Let s Grow Tooth. Jack D Griffin Jr DMD 1. Let s Grow Some Tooth. Let s Grow Tooth Excellence with bioactive/regenerative materials.

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1 Let s Grow Tooth Excellence with bioactive/regenerative materials Let s Grow Tooth: 1. Bioactive vs- Regenerative 2. Direct restoratives 3. Indirect restorations 4. Cementation to heal margins 5. Regenerative Aesthetics Jack D Griffin Jr DMD Master Academy of General Dentistry Accredited American Academy of Cosmetic Dentistry Diplomat American Board of Aesthetic Dentistry New burs Water Isolation Effective decay removal Bioactive/ regenerative materials Selective etch Thorough rise Moist surface Universal DBA Evaporate solvent Shrinkage management Effect curing Proper adjustment Let s Grow Some Tooth Bioactive [bi o-ak,v] having an effect on or elici,ng a response from living,ssue. Regenerative To provide an environment that promotes tissue repair Let s Grow Some Tooth Regenerative To provide an environment that promotes tissue repair Optimal ph Bacteria inhibition Void free Moisture tolerant Bio-friendly Well sealed Tooth-like physicality regenerative materials: TheraCal LC (Bisco) a liner Activa (Pulpdent) a base/restorative Ceramir (Doxa) a cement Giomers (Shofu) a class of "restorative materials Jack D Griffin Jr DMD 1

2 TheraCal LC (Bisco) What it is A Resin Modified Calcium Silicate (RMCS) Stimulates apatite formation and 2 0 dentin MTA (Mineral Trioxide Aggregate) chemistry Early high alkalinity (high ph = 11) Neutralizes over weeks Self-sealing minor bond to dentin Anti-microbial Clinical use Liner to protect pulp Place on moist dentin prior to DBA Keep 1mm deep or less Opacity prevents deep cure Direct pulp cap possible Keep 1mm from enamel May show through less opaque composite Giomer Shofu A class of restorative materials Giomer ion release by S-PRG: Margin Perfect Matrix A stable glass ionomer which allows ion release and recharge. The surface layer is protected giving great physical properties. The glass core is protected from moisture. Remin Pro (Voco) Fluoride Hydroxyapatite Xylitol MI Paste (GC) Fluoride Ca phosphate Xylitol Perio Gel Antimicrobial No stain Decent taste Perio Protect system Jack D Griffin Jr DMD 2

3 Problems with posterior composites? Contacts Shrinkage Depth of cure Sensitivity Longevity Time Best polishers Disposable. Super Snap Singles One Gloss (Shofu) Can t afford to re-use burs Microcopy NeoBurr NeoDiamond Regenerative Dentistry Providing an environment where tissues can heal Caries indicator Sable Seek Ultradent Jack D Griffin Jr DMD 3

4 A source of reparative ions Alkaline environment Promote dentin healing Bacteriostatic Dentin tubule sealant Thermal insulation NOTE: Polyacrylic acid of GI inhibits HA formation Source of reparative ions Alkaline environment Bacteriostatic Dentin tubule sealant Thermal insulation = apatite Liner Moist Dentin Light cure Etch DBA Restore No direct pulp capping if Spontaneous pain Throbbing PA problem Bleeding hard to control Universal Dentin Bonding Agents Regardless of etch technique, they work well Total etch No etch Selective etch Jack D Griffin Jr DMD 4

5 Practice building 101 Aging population Recession Abfraction Repeatable success Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable Micro Etcher Prep Star 50 micron aluminum oxide Danville Engineering Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable Advantages Decrease sensitivity Non-invasive Esthetic Root seal Predictable Profitable Jack D Griffin Jr DMD 5

6 Does your etch matter? Textu re Rinse-ability Color Long term antimicrobial? Phosphoric acid kills NOW Bezalkonium Chloride kills LATER Isolation is critical Dam Isolite DentaPop/DriTip Cotton rolls Gauze Damphobia? TheraCal Sectionals Wedge Ring Burnish All Bond U Flow Bulk Does killing bugs matter? Matrix metalloproteinases = MMP s enzymes that may break down the hybrid layer between dentin and resin Cured giomer Where It Matters Most Jack D Griffin Jr DMD 6

7 Trans-enamel curing 20 seconds each after Where it matters most Margins Dentin Where our technique is most critical Beautifil Bulk Shofu 4mm depth Somewhat clearish Good color Low shrinkage Good strength Easy to form contacts Giomer bulk fill Fluoride release Regenerative environment Activa: Dual cure 15 second total etch DBA optional Decent color Ion exchange Calcium, phosphates, fluoride release Re-chargeable Glass ionomer replacement Jack D Griffin Jr DMD 7

8 New burs Water Isolation Effective decay removal Bioactive/ regenerative materials Selective etch Thorough rise Moist surface Universal DBA Evaporate solvent Shrinkage management Effect curing Proper adjustment Doc, that tooth never hurt until you FIXED it Let s Grow Tooth Indirect restorations FULL day Jack D Griffin Jr DMD Master Academy of General Dentistry Accredited American Academy of Cosmetic Dentistry Diplomat American Board of Aesthetic Dentistry Cementation Sanity The most durable aesthetic restorations Cementation EVER. Sanity (and how to stick em in) Doc, that tooth never hurt until you FIXED it New burs Water Isolation Selective etch Universal DBA Air thin well Regenerative Flowable 0.5mm cure Dentin replacement Max polymerization Polish well mon o lith ic [mon-uh-lith-ik] Adjective NO layering porcelain Use the strongest material that meets the minimum cosmetic need of the patient. e.max zirconia PFM gold Jack D Griffin Jr DMD 8

9 Let s Grow Tooth Monolithic zirconia J Very durable J Prep similar to gold J CAD/CAM made J Digital impression perfect for it J Cement or Bond J Fast turn around from lab J Total PFM replacement? J Inexpensive Monolithic zirconia C Treat as a metal C Meets aesthetic demands of 80-90% of molar crowns C Wear similar to enamel and less than feldspathic porcelain if polished well C ADJUST: Fine diamond, concentric burs, light pressure, water, polish mm clearance, 0.5-1mm chamfer 0.8-1mm rounded 1.5-2mm,p Cementation sanity Non-Adhesive GOOD 1. Resin Modified GI most popular RelyX Lu,ng (3M ESPE) Fuji Plus (GC) Nexus RMGI (Kerr) 2. Easy mix, easy clean up 3. Low sensihvity 4. Does not strengthen restorahon 5. Good if retenhve prep Cementation sanity Self-Adhesive BETTER 1. Dual cure resin cement with primer/sealer inside RelyX Unicem (3M ESPE) Maxcem (Kerr) SpeedCEM (Ivoclar) SmartCem (Dentsply) Beau,Cem (Shofu) 2. Moderate bond to denhn 3. Strengthens restorahon moderately Cementation sanity DBA + Dual Cure Resin BEST 1. Universal DBA All Bond Universal (Bisco) Scotchbond Universal (3M) Mul,Link Primer A&B (Ivoclar) 2. Dual cure resin cement DuoLink Universal (Bisco) Rely X Ultimate (3M) Mul,Link(Ivoclar) 3. Highest bond to denhn 4. Highest restorahon strengthening Jack D Griffin Jr DMD 9

10 GI plus calcium aluminate Bioactive cement apatite formation Easiest clean up ever Least sensitivity of any cement tested NO RESIN Alkaline ph Hydrophilic No silane, no primer, no bonding agents Awesome for metal, zirconia, implants No bad taste Compare margin sealing: Rely X Luting Rely X Unicem Fuji GI Ceramir ProRoot MTA Material Cement Aesthetics Bond Retention Zr adjsutments Fine diamond High speed Light pressure Concentric turbine Rubber polishers Polish paste? Ceramaster Shofu Prep not ideal Zr primer Z-Prime Plus Bisco Self adhesive resin BeautiCem Shofu Monolithic lithium disilicate J Very durable, versatile J mm clearance J Monolithic esthetics good for 95% of posterior restorations J Cementation good if prepped well J Adhesive cementation may result in higher ceramic strength J Slightly better esthetics than zirconia, more translucency Jack D Griffin Jr DMD 10

11 Implant Crowns RestoraHon success Bio-friendly cements Thorough clean up Good reten,on Sob,ssue tolerance Air abrasion Frosted Supra G 5.0mm Nobel Biocare Titanium abutment Implant Direct E.max J Isolate J Try in J Ivoclean 20 seconds, J Rinse J Silane J BeautiCem Zirconia (Implants and retentive preps) J Isolate J Try in J Ceramir J Clean up Jack D Griffin Jr DMD 11

12 Cementation Soft tissue enhancement 2 zirconia crowns soft tissue regeneration GI plus calcium aluminate Sounding the bone Probe to sulcus depth Margins mm from bone crest to prevent biologic width violation Plan 1. Get pt a tooth brush 2. Perio Protect 3. Records 4. Wax up 5. Extraction #19 6. Length determination 7. Long term mock up 8. Establish bite 9. Restore lower posterior 10. Restore the rest CheckBite Microcopy Jack D Griffin Jr DMD 12

13 Thank you very much Eurekasmile.com Jack D Griffin Jr DMD 13