Keeping Up With the Technology of Restorative Dentistry

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Brian Hawkins
6 years ago
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1 Keeping Up With the Technology of Restorative Dentistry

8 Keeping Up With the Technology of Restorative Dentistry -Training (learning curve) and continued education -Accuracy of digital scanning and quality of Cad/Cam restorations -Efficiency of digital intraoral scanning (technique and dental lab communication) -Cost analysis of single visit Cad/Cam restorations -Work flow utilizing CBCT and Intraoral scanning/cad/cam technology

9 Training (learning curve) and Continued Education Cad/Cam Training for All Level of Users

10 Training (learning curve) and Continued Education

11 Training (learning curve) and Continued Education

12 Training (learning curve) and Continued Education Many ways to continue learning and advance skill level

13 Training (learning curve) and Continued Education Training (learning curve) and continued education Excessive powdering of preparation

14 Training (learning curve) and Continued Education Training (learning curve) and continued education Tooth Preparation Site Management -Dental arch isolation -Heme control -Gingival retraction Intraoral Imaging with Scanner CAD/CAM software Excessive powdering of preparation

15 Training (learning curve) and Continued continued education Education Circa 1993 Milling Chamber Cad/Cam Scanner/Milling Chamber Excessive powdering of preparation

16 Training (learning curve) and Continued Education Circa 1993 Monitor screen view of scan Virtual view of restoration

17 Training (learning curve) and Continued Education In 1993 there was a steeper leaning curve due to limitations of the software and milling capabilities Milled on 2 axis Finished restoration

18 Training (learning curve) and Continued Education Finished restoration

19 Cad/Cam Crown with inadequate adaptation Emax/Cad Crown with excellent adaptation Conventional PFM Crown with inadequate adaptation Conventional PFM Crown with excellent adaptation

20 Training (learning curve) and Continued Education Tooth Preparation Visible, clean and smooth margins

accurately Leads to defective margin Need a

21 Training (learning curve) and Continued Education Residual lipping of gingival margin Proposed milling Actual milling Milling chamber cannot mill entire defect accurately Leads to defective margin Need a complete understanding of milling chambers capabilities

22 Training (learning curve) and Continued Education Poor transition at cavosurface margins Visible transition at cavosurface margins Wide isthmus width for lingual extension

23 Training (learning curve) and Continued Education Inadequate Reduction Inadequate isthmus width for lingual extension Increases probability of porcelain fracture

24 Training (learning curve) and Continued Education Accentuated occlusal surface Correct reduction for porcelain crown Occlusal surfaces of crown preparations need not be accentuated

25 Training (learning curve) and Continued Education Gingival Retraction Syringed clay based retraction/hemostatic agent Minor gingivectomy to increase crown margin visibility Make certain not to leave tissue tags visible to scanner Retraction cord must be placed below crown margin...no fuzz above margin

26 ISOLATION Training (learning curve) and Continued Education

27 Training (learning curve) and Continued Education Dental (Rubber) Dam Optimum barrier against crevicular fluids and oral cavity humidly

28 Training (learning curve) and Continued Education Alternative Isolation Autoclavable base and HVE tube Attaches to HVE Disposable cheek/tongue shield and bite guard Isolates maxillary and mandibular arch at same time

29 Training (learning curve) and Continued Education Alternative Isolation Excellent Isolation for anterior segments

30 Training (learning curve) and Continued Education Types of Intraoral Cameras 1) Static Camera Systems -have a steeper handling learning Curve -slower imaging speed -camera angle criteria must be followed for accuracy Static Intraoral Camera Imaging

31 Training (learning curve) and Continued Education Static Intraoral Camera Imaging Poor Static Intraoral Camera Image

32 Training (learning curve) and Continued Education Types of Intraoral Cameras 2) Continuous Capture Color Streaming Systems -featuring an ergonomic handpiece and special optics, the Omnicam camera has Color Streaming to allow for continuous capture of the oral cavity as well as displaying 3D data in full color. The system is completely powder-free. -the slim, rounded camera tube provides for easy rotation of the camera in the intraoral space. The small camera tip makes it easy to best position the lens anywhere in the mouth. The camera captures images in 2D and 3D and can rapidly capture half-arch and full-arch impressions.

33 Training (learning curve) and Continued Education Intraoral Camera Full Arch Impression Demonstration

35 Training (learning curve) and Continued Education Software Early Days without efficient work flow software

36 Training (learning curve) and Continued Education Software Click tooth number Select restoration type Task Bar prompts user to next step

-Crevicular fluids at bay -Intra oral graduex

37 Training (learning curve) and Continued Education Software Recurrent Caries Scanning criteria met -Crevicular fluids at bay -Intra oral graduex cleansed from preparation surface -Gingival margins visible to camera

38 Software Training (learning curve) and Continued Education Click on the draw margin function Mark gingival margins of #29 and #30

39 Training (learning curve) and Continued Education Click on the Tools function Click on the Move function

40 Training (learning curve) and Continued Education Move function allows user to reposition virtual crown within the arch

41 Training (learning curve) and Continued Education Use Shape Tool to modify occlusal and interproximal contacts

42 Training (learning curve) and Continued Education Color intensity relates to contact strength

43 Training (learning curve) and Continued Education Crystalized and Glazed Lithium Disilicate Crowns Crowns cemented with the Maximized Adhesive Dentistry Technique Post operative radiograph

tooth pain at teeth # s 28,29 Radiographic and clinical exam

44 Training (learning curve) and Continued Education Software Software work flow with clinical case Patient complaint of tooth pain at teeth # s 28,29 Radiographic and clinical exam revealed acute periapical periodontitis and irreversible pulpitis

45 Training (learning curve) and Continued Education Software Can duplicate full contour build ups or diagnostic wax up for morphology and occlusion Intraoral scan of existing morphology Intraoral scan of centric bite Intraoral scan opposing arch

46 Training (learning curve) and Continued Education Endodontic treatment completed Scanning criteria met Scanned image of prepared teeth # s 28 and 29

47 Training (learning curve) and Continued Education Software Superimposed image of original morphology onto the preparations Software editing of the virtual crowns

48 Training (learning curve) and Continued Education Crystalized and Glazed Lithium Disilicate Crowns Crowns cemented with the Maximized Adhesive Dentistry Technique Post operative radiograph

49 Quality of Cad/Cam Restorations

50 Accuracy of Digital Scanning With current intraoral scanning systems, full arch dental impressions are possible with high accuracy.

51 Quality of Cad/Cam Restorations

52 Quality of Cad/Cam Restorations

53 Quality of Cad/Cam restorations

54 Efficiency of Digital Impressioning

55 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Combining intraoral scanning with todays Cad/Cam technology allows for proficiency in the dental operatory

56 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Design and mill

$recurrent caries and vertical fractures$ Tooth Preparation with Scanning criteria

57 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Existing Amalgam Restoration with recurrent caries and vertical fractures Tooth Preparation with Scanning criteria met Lithium Disilicate Crown with Crystallization and Stain and Glaze Cemented with the Maximized Adhesive Dentistry Technique

58 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Existing Restorations with recurrent caries Tooth Preparation with Scanning criteria met Lithium Disilicate onlays cemented with the Maximized Adhesive Dentistry Technique

$caries and vertical fractures$ Lithium Disilicate onlays

59 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Recurrent caries and vertical fractures Lithium Disilicate onlays cemented with the Maximized Adhesive Technique

restorations with interproximal recurrent caries Lithium

60 CAD/CAM Efficiency of Digital Techniques Intraoral Scanning (Chairside and Dental Lab communication) Existing amalgam restorations with interproximal recurrent caries Lithium Disilicate Crown* Lithium Disilicate Onlays* *Cemented with the Maximized Adhesive Technique

61 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Existing PFM Crowns Empress Cad BL3 Crowns with stain and glaze Note Maximized Adhesion Technique facial resin

62 Efficiency of Digital Intraoral Scanning Posterior Crowns (Chairside and Dental Lab communication) Existing Amalgam with recurrent caries Zirconia Restoration cemented with Glass Ionomer

63 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Zirconia Custom Abutment Pre-Stained Empress Cad Implant Supported Crown Stained and Glazed Crown cemented with the Maximized Adhesive Technique

64 ZIRCONIA CUSTOM ABUTMENTS Have we placed all Zirconia abutments? Fractured Zirconia abutment at fixture level Would I do it again? Friction and abrasion marks

65 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Hybrid Custom Abutments Provides precise implant location transfer Prefabricated rotation locks in zirconium block and on Ti-Base Metal to metal screw connection

66 Hybrid Custom Abutments Orientation Recess Orientation Notch Ti-Base Scan Body

67 Hybrid Custom Abutments Orientation Recess Zirconia Blocks Screw Access Hole Magnified View of Intaglio Surface of Milled Zirconia Crown

Abutments Gingival Emergence at Implant Fixture

68 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Hybrid Custom Abutments Gingival Emergence at Implant Fixture Level Custom Healing Abutment Custom Healing Abutment removed

the fixture level connection to the implant body Scan Body*

69 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Ti-Base* inserted at fixture level *Ti-Base is the fixture level connection to the implant body Scan Body* inserted over Ti-Base *Scan Body is the orientation marker for the software

70 After cementation need to polish gingival 1/3 Occlusal View Abutment Crown crystalized and glazed cemented onto Ti-Base

71 Efficiency of Digital Intraoral Scanning (Chairside and Dental Lab communication) Zirconia Hybrid Custom Screw Retained Implant Crown Natural Emergence Profile

72 Cost analysis of single visit Cad/Cam restorations Ya its awesome but.

73 Cost analysis of single visit Cad/Cam restorations

74 Cost analysis of single visit Cad/Cam restorations What a conventional 2 visit crown really cost Tooth Prep and Impression -anesthesia $.52 -syringe $.11 -Burs $1.80 -Retraction cord $.29 -Impression material $ Impression tips $2.89 (coe syringe tip, heavy and light body -Impression tray $.90 Grand Total $14.45 $ per crown

75 Cost analysis of single visit Cad/Cam restorations What a conventional 2 visit crown really cost Laboratory and Final Cementation -Lab Fee $200 -Permanent Cement $5.46 Grand Total $ Miscellaneous Cost -Employee Salaries $37 -Square footage cost $ Room turn over $50 Grand Total $97.27

76 Cost analysis of single visit Cad/Cam restorations What a single visit Cad/Cam crown really cost Digital Crown with milling chamber Cost -anesthesia $.52 -syringe $.11 -Burs $1.80 -retraction cord $.29 -Ceramic Block, wear and tear on burs $38 -Cost of technology (note /30 crowns per month) $73 -Warranty and software club (at 30 crowns per month) $2.5 -Permanent Cement $ Employee Salaries $37 -Square footage cost $10.27 Grand Total $168.95

77 Galileos-Cerec Integration for Guided Implant Surgery

78 Combining 3D Conebeam / CT Scan and Cerec Technology Fiduciary Markers Crown Soft Tissue Implant Reference Body Scan Cerec Virtual Crown Virtual Crown, Implant and Soft Tissue Superimposed on CT Scan

Reference Body Implant Specific Drill Sleeve Thermoplastic Material

79 The Guide can be fabricated chairside with inexpensive materials and used to place implants for one to four missing teeth. Reference Body Implant Specific Drill Sleeve Thermoplastic Material Package of two reference bodies and two drill bodies.. $80. Cerec Milled Drill Body

80 Reference Body: Radiopaque Markers Medium is most commonly used size. Concave tissue surface Center reference body in edentulous space.

81 Combining 3D Conebeam / CT Scan and Cerec Technology Reference Body Diagnostic Cast Thermoplastic material

82 a.com Adapt material to edentulous space and adjacent teeth. Center reference body in space and press to place, making contact with ridge. Adapt material to sides of reference body. Thermoplastic material softens and turns clear in 120 water.

83 Material adapted to adjacent teeth. Material adapted to sides of reference body. Reference body in contact with tissue of ridge.

84 Scan with Cerec guide and reference body in place intraorally:

85 Combining Galileos 3D Conebeam / CT Scan and Cerec Technology Radiopaque fiduciary markers embedded in Reference Body will be used by Sidexis software for orientation.

86 Software allows for viewing in three dimensions. Lateral View Coronal View Crossectional A/P View

87 Locate and highlight the Mandibular nerve:

88 Implant selection using software library of multiple implant companies:

89 Implant Positioning: Guidelines: 1. Implant positioned in sound bone. 2. Avoid nerve by at least 2 mm. 3. Minimum of 2mm bone thickness on buccal and lingual. 4. Remain 3.5 mm away from adjacent teeth.

90 Implant Positioning: Outline of Reference Body Center implant position within outline of reference body to insure accurate fabrication of drill body.

91 Sidexis software directs Cerec machine to produce milled drill body.

92 Milled Drill Bodies: Implant Drill Guide Channel Orientation Projection Vertical Stop Tissue Surface

93 Drill body produced in Cerec milling chamber. Orientation Notch Reference body removed. Projection Drill body snapped into Cerec Guide.

94 Implant site Tissue punch used with drill sleeve to enter tissue while protecting the milled drill body.

95 Drill sleeves are specific to implant manufacturer and size. Sleeves fit into drill body on stent and guide drill bits to pre-determined angle and depth.

96 Tissue punch technique provides: 1. Atraumatic entry into implant site. 2. Minimal bleeding. Initial trephine drill guided to full depth.

97 Drill sleeves and drill bits of progressively larger sizes are used until implant can be placed at correct angle and pre-determined depth. Multi-purpose fixture mount holds implant while its driven into bone.

98 Multi-purpose fixture mount.

99 Careful planning...leads to ideal implant positioning.

100 Guided implant surgery produces. Zirconia Screw Retained Hybrid Implant Crown excellent results.

101

Screw retained implant crown restoration with digital workflow using scan body and surgical guide

Dr. Anthony Mak W Dental Screw retained implant crown restoration with digital workflow using scan body and surgical guide Solutions featured: 3Shape TRIOS 3Shape Implant Studio 3Shape scan bodies 3Shape