Incorpora(ng Ceramic Bonded Restora(ons in our Prac(ce. Thursday, January 12, 12

Transcription

1 Incorpora(ng Ceramic Bonded Restora(ons in our Prac(ce

2 Change is Good Growth means change and change involves risk, stepping from the known to the unknown. - George Shinn

3 Are we behind Full coverage made of gold or porcelain fused to metal have been the standard. We are using the same techniques we learned when zinc phosphate was the only available cement. Pressed ceramics and milled Zirconia crowns have been successfully for several years.

4 The Present We tend to jump to a crown when a smaller more conserva@ve restora@on could address the problem. Because we have tradi@onally relied on mechanical reten@on instead of the adhesion of the cement. We are worried that the insurance company will not reimburse an onlay.

5 Are we using the best cement? Resin modified glass Ionomer Easy to use Soluble, it will eventually wash out. Average bond strength Composite Resin Cement Insoluble, its not going anywhere. Technique must have a dry field. Significantly higher bond strength than RMGI

6 CAD/CAM (Computer Aided DraTing/Computer Aided Machining) All the Lava and Procera crowns we have been doing were manufactured via cad/cam. We send a physical impression, it gets poured up and op@cally (Lava) or manually (procera) scanned. A technician using sotware, designs and then sends the informa@on to a milling machine. Restora@on is stacked with layered porcelain.

7 Digital Impressions In- lab digital impressions have been around for several years. done via chairside scan are more accurate than ones scanned off of a model.

8 Strengths of Various Crowns The pascal (symbol: Pa) Is a measure of perpendicular force per unit area i.e. equivalent to one newton per square meter or one joule per cubic meter We measure the compressive strength of materials in megapascals. PFM LAVA 1000, then 100 at the porcelain interface Empress 160 Emax 360

9 Monolithic The weak point in a crown is the junc@on between the porcelain and the coping. Gold is monolithic, strongest thing we can put in the mouth Zirconia is strongest non- metal material Very difficult to handle Emax is the best non- metal op@on for posterior restora@ons, even in bruxers. 4X stronger than PFM

10 For the last year, we have been doing Emax, milled in- lab on a CEREC machine. Outstanding margins Very accurate contacts and occlusion Polishes becer than porcelain We can stain and glaze in house Stronger than anything else we are pudng in the mouth

11 to implement CAD/CAM Pros Provide a becer service to our pa@ents Reduce reliance on dental lab Eliminate impression material associated costs of taking impressions Eliminate temporaries. More conserva@ve supra- gingival prepara@ons Less likely to use cord.

12 to implement CAD/CAM in our is now Cons Cost Change Hard to adjust way of thinking. Doctors have to prepare differently. Learning curve Doctors and assistants will receive training before machines are delivered. We will have a very thorough understanding of the system before we treat pa@ents with it.

13 Convenience for our One appointment! Who wants to wear a temporary for two weeks, come back and have to get numb again? Conserva@on of tooth structure Pa@ents don t like taking impressions Clinical study show that early sealing of den@nal tubules reduces likelihood of sensi@vity and future endo.

14 Great Internal don t want to come back for seat appointment. They will have less sensi@vity because den@nal tubules will be sealed within minutes of prepara@on. They won t have to hesitate for two weeks and have sore gums, or come back because their temporary came off. They will be able to watch us design their crown and see it being fabricated.

15 They will tell their friends, and they will refer the type of people who will appreciate this service. We will show we are using cudng edge technology. We can draw people who are looking for single appointment crowns who may have gone somewhere else.

16 How CEREC can help us grow We need a shot in the arm. We need to differen@ate ourselves from the other local prac@ces Our area has been hit hard by the economic downturn and we need to increase our marke@ng efforts Easy to put educa@onal info on website

17 Why now? New scanner technology Easier to use than red cam More accurate than what we re doing now E- max Strong BeGer looking than Lava

18 Appointment Protocol It may take a few months before we have a predictable way to schedule. For now: Emax 2 hours Empress 1:45 Doctor may do other procedure during the middle of the appointment. As assistants increase their skill level, they can stain / glaze, and make adjustments. Assistants will be able to design in correla@on if they want to.

19 Appointment Protocol Seat and Prep Pack cord (if necessary) Scan Design Mill Stain/Glaze Bond

20 What if we can t scan? On teeth that have exis@ng restora@ons that look deep inter- proximally, we will take a matrix ahead and may take a tradi@onal impression. There will be some trial and error in determining which teeth we can restore in one appointment. Pa@ent will always get the ideal restora@on whether its done with CEREC or sent to the lab.

21 Picasso Diode Laser We will have one in each operatory Easier to use than electrosurge Help with hemostasis Minimize the use of cord

22 How are we doing so far? So far the results have been outstanding. Licle to no adjustment Great margins Empress blocks have great Emax posteriors are strong, but not as