2017 Oregon Dental Conference Course Handout

Transcription

1 2017 Oregon Dental Conference Course Handout Ewa Bujalski, CDA, Geri Holmes, CDA, Jean Carlos Ocasio, CDA, & Thomas Saucedo, RDA Course F9006: Chairside Excellence for the Dental Assistant (Workshop) Friday, April 7 2 pm - 5 pm

2 Considerations for a temporary restoration Dentin and Pulp Protection Patient Comfort Periodontal Health Space Maintenance Provisional (Temporary) Occlusal Function Marginal Integrity Phonetics Esthetics

3 Measure Width Measure Height Select Size and Remove from Package Remove Liner Measure Height Trim to Contour Place and Adapt Contacts

4 Close and Adapt Buccal Margin Adapt Occlusal Margin Close and Tack Cure Buccal Adapt Lingual Hold Buccal in Place Tack Cure Lingual Tack Cure Occlusal

5 Remove Crown Final Light Cure Finish and Polish Apply Cement Seat Crown and Remove Excess Check Occlusion

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16 Lock On Technique Spot Etch Rinse

17 Add Excite and Dry Start Loadng

18 Load Insert the putty matrix

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20 Whitening Analysis Form Patient Name: Patient s Last Recall: Interviewer Name Dentist: Interview Medical History: Dental History: Allergic to plastics or peroxides? History of Tetracycline Antibiotics Do you routinely use tobacco? Pregnant or nursing mother? Onset of discoloration? History of trauma? Reason: Radiographs: Previous treatment for discoloration? What product did you use? Were you happy with the results? Did you get any sensitivity? Have you ever had ortho or Invisalign? Do you wear night guard Do you wear retainers? Are they wire or Vivera? Pull up and review radiographs for pulp size. Any Periapical, pulp size difference or internal resorption concerns? Restorations/Prosthesis? Discolored restorations needing replacement & shade q Crowns, Veneers, Bridges q Bonding q Partial, Bridge, Denture Soft Tissue Morphology / Characteristics: Photographs: q Full face and smile soft tissue lessons/attached gingivae periodontal conditions q Retracted and shade tab (Take before and after photos with same camera, magnifications and shade tab system) Starting shade of natural teeth Shade of Existing Restorations Tooth Morphology / Characteristics: Fluorosis Tetracycline Amelogenesis Devitalized Tooth Defective Restoration Tooth Aging Exposed dentin Caries Wear Facets / Cracks Abfractions Recession Wear facets Intrinsic Stain Extrinsic Whitening Procedure Selected q Go q Custom Tray q Boost and Go q Boost and Custom Tray q Internal Whiting and Custom Tray Notes: Follow us on

21 Opalescence Whitening System Congratulations! You ve just experienced a revolutionary tooth whitening procedure. The next 48 hours are important to enhance and maximize your whitening results for a long lasting, bright and healthy smile. For the next 48 hours, dark staining substances should be avoided, such as: Tobacco Beets Coffee Curry Tea Sports Drinks Frozen Fruit Bars and Popsicles Texas Pete Sauces Soy Sauce Carrots Wine Candy Tomato and Pasta Sauce Barbeque Sauce Blue Berries Soft Drinks It is normal for some people to experience minor tooth sensitivity for 1-3 days after the procedure. To minimize this, you may want to avoid excessively hot or cold foods and beverages. With the approval of you doctor, you may want to take 2 to 4 Advil (up to 800mg) every 4 to 6 hours as need for any discomfort. If you experience any severe or prolonged sensitivity, you should contact our office. All whitening procedures do have some relapse due to tobacco, foods and beverages. This is why we recommend a follow-up home tray system to maintain the whitening results. Seek regular professional dental hygiene care to maintain oral health, keep staining to a minimum and determine the need for whitening touch-ups. In addition, continue to practice good oral Hygiene including thorough tooth brushing, flossing, and tongue cleaning. Your dental professionalwill assist you in selecting the products to maintain not onlt a white smile, but a healthy one as well! Follow us on

22 Informed Consent for Teeth Whitening (In-Office and Home Treatments) This information read and given to me so that I can make an informed decision on teeth whitening (in-office or home treatments). I have been examined by my dentist and told I am a good candidate for whitening. I have the choice of home or in-office whitening treatment. I have been given all the details of whitening treatments by my dental professional and explained the procedure in detail. Power Bleaching Photoreactive Drug Information The following medications are commonly considered to be photoreactive and may cause an adverse condition if used in conjunction with the Power Bleaching solutions. If you are currently taking any of these medications, please consult with your physician before going through with bleaching procedure. To check photoreactive properties of any medications not listed below, please consult the most recent edition of the Physician s Drug Reference (PDR). Generic Name experience Hydrochlorothiazide Aldacteride, Aldoril, Capozide Chlorthalidone Naprosyn Oxaprozin Nabumetone Piroxicam Doxycycline Ciprofloxacin Ofloxacin Psoralens Democlocyline Norfloxacin Sparfloxacin Sulindac Tetracycline St. John s Wart Trade Name Aldoclor, Diupres, Diuril Dyazide, Hydrodiuril, Lopressor, Orotic, Moduretic Combipres, Tenoretic, Hgroton Naproxen Daypro Relafen Feldene Vibramycin, Doryx Cipro Floxin Methoxsalen, Trisoralen Declomycin Chibroxin, Noroxin Zagen Clinorilm, Sulindac Achromycin Patient Acknowledgement By signing this document in the space provided I indicate that I have read and understand the entire document and that I give my permission for any of these whitening treatments to be performed on me. I have read the list above and understand that the medications listed, if taken, can have an adverse reaction when used with the in-office or home bleaching treatments. I also acknowledge that I do not currently take any of these prescribed medication. Patient Signature Date Witness Signature Date Follow us on

23 Trouble Shooting Impressions Common Problems Voids or Holes CAUSE: Air in the impression SOLUTION: Keep mixing tip immersed in tray material while filling the tray Pulls CAUSE: Tray movement or repositioning impression tray after it was seated SOLUTION: Do not move the tray once it is seated in place Tooth/Tray Contact CAUSE: Wrong tray size SOLUTION: Explore different tray sizes before taking impression Voids or holes can be avoided by the keeping the mixing tip immersed in tray material. Tooth contact cause by wrong size trays. Delamination CAUSE: Impression material are not blended or mixed together SOLUTION: Follow manufacturer s mixing directions Missing Dentition CAUSE: Misfitted impression tray SOLUTION: Check tray length during try-in FURTHER RECOMMENDATIONS Fast Setting Materials Fast setting PVS materials are not recommended- always use regular set materials to make sure you have proper working and setting times to capture all the dentition and detail. Material Brand Always choose a quality impression material. Never mix dental manufacturers materials (i.e 3M ESPE Putty with Invisalign wash). Use the same brand of putty and wash for all impressions. Delamination can appear when the materials are not blended or mixed together. Rejections can occur if the distal of the last tooth is not captured in the impression. Gloves For PVS impressions, always use Nitrile gloves instead of powder or powder free gloves. These gloves can cause the impression to not completely set and create shiny surfaces that lack detail. Disinfection Inadequate disinfection effects the surface quality and detail reproduction and dimensional stability. Always use water-based disinfectants according to FDA guidelines and follow manufacturers instructions. Sending Cases Avoid sending impressions in sealed bags. Incorrect storage conditions affects the PVS impression s surface quality, detail reproduction, and dimensional stability. Guidelines for Good Impressions Follow us on

24 Guidelines for Good Impressions Impression Trays Always use provided Invisalign trays. Before taking an impression, try-in the tray for proper fit. No teeth or support tissue should hit the tray during the try-in. Use proper tray size for the patient s arch. Extra large, large, medium and small trays are available through Invisalign.com on For Doctors Site. Trays can be altered or manipulated by using a torch to warm the plastic. You can also use a lab acrylic bur to adjust tray margins for patients who have large tori. Clinical Technique Maxillary - Prepare for impressions by putting on nitrile gloves. Place a new tip on the light wash impression material and bleed the tip. Try-in maxillary impression tray to ensure proper fit. Load the impression tray with 3M ESPE Imprint 4 Penta Putty impression material starting with the most posterior areas of the impression tray. Load the impression tray without lifting the tip to avoids air and bubbles into the impression. Mandibular - Prepare for impressions by putting on nitrile gloves. Place a new tip on the light wash impression material and bleed the tip. Try-in mandibular impression tray to ensure proper fit. Load the impression tray with 3M ESPE Imprint 4 Penta Putty VPS impression material starting with the most posterior areas of the impression tray. Load the impression tray without lifting the tip to avoids air and bubbles into the impression. notes Impression Material Use only PVS materials - do not use polyether, alginate or alginate alternative materials. Cases submitted do require both an upper and lower impression. It is important to remember that impressions will not be returned. If needed, take a second set of impressions for your records. > Expiration date < Always check the expiration date on both, tray and injected materials. Expired impression material will not set properly and elastomeric properties are insufficient. Impression materials must be stored at room temperature (73 degrees F). Storing at lower temperatures will prolong setting times. > Inadequate Mix < After removing the impression material cartridge cap, extrude or bleed the material before applying mix tip. This will ensure even flow for dispensing material. Do not substitute mixing tips. Always use the supplied manufacturer mixing tips and follow instructions for use. > Follow Manufacturers Directions < Ensure mix tip is correctly attached. Impression tips are different in size and color. Check the manufacturer s directions for which tip should be used. When using a putty or hand-mix impression material, always use the supplied measuring scoop to ensure proper ratios of material. Thoroughly mix the catalyst and base. 3M ESPE Imprint 4 VPS impression material family of products. Using your index finger, make a putty trough where the teeth should be to allow room for light body wash material. Pinch the putty to extend the material in the vestibule area. Examine the putty in the tray to make sure you have good depth for the Imprint 4 light body wash. Reline the impression with Imprint 4 light body wash. Extrude into clinical crown areas making sure not to lift the tip. Make sure you have an even amount of Imprint 4 light body wash impression material to take a good detailed impression of the patient s dentition. You must get the filled tray in the patient s mouth within 1:30 from the start of mix. Seat the impression straight up to avoid any drags or scrapes. Make sure the handle is always aligned up with the patient s midline. Always hold the impression tray in the pre-molar area for stability. Intra-oral set time is 2:30. Final maxillary impression using Imprint 4 Penta Putty and Imprint 4 light body wash. Using your index finger, make a putty trough of where the teeth should be to allow room for light body wash material. Pinch the putty to extend the material in the vestibule area. Examine the putty in the tray to make sure you have good depth for the Imprint 4 light body wash. Reline the impression with 3M s Imprint 4 light body wash. Extrude into clinical crown areas making sure not to lift the tip. Make sure you have an even amount of Imprint 4 light body wash to take a good detailed impression of the patient s dentition. You must get the filled tray in the patient s mouth within 1:30 from the start of mix. Seat the impression straight down over the arch while pulling out the patient s cheek. Move around behind the patient holding down the impression in the pre-molar area with thumbs for stability while gently holding the mandible with fingers. Intra-oral set time is 2:30. Final mandibular impression using Imprint 4 Penta Putty and Imprint 4 light body wash. Disinfect the impressions, then package for shipment for aligner fabrication. The 3 Nevers of Tray Support Never ask the patient to hold the tray. Never ask the patient to bite together. Never have the patient bite on cotton rolls. Upper impression positioning of dental assistant Always insert tray straight up. Once tray is seated move behind the patient to ensure proper position of tray and tray is seated properly. Always line up tray handle to the patient s midline. Place index and middle fingers in the premolar area when taking upper impressions for stability. Never hold impression by the handle. Bring arms to your side to give more support. Lower impression positioning of dental assistant Always insert tray straight up. Once tray is seated, move behind the patient to ensure proper position of tray and tray is seated properly. Always line up tray handle to the patient s midline. Hold tray with thumbs and take fingers under the patient s chin to stabilize the impression. Remember impression materials are spongy and can lift if not stabilized.

25 Troubleshooting Photographic Records Avoid canted photographs by sitting knee-to-knee with the patient and holding the camera parallel to the floor. Buccal photos are taken with the Y end of the retractor (opposite end). Have the patient pull the retractor back toward their ear. Encourage the patient to smile big and wide - large enough to see all the teeth. Make sure hair is pulled back to see the ear and full profile of the face. Buccal views need both retractors, not just one. Holding only one will cause the lips to collapse in the anterior. Occlusal views require using wire retractors to get lips out of the frame and a better view of the teeth. Always use translucent retractors. Color attracts the eye drawing attention away from the teeth. Never use patterned wallpaper or distracting colors as the background. Invest in a good digital SLR (DSLR) camera. Have a battery charger with extra rechargeable batteries on hand. Never use an iphone or ipad for taking photographic records. This is considered a HIPPA violation. Patient s permission is necessary. You must have a signed consent or photo release form in order to share patient images with anyone including the aligner company. A photo consent form is available for your use at our website, Keep our photography guide in each operatory to remember the number and sequence of photographs along with camera settings. This will maintain record consistency for everyone taking photographs. Proper retractors and intraoral mirrors are critical with taking good photos. Both double-ended wire and double-ended plastic retractors are needed for the retracted view and buccal views. Always use wire retractors for all photographs that require the intra-oral mirror. Wire retractors are important to keep the lip from touching the teeth. During autoclave sterilization, make sure the water is clean or the translucent plastic retractors may turn opaque. Prevent intra-oral mirrors from fogging by using a heating pad, a defogging agent, hot water, or simply move fast. Patient positioning is the key to taking great photographic records: The three full face views, should have the patient is standing tall with hands at their side. For full smile and retracted views, have the patient sit on bend of the dental chair facing you, while you sit on the doctor s chair at eye level, knee-to-knee with the patient. For the maxillary occlusal view, always stand behind the patient with the chair laid back to your waist. Have the patient raise their chin as high as possible. The higher they lift their chin the further the tongue falls back. Place the intraoral mirror flat against the maxillary teeth. Make sure you are not positioning the mirror at an angle that will create a double image. Always use a intra-oral mirror with a handle. The length allows more control with intra-oral mirror shots. DSLR cameras can be heavy - use a neck strap to lighten the load. We hear many complaints about how heavy cameras can be, which indicates the need to practice more shots with the help of the neck strap. A camera card reader will be needed to transfer image files to the computer. A Wi-Fi card can be used to wirelessly transfer image files to your computer. Maxillary images are the hardest to achieve. Have the patient chair laying back with the top of the chair even with your waist. Come from behind the patient. When taking occlusal views always wear gloves and retractors are necessary. Try to focus on the center of the palate and remove the nose from the frame. Follow us on Guidelines for Good Photo Records

26 Guidelines for Good Photo Records notes full face repose, smile, profile Use a non-distracting background: white, black, blues or greys all work well. Have the patient stand with hands at their sides. Long hair should be pulled back or tucked behind ears. HINT: Use the interpupillary line and long axis of the face to align the camera. Camera angle should be at the same level as the patient s nose. FULL FACE - REPOSE FULL FACE - SMILE FULL FACE - PROFILE anterior smile and retracted Patient is seated knee to knee facing the assistant. Both patient s and photographer s chair are the same level allowing the photo lens to be parallel. HINT: Use buccal retractors without a mirror for retracted shot; focus is on the central teeth. ANTERIOR - SMILE ANTERIOR - RETRACTED buccal left and right Same seating position - knee to knee with patient. Have the patient place retractors, pulling further back the retractor side you are capturing. HINT: Upper and lower teeth should be together; focus are on the cuspids (right and left) and should be in the center of the frame. RIGHT BUCCAL LEFT BUCCAL upper and lower occlusal Try not to leave any teeth out of the photo the wider the patient opens, the more teeth will be in the frame. Keep nose out of the picture. Keep mirror warm to avoid fogging. HINT: Place retractors and mirror then stand behind the patient and lower the chair to waist level. Ask patient to lift their head as high as they can, again encourage them to open wide. The full arch mirror should rest flat against the opposing arch teeth. UPPER OCCLUSAL LOWER OCCLUSAL