at Glidewell dental laboratories today i want to share with you
a case where a patient had a lot of periodontal involve teeth and was in the need of immediate
dentures however i was worried that if i went ahead and took an alginate impression I was
gonna extract some of the patient's teeth so I went the digital route I went ahead and captured
the patient's impression digitally and I was able to utilize that file in order to fabricate
a complete denture why don't we go ahead and take a look at the video and I'll take you through the
case as you can see in these pre-op pictures patient presents with very poor oral hygiene
the patient is diagnosed with generalized chronic periodontitis what I did for him was I brought him
in and I wanted to showcase a digital impression for his initial impression making and the reason
for this is because taking a regular alginate impression the teeth are at risk of being
extracted at the time of impression making so I went ahead and utilized a trios three shape and
oral scanner and as you can see on the screen the impression making is made fairly easy using the
scanner and the next step is to actually upload all that information that I captured from inside
the patient's mouth onto a software it's uploaded and the denture is designed now before the denture
is actually designed what we did was digitally extracted the teeth so basically treated this case
the same way as we would do in the laboratory on a stone model we take it and we go through which
teeth we want to extract and in this case we want to extract all the teeth in both arches and as
you can see we have an articulated model with the teeth missing now so the next step is to actually
go ahead and import a library of teeth to set up for the patient and before we do that I like to go
ahead and design exactly where the occlusal plane is and because this is an immediate we're actually
going to use the previous teeth as a guideline the point is to remove the teeth have the patient go
home with a prosthesis and and have something to wear while he's healing any little adjustments
and mistakes we make with the immediate we can fix with a definitive so the planning of occlusion was
set and the arch form is also set in the computer program and the next step is to outline the actual
outline of the of the denture base so as you can see in the pink the denture base is outlined and
the best part about using the software is that we can move around for the wax up this for the
base plate so I think it's extremely convenient to do it digitally rather than analog by using
the additive wax technique which would take quite a bit of time and the next step is to actually
import the denture teeth into the software and we've already established our occlusal plane and
all we need to do is slight minor adjustments what I really like and what I'm really impressed with
is the ability to festoon the gingiva while this denture is designed so as you can see using the
festooning tool technician can go around each tooth and add wax or even remove wax if needed
and we have a nice 360 view of what the final denture is going to look like now at this point
we have a digital file that we can utilize for the fabrication of the final denture one of the things
that we do is actually print in this situation printing the extracted a denture lists arch
both arches and also we're printing a denture so a denture can be processed based on what the denture
this arch is so we're going through the processing of the denture and once we have that negative of
the denture and the duplicate is taken out of the mold a wicking place the acrylic in its place
and go ahead with a with processing an alternate method is actually to have the denture milled with
acrylic material so if you want to go completely digital and not have any sort of analog work the
entire denture can be printed so here we have a nice final product the denture is ready and the
technician wraps it up and sends it back to me for the actual procedure so when the patient returns
to me for the second appointment the extractions as you can predict are fairly easy relatively
especially because of the patient's periodontal condition so the teeth are gently extracted and
all the sockets are curated and cleaned and the good thing about this case was that because most
of these teeth were retained but with the tissue the healing time was fairly quick as you'll see
in the before and after pictures so here we have the extractions completed and the denture
is relined with Coase off to realign material and delivered on the second appointment the good thing
about this type of Dentistry going digital is not really having to worry about extracting the teeth
and your preliminary impression when a patient presents with this type of situation along with
the fact that it's actually extremely fun to do this cyber dentistry as I spoke to you a little
bit earlier the healing time was fairly quick for this patient so this is actually two days
post-op and we have a two week post-op picture so the extraction sockets are healing fairly
well there so there you have it a digital denture fabricated and processed analog with the option of
being able to mill the final denture I hope that you enjoyed this presentation thank you for that
doctor bye and don't forget you can earn while you learn this holiday season with free seee courses
at Glidewell dental comm new courses are added all the time so check back often for our latest
courses its accredited informative and as always free ok now it's time to go grab your a dental
assistant because we're about to introduce a brand new segment we like to call across the chair
all right so here we are up on our operatory and I'm here with registered dental assistant
will Schmidt who he's the host of your new segment across the chair where he's gonna give you insight
from the other side of the chair so why don't you tell us a little bit about your history in
dentistry Megan I have about 15 years of clinical chairs had experienced 13 of those in which as a
registered dental assistant worked in just about every aspect of Dentistry thus far and now I find
myself at Gladwell laboratories moving my way up nice and what is your role here at Glide well I
am the assistant to the clinical supervisor we do all of the tests on any dental products that
Glidewell produces we also do clinical studies for all sorts of things long-term effects of
dental restorations and just real anything where we're pushing to doing nice and I hear that not
only are you so well skilled in dentistry as a registered dental assistant but you also are
a professional athlete can you tell us just a quick little bit about that that's right I am a
professional ocean athlete I do hold six stand up paddle world records travel the world doing
all sorts of things and for charity mainly I'm an advocate for anxiety depression and post-traumatic
stress through the Wounded Warrior Project however I keep keeping my role in dentistry because as of
today I still have not collected one paycheck from anything else that I've ever done in my
professional career nice well let's get started in our first across the chair so I'd love to talk
today about chair side milling in your own dental office a lot of times we prep a patient we take
an impression we send it to the laboratory and then we don't worry about it they come back we
put that crown in we want to start moving forward and working on scanning and milling crowns in our
own offices whether using the CEREC technology or Glidewell laboratories own TS 150 with our Brooks
or now technology one common misconception about milling chairside is that we're saving money by
keeping all this in-house what really is going on is this is basically a line item shift either
paying the laboratory for their services or we are paying for blocks and burs and patient time
in the chair so what I want to figure out here is how do we give this benefit to our patients
but at the same time make money and do dentistry because if not we're going broke and we're not
doing dentistry at all let's begin the most important thing I can tell you to start off
with is always always always no matter what the situation is sending a case to the laboratory or
million chairside taking pre impression you're going to hate yourself if you don't so what I
want to teach you today is how to let the doctor go into another room and be able to continue to
preparations or continue to work on patients while you do the scanning the powdering the
milling and the adjustment of the Crown's now of course we understand that only an expended
functions dental assistant can place check bite and adjust contacts however we as registered
dental assistants can do everything else up until then let's begin before patterning and
scanning proper isolation is critical to be able to keep the area dry and for the patient to be
able to stay open and still I recommend either a bite block and a suction or a product to like
the isolate to help keep the area clean clear and get yourself the best scan possible on the first
try powdering is a very important step saliva is reflective this powder is going to keep the
saliva from interfering with your scan so you get a good nice scan first time every time I like to
use a suction just because I don't want any excess pattern to get out into the room and bother our
patient or myself most dental assistants should be proficient with an intraoral camera if so then
it's very easy to translate that to the intraoral scanning device made by iOS technologies and 3m
after scanning the teeth that you're milling today make sure you scan in opposing as well
as your bite send that over to be processed designed and eventually milled now the great
thing about the Brooks are now technology milled in the TS 150 million unit it falls
along my lines of keeping it simple unlike other chairside milling units the Brooks are now usual
eise's one single size block different shades one burr burr comes with your block place it
in after design and start your mill after milling is complete simply remove from the TX 150 million
unit get ready to remove from the sprue polish and get your current ready for the placement on
the patient have you noticed this whole time where my doctor is my doctor is out prepping
teeth and making this practice flow now the great thing about these Brooks are now restorations is
that they are pre centered so they are already baked and ready to be polished and placed in the
mouth unless you decide that you would like to stay in angle A's you have the option for that
as well in this case we're just going to polish in place in the mouth your armamentarium for this
is very simple simply a rubber wheel a Robertson wheel with - ein and something that's overlooked
most often the actual bird that milled your crown in the first place is the best thing
that's not going to scratch your restoration take that sprue off and any inconsistency as you might
want to remove making sure to wear your proper protective equipment removal the sprue is as
simple as using a disc giving it a couple hits and we're in business removal of the excess amounts of
the sprue can be as simple as using your disk in short strokes like this notice we're not touching
that contact area at all if there's going to be a contact adjustment your doctor or your expended
functions dental assistant will be the one take care of that for more reduction the burr that just
milled your crown is able to fit into your slowed speed handpiece and using a proper fulcrum can be
utilized remove remaining areas of inconsistencies and of the sprue after the sprue is taken off I
like to use my rubber wheel to then get a nice luster and polish all around this restoration I
have the luxury here at global laboratories to be able to use an industrial-sized micro
edging unit however most offices and your should - especially if you're doing all
porcelain zirconia or lithium silicate crowns should have a chairside sandblaster available
remember this also increases your bonding strength sometimes upwards of 300% now that
we've sandblasted we use a little Robinson wheel and - ein to complete the process
I always make sure after your polishing is complete the best thing to remove - ein is
simply an alcohol soaked gauze pad your crime is now polished and ready for the doctor to try in
adjust context and occlusion if you've done your milling and you've done your designing
right there shouldn't be any contact or occlusion to be adjusted if there is simply repeat these
steps before segmentation after the crown has been tried in the mouth adjusted if necessary
make sure you use a product such as I have a clean to clean saliva contamination or anything
to increase your bonding strength 20-second scrub and spray to clean in conclusion make
sure you set yourself up for success make sure you become proficient with polishing
milling scanning all aspects of doing dentistry chair side keeping in the house and providing
that for your patients thank you for that will well I hope you all enjoyed that new segment so
stay tuned for more across the chair in future episodes we've got something for everyone here
and shares my lives so pop some popcorn and don't forget to floss and invite the whole
office to watch without about wraps it up for this episode of chair side lies on behalf of
everyone here at Global laboratories we thank you for watching and hope you'll come back next week
you