impression - part 2

8/12/2019 Impression - Part 2

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IMPRESSION

TECHNIQUES

Impression CordRetraction Technique



Impression Materials

IVOCLAR VIVADENT

Virtual Light Body

Virtual Heavy Body

3M ESPE

Penta H Heavy Body

Dimension Garant L

Advantages of SoftTissue Laser Surgery

Time savings with Multiple

Simplified Procedures

Reduced referrals

Combined appointments for Time

Savings and Patient Comfort

Recommend taking a Laser CE Course


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Advantages of SoftTissue Laser Surgery

Dry and bloodless surgery

Instant decontamination of the surgical site

Reduced bacteremia

Reduced mechanical trauma

Minimal postoperative swelling and scarring

Minimal postoperative pain

SoftSoft--Tissue Laser Utilization inTissue Laser Utilization in

ProsthodonticProsthodontic PracticePractice

Esthetic Recontouring for C&B and Veneers

Blending papilla heights Blending cervical heights Reestablish distal-buccal height of

contour on upper incisorsEsthetic Recontouring before WhiteningCrown lengthening/soft tissue management

around tooth preparations..limited by

sulcular depth and challenge of circular fibers


ProsthodonticProsthodontic PracticePractice Troughing for impressioning Formation of ovate pontic sites Exposure of Implants

Removal of hypertrophied tissueson implants and teeth

Bloodless exposure and access tosubgingival decay in non-esthetic areas

Hemostasis

Frenectomy Limited Vestibuloplasty


ProsthodonticProsthodontic PracticePractice

Hygienist Uses: Treatment of periodontal pockets with

currettage and decontaminationWhere, When, Why.other options

Activated tip vs. non-activated tip

Desensitizing sensitive teeth

Treating intraoral apthous ulcers andherpetic lesions

Soft Tissue Diode Laser

There is minimal tissue shrinkage after lasersurgery, which assures that the tissue

margins will remain at the same level afterhealing as they are immediately after thesurgery

Soft Tissue Diode Laserfor Limited Esthetic Recontouring

In addition, the use of the laser can

eliminate the trauma to the tissue of flap

reflection and suture placement (assumingadequate zones of keratinized tissue)

Knowledge of where implants have been

placed allows for exposure with Laser witha clean, bloodless field


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Which Laser would work best?

Every laser on the market has the

ability to perform incisions andexcisions of soft tissue, whiledestroying bacteria at the surgicalsite.

Reduced mechanical trauma to thetissue, less postoperative pain,swelling, and scarring are notunique to any specific wavelength.

Soft Tissue Diode Laser

Ivoclars G-4 & Navigator Soft

Tissue Diode Laser offerconvenient features:

Preprogrammed settings Wireless Foot control Sometimes no anesthesia Bloodless

Navigator Soft Tissue Diode LaserImpression Technique with

Laser Troughing:Your High Tech Solution

Avoid latex glove contamination

Advantages and Technics for success:

Finesse Preparation margins aftertroughing

Lowest wattage needed to work

Understand gingival tissue quality

Need for minor soft tissue manicure for

enhancement of golden proportion andsymmetry

Impression Technique withLaser Troughing:

Your High Tech Solution

Sounding to Bone : Normal, Highand Low Crest for laser-plasty

options

Aesthetic Periodontal SurgeryConsiderations with Laser

Minor Crown Lengthening

Lengthening all cervical areas with

or without papillaplasty Esthetic blending of cervical

margins

Be aware of anterior/posteriorblend

Create Ovate Pontic Form


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LASER TROUGHING

Safety steps first

Activate Tip

Stroking Motion At Lowest WattagePossible

Cleaning Tip

Viscostat Scrub

Hydrogen Peroxide Scrub

Consepsis Scrub

Recheck and Remove any Small TissueTags

Laser Esthetic Contouring Laser Troughing

Laser Troughing

vs. Cord Retraction

Combination Laser Troughing withSingle Cord Retraction Technique


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Impression Technique MedicationOptions

Probantheline ( 2 tabs of 15 mg.) for a dry

field, taken 30 to 60 minutes beforeimpression

Sal-Tropine (0.4 mg. one tab one hour beforeappointment and one more at start ofappointment depending on length ofappointment needs)

Peridex Antimicrobial rinses helps to managegingival health for up to 2 weeks prior toimpression appointment combined withaggressive home care.

Review: Impression TechniquesCord Retraction vs.Laser Troughing

Sequence and technics for success Use of 1:50,000 Lidocaine

infiltration or Ultradents Viscostatscrub for hemostasis

Thin cord for recession prevention

One cord technique, with multipleturns

Two cord technique, leaving inUltradent Black 000

Impression Technique:Tips for Success

The amount of retraction cord will

depend on sulcus depth and tissuebiotype

The use of probing for bone soundingor sulcus depth determination will alsoaid in determining margin placement

2 cord technique can be used most ofthe time since normal crest/ bone

appears 85% of the time


Sequence and technics for success:

Custom tray

Customized rigid moldable

crystal clear disposable

impression tray

(palate filled with wax)

Affordable Dental Products Corp.



Use of DAM it to

block palatal flow

and minimize gag

reflex (Danville Corp.)



Use of 5th Hand

Black Cheek Retractor

(Affordable Dental

Products Corp)


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Sequence and technics for success Baharav study found 4 minutes to

be minimum optimum time for cordto create 0.2 mm crevicular widthcritical to quality of final impression

Air blowing technique option withreinjection of light bodiedimpression material (but material

sensitive)


Be sure all undercuts blocked out

When cord is removed, visual inspectionshould show uniform width of sulcus and all

margins clearly visible and grooves captured

Do not remove impression with handle;break seal on sides and remove on path ofinsertion

Recommend use of Nitrile gloves to avoidlatex glove contamination of PVS materials

Rinse and Disinfect impression

Characteristics of an ExcellentFinal Impression

Be free of distortion ( elasticity so notdistort on removal, especially with longperiodontally involved teeth )

Be free of debris ( blood and saliva )

No voids, bubbles folds or tears

Completely capture preparations andadjacent anatomy, with very readablemargins

Fully set before removal for dimensionalstability

Digital Impressioning

In-office systems with chairside milling areCerec (Sirona) and E4D (D4DTechnologies)

Chairside digital impressioning with image

transfer to Lab or Manufacturing facilityare iTero (Cadent), Cerec, and LAVA

C.O.S. (3M-ESPE) Systems

PROVISIONAL ACRYLIC RESTORATIONS

Utilization & Fabrication

Rationale

Characteristics of a good temporary

Benefits of a good temporary

Failures

Criteria for Material Selection

18 Reasons for provisional temporizationprior to periodontal surgery

PROVISIONAL ACRYLIC RESTORATIONS

Multiple technics are to be reviewed, including

both chairside and prefabricated heat-curedBiotemps, cold-cured ethyl andmethylmethacrylates, and Bis-GMA compositetemporaries


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Ivoclar-Vivadent Telio CS C&B &3M-ESPE Protemp Plus

Features/ Benefits

Outstanding strength Long-term durability

High esthetics (smooth surface,

fluorescence)

Easy handling (less inhibition layer)

Time saving (no polishing or glaze

necessary)

Safe (low temperature peak)

Desired Combination of

Properties for Fracture Resistance

But know limitations!

High flexural strength

High flexural resistance

Limited deflection

High tensile strength

High fracture stability

Putty Matrix for Telio CS C&B

Bis-GMA Chairside Provisionals

Fabricate Putty Matrixwith Ivoclars VirtualFast Set Putty -Exquisite Detail!

Be sure to trim only 1mm. from margins

PROVISIONAL BIS-GMA COMPOSITERESIN RESTORATIONS

Fabrication Technique Review:

Dry teeth and with predetermined guide pointtrimmed, seat matrix for 2 minutes

Remove matrix from mouth, trim excess film offother teeth and then gently use curved hemostat toremove temporary from mouth

Remove air-inhibitor layer from temporary withsaturated alcohol cotton ball

Pencil margins and contacts, trim and polish

PROVISIONAL RESIN RESTORATIONSFabrication Techniques with my favorites:

Axis Disc # D911 HEF- 220T& Lab Bur # UC079E-040

Telio CS C&B Temp


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Finishing Technique Review:

Tetric Color (Ivoclar)custom staining


Finishing Technique Review:

Polish and/or useBisCover LV when

doing Laminates orcustom color temps,

light-cure and then

coat with BisCover LVand light-cure again.

SMILE MAKE-OVERSCOMMUNICATION TECHNIQUES FORSUCCESS AND QUALITY CONTROL

LAB RX AND OTHER EXTRA LAB GUIDES

FACEBOW MOUNTING

PUPILLARY PLAN INDEX OR HORIZON

INCISAL / OCCLUSAL INDEX GUIDE

STUDY MODELS OF TEMPORARIES AND OPPOSSING

ARCH CROSS-MOUNTED ON ARTICULATOR

CUSTOM INCISAL GUIDE TABLE

SHADE COMMUNICATION

Shade Communication

Digital Photography with shade guide,

stump shade guide, and Black &White Clear Color Strip with A-2

X-Rite Shade Vision Colorimeter

The Ladder

Vita 3-D Shade Master

Shade Mapping

Shade Communication

E-mail digital photos

to lab with shade

guides

E-mail digital photos to

lab with black & white

holder with Lumen A-2

& Lab converting with

Clear Matchsoftware

Shade Communication

E-mail Digital Pictures to the LabIncluding stump shade & Clear Match


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Shade CommunicationE-mail Digital Pictures

to the Lab

Gingival Shade CommunicationE-mail Digital Picture to the Lab with

Ceramco Pink Gingival Guide

Shade CommunicationE-mail to Lab

Shade Communication

The Ladder

A colorful shared

photographic aid

with detailed shade

characteristics

Empress Veneer Cementation

OptraGate or Rubber Dam for isolation

Light cured resin cements are the mostcolor stable for luting veneers, ie. Ivoclar-

Vivadent Variolink II without catalyst.



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Review of Self-Etch vs. Total Etch

Total Etch most widely accepted with anticipatedhigher bond strength

Total Etch concerns with post-op sensitivity leadingto patient management problems

Self-Etch Primers with Light-Cured VeneerCements without post-op sensitivity DiTolla,DDS 2005 ( one year no pop-offs )but also saysif its not broken, dont fix it!For some trade-offmay be worth it.


Place central incisors first

Brush away all excess cement (if dont seeexcess, remove, add cement and re-place it)

Tack with 2mm curing tip

Glide Floss

Wave technique with large curing tip Clean up during gel set

Clean-up

Final Cure

Minor Reshaping and Occlusal Adjustments

CEMENTATIONMultilink Automix Dual Cure.

Easy cleanup.

High initial bondstrength.

High Radiopacity.

Mix primer A & Bfor self etch andbond.

Low sensitivity.metal or metal -free

metal, glass ceramic, zirconia

immediate shear bond strengths -various substratesDr. Carlos Munoz, SUNY @ Buffalo

immediate shear bond strengths -various substratesDr. Carlos Munoz, SUNY @ Buffalo

3.7

2 1.5

1213.3

1.9

5.27.4

10.7

36

17.9 18.3

0

10

20

30

40

MaxCEM RelyX Unicem Panavia Multilink

Immediate bond. Light Cure - dentin; surfaces treated according to instructions for use

MPa

Multilink Cement

Note that the use of Multilinks Alloy

(Metal) Bond on Zirconia has been provento increase its bond strength

Reality Check

Is it really the best thingto come down the pike?

Are fees high enough tocover failures?


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Planning for Success

Complications from Crowns & Bridges

Caries 18% Pulpal 11%

Porcelain Fracture 3%

Prosthesis or Tooth Fracture 5%

Cement Wash-Out or Loss of Retention 7%

Esthetics 6%

Periodontal 4%


8 Studies showed 11 % of Crowns

have complications 3 Studies showed C & B Failures

After 15 years 25 %

After 10 years 10%

All Ceramic Failures 8% Fractures: 3% Anteriors; 7% Bicuspids;

21% Molars


Protect your China with Occlusal Guard

Risk factors cannot be predicted, but datais a good guide to avoiding high risk

These factors must be assessed in theearly stages of treatment planning andprepare patient for realistic expectations

A wise man proportions his belief

to the evidence E. Hume

SUCCESSFUL CONSULTATIONS

KEYS TO TREATMENT PLAN ACCEPTANCE

THREE PART PROCESS

Establish value Learn patients wants and needs

Determine all existing problems and help patientsee them with you and understand implications ofeach problem

Help patient understand the best solution to eachproblem and achieving Their Goals

Whats in it for me!

Must address patients

wants and needs

You Can Only Do Two Things: Do the best you can do

Commit to doing better every year

Then Reap the Rewards of: Patient satisfaction

Staff enthusiasm Personal gratification Increased success and prosperity

Please fill out Course Survey to

Qualify for Drawing for Prizes

thank you


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NOW LETS GET STARTED

Understanding and applying the

principles of how esthetics andfunction come together will give you

the tools to help produce morepredictable long term outcomes

PRO.S. MENTORSHIP

PROsthetic Seminars and MentorshipProgram

Your greatest asset can be a Mentor Keeping you motivated and getting you

through the early learning curve withconfidence and success

Into our office for a day and back toyours for a year of support andguidance

PRO.S. and MentorshipPROsthetic Seminars and Mentorship

Over the shoulder and by your side:

The support you need to make it

happen after the course is over.

Its the follow through that counts!

E-mail for more info

[email protected]

Thank you. Thank you, Thank you!

impression - part 2

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