hello and welcome to chairside live I'm your host Megan strong thanks for hanging out with us today
here's what's going on dr. chi is removing an over contoured gold crown on number 19 it was
trapping food and causing severe gingival irritation so let's watch as dr. chi works
his digital dentistry magic and places a Bruck Surnow crown in a single appointment using the
glide we'll do in office solution dr. chi Thank You Megan on this episode I'll take you through
the easy process of using the glide well dot IO CAD cam system to fabricate a Brux ER crown
chairside we have a 28 year old male whose chief complaint is pain and bleeding gums around the
crown in his lower left quadrant he presents with a full-coverage gold crown on his mandibular left
first molar tooth number 19 that has localized gingivitis characterized by the swollen purple
gums around the crown the over contoured crown with an extensive overhang is the primary cause
the plan is to replace the crown with a same visit restorative approach utilizing the glide
well dot IO chairside system since the truth is in DES nautically treated i only administer
local infiltration for gingival pain control I begin the removal of the old crown with a
5:57 carbide to section through the buckle and occlusal I use light pressure to ensure I don't
utilize the underlying tooth structure since most gold crowns are fabricated very thin once I can
visualize the prep I use a 90-degree Christensen crown remover to break the seal between the crown
and tooth and wiggle the crown off using crown removal forceps from the buccal view of the old
prep we can see the occlusal surface of the prep is almost even with the occlusal table of the
adjacent teeth it'll be important to reduce this further to allow adequate room for our brookster
crown I begin refining the preparation on the occlusal using a coarse grit football diamond
with the tip slightly angled downward to ensure the central fossa area is deeper to allow for
more natural contours of the crown on the axial surfaces I use a coarse grit 850 o 1/8 burr to
establish a one millimeter chamfer margin with a periodontal probe angled toward the tooth with
light apical pressure I trace along the margins circumferentially around the tooth to verify
that there's adequate reduction and it's smooth and continuous I'll continue refining the axial
surfaces if the probe slides off or I detect any roughness for hemostasis I typically use
ultra Det viscous that clear but the severely inflamed tissue around this tooth didn't really
respond so for these situations I use a 12 percent ferrous solution astringent an X which is ultra
dense most powerful hemostatic agent here I'm using curves pink flex tap to verify that I've
established at least one millimeter of occlusive clearance I also place a strip of articulating
paper on the bottom of the tab to mark on the tooth where there's insufficient reduction for
the final prep I'm aiming to establish adequate axial reduction to create a sharp cable surface
margin adequate occlusal reduction for strength and ideal anatomy of the final restoration and
smooth and rounded internal angles so that we can have an optimal fitting restoration since all the
margins are subjuntivo I'm placing a single size 2 cord into the sulcus to retract the
soft tissue for our optical impression I remove the cord after 5 minutes and then isolate and dry
the area for the impression I begin capturing the digital impression using the I taro element after
scanning the prep I noticed the mesial aspect of the margin wasn't very clear I repack the cord in
the mesial area while my assistant deletes that spot from the digital model when I rescan the
eye taro automatically fills in the missing data being able to evaluate our work and make changes
immediately is one of the greatest advantages to taking digital impressions once I've captured
the upper lower and bite the digital models are transferred to the fast design workstation where
the first step is to identify the margins I'll guide the software with a series of clicks along
the prep this step is made easier by creating a sharp cable surface margin and providing enough
tissue retraction after the margin is placed I then established the occlusal and buccal
orientation so the software will know how to best position the library tooth for this prep
once fast design establishes the correct tooth orientation we can customize the initial design
proposals angulation position and size from there the software analyzes the adjacent and opposing
dentition to establish the appropriate proximal and occlusal contacts for this restoration which
can then be adjusted to the users desired strength values I spend no more than three minutes marking
the margin and designing the restoration when the design is completed I load and lock in a
Brookstone l block within the block holder and see a new diamond bur in the mill collet because
Brooks are now is a fully centered zirconia each block comes with a new single use diamond bur that
was specially designed for this purpose in only 35 minutes the fully electric fast mill completes the
crown the screw connection between the crown and the rest of the block is also reduced in size by
the mill so users can easily snap the crown off I'm now using a fine grit rich stripe 850 o 1/8
diamond bur to finish down the remaining sprue with light pressure I run the burr side to side
until the crowns contour is smooth and continuous in this area if proximal contacts are heavy I like
to position a cut piece of troll foil articulating paper between the crown and adjacent tooth to mark
the contact this way I'm not blindly adjusting the mesial and distal surfaces next I checked the
occlusal contacts again with TRO file articulating paper by dialing in my preferred contact settings
in the design software there's typically very little to no adjustments needed I'll now complete
the finishing of the crown with a spiral polisher from clinicians choice ASAP polishing kit it's
incredibly easy to get a high shine using these polishes on any type of restorative material in
fact for our church at Millbrook sir crown I only use the pre polisher since this patient's
adjacent teeth aren't very smooth and shiny once I polish the restoration the crown is ready for
delivery I scrub a small amount of glue m'a onto the prep to help disinfect and clean the surface
and if the tooth was vital it would also help with desensitizing i cement the crown with three M's
relax looting Plus which is their resin-modified glass ionomer cement after about two minutes the
cement enters its gel state and makes removal of excess pretty easy with this amazing chair aside
technology in less than 50 minutes we were able to capture our digital impression design and mil
a fully centered monolithic zirconia crown I'm always so impressed with the speed in which we
can deliver the strongest restorative material we have in dentistry without any compromise in
quality and fit thank you for your time back to you Megan thank you for that dr. chief well
that about wraps it up for this episode of chairside live so on behalf of everyone here
at Glidewell dental thank you for watching and I'll meet you right back here next time