21ST CENTURY DENTISTRY DIGITAL, INTERDISCIPLINARY & EMOTIONAL

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1 21ST CENTURY DENTISTRY DIGITAL, INTERDISCIPLINARY & EMOTIONAL

2 21ST CENTURY DENTISTRY DIGITAL, INTERDISCIPLINARY & EMOTIONAL

3 The AMAZING things that can happen when having an IOS in your hands

4 The positive emotional/marketing impact on the patient. The Advantages of Scanning Every Patient Every Time. Visual Chair side communication Advantages of doing bite registrations with IOS. Transferring the CR position from function/orthopedic devices Patient monitoring: soft tissue. tooth structure and occlusion IOS + Printer and immediate motivational mock-ups Predictability between initial design and final restorations Perform 3D quality control, the key for real 21st century modern dentistry. Avoiding analogue steps to reduce distortion, complication and room for error. The DSD Natural Restoration strategy Efficiency with implant cases. From single to full arches. Paths of communication. Integrating the clinic to the Lab, DSD Planning Center and Invisalign. The AMAZING things that can happen when having an IOS in your hands

5 The AMAZING things that can happen when having an

6 RELATIONSHIP

7 Like you Trust you RELATIONSHIP

8 Technical Explanation

9 EDUCATION MOTIVATION EXPECTATION CASE ACCEPTANCE TRUST EMPATHY

10 MOTIVATIONAL MOCK UP

11 MOTIVATIONAL MOCK UP

12 MOTIVATIONAL MOCK UP

13 1st 2nd RELATIONSHIP MOTIVATIONAL MOCK UP EXPLANATION TX PLAN PRESENTATION CLOUD 3D DOCUMENTATION

14 2nd EXPLANATION TX PLAN PRESENTATION CLOUD 3D DOCUMENTATION

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16 Visual Communication - 3D I.O. Camera Color Gum Recession/Defects Old Restorations Bite Issues Diastemas, Black Triangles Crowding, Position

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20 BITE REGISTRATION VDO & CR

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25 ANALOGUE X DIGITAL BITE REGISTRATION Analogue Digital

26 Soft Tissue Evaluation: -recession -grafting -orhto -defect Tooth Structure Evaluation: -abrasion -erosion -movement QUALITY CONTROL Occlusion: -Bite change -Jaw shifting -VDO loss

27 Systematic Digital Patient Monitoring Compare to last visit Visit 1 Visit 2 Visit 3 Visit 4

28 THE MODERN DIGITAL TECHNICIAN WILL BECOME EXPERT ON 3 THINGS: IMPORT, EXPORT AND OVERLAP FILES, CONNECTING DIFFERENT SCANNERS WITH DIFFERENT SOFTWARE AND DIFFERENT MILLING AND PRINTING MACHINES, RELATING THE DESIGN OF ALL DEVICES AND RESTORATIONS TO THE INTIAL PROJECT APROOVED.

29 KOis digital deprogrammer By calamita, cofa r & coa chma n

30 KOis digital deprogrammer By calamita, cofa r & coa chma n

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38 KOis digital deprogrammer By calamita, cofa r & coa chma n

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45 the smile Donar

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47 the Digital smile Donator

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50 SK.01 SK.02 SK.03 SK.04 SK.05 SK.06

51 SK.01 SK.02 SK.03 SK.04 SK.05 SK.06 NATURAL ALGORYTHMS

52 SK.01 SK.02 SK.03 SK.04 SK.05 SK.06 Should we try to recreate Nature Paulo Kano

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54 PREDICTABILITY

55 Color/Layering Shape/Texture

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58 SK.01 SK.02 SK.03 SK.04 SK.05 SK.06 by Paulo Kano

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60 SK.01 SK.02 SK.03 SK.04 SK.05 SK.06

61 SK.01 SK.02 SK.03 SK.04 SK.05 SK.06

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63 SK.04

64 3D Facially Driven Project + Prep Scan PLANNING CENTER

65 3D Facially Driven Project + Prep Scan PLANNING CENTER

66 3D Facially CAD/CAM Driven Project + Prep Scan PLANNING CENTER

67 3D Facially Driven Project CAD/CAM Milling + Prep Scan PLANNING CENTER

68 3D Facially Driven Project + Prep Scan PLANNING CENTER

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70 PMMA blocks Lithium Dissilicate Zirconia blocks Ceramic blocks

71 Monolithic CAD/CAM Natural Algorithms No Buccal/Incisal Reshaping Dr. Manuel Nani Lab Microdental Madrid

72 Dr. Manuel Nani Lab Microdental Madrid

73 MONOLITHIC CAD/CAM RESTORATION No Wax-up No Pressing No Casting Dr. Manuel Nani Lab Microdental Madrid No layering

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75 PREDICTABILITY

76 W O R K F L O W

77 Dr. Paulo Kano Sao Paulo, Brazil MONOLITHIC CAD/CAM NATURAL ALGORITHMS

78 EVALUATING CAD/CAM Shape Macro Texture Micro Texture Translucency Value/Fluorescence Fit/Precision Thickness MONOLITHIC CAD/CAM NATURAL ALGORITHMS

79 No Wax-up Color/Layering No Layering No human hands by Paulo Kano

80 Color/Layering Shape/Texture

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88 Dr. Anas Aloum Abu Dhabi, UAE MONOLITHIC CAD/CAM NATURAL ALGORITHMS

89 Dr. Fadi Yassmin, Angelo Raphael & Carla de Castro Sydney, Australia MONOLITHIC CAD/CAM NATURAL ALGORITHMS

90 Dr. Fabio Dantas Rio de Janeiro, Brazil MONOLITHIC CAD/CAM NATURAL ALGORITHMS

91 Dr. Sergio Saraiva Sobral, Brazil MONOLITHIC CAD/CAM NATURAL ALGORITHMS

92 Dr. Marcelo Calamita São Paulo, Brazil MONOLITHIC CAD/CAM NATURAL ALGORITHMS

93 Dr. Nazariy Mykhaylyuk Kiev, Ukraine MONOLITHIC CAD/CAM NATURAL ALGORITHMS

94 Dr. Nazariy Mykhaylyuk Kiev, Ukraine MONOLITHIC CAD/CAM NATURAL ALGORITHMS

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98 Nemo 3D by Coachman

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101 Dr. Fadi Yassmin Sydney, Australia Over the prep design

102 Motivational Design Over the prep Design

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104 Lab Work: John Scollo Dental Solutions - Sydney Empress CAD Multi BLT 3 CAD: Exocad CAM: Mcxl Inlab 16

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106 Smile Design Francis Coachman DSD Planning Center, Madrid Nemo3D by Coachman Clinical Work Fadi Yassmin DSD Planning Center, Madrid DFY Dental, Sydney Lab Work John Scollo Dental Solutions, Sydney Empress CAD Multi BLT 3 CAD: Exocad CAM: Mcxl Inlab 16

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110 Dr. Fadi Yassmin Sydney, Australia

111 Dr. Fadi Yassmin Sydney, Australia

112 natural restauration Completely Digital Facially Driven Natural Shapes Monolithic CAD/CAM

113 Angelo Raphael / Sérgio Saraiva / Francis Coachman / Christian Coachman

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115 NemoDSD 3D Cerec InLab

116 MOTIVATIONAL MOCK UP

117 Facially Driven Monolithic Restoration with Natural Algorithms Dr. Marcelo Calamita Dr. Angelo Raphael CDT. Dr Eduardo Dantas

118 Dr. Marcelo Calamita Dr. Angelo Raphael CDT. Dr Eduardo Dantas

119 NemoDSD 3D Cerec InLab

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126 DSD 3D = DSD Shell + Pre Op

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129 Pre op Donator/Inspiration The patient's younger smile Final Design Pre op Donator/Inspiration The patient's daughter Final Design Digital smile Donator Pre op Donator/Inspiration A third party Final Design Donator/Inspiration A celebrity

130 Digital smile Donator SMILE MENU

131 Digital smile Donator SMILE MENU

132 S M I L E M E N U

133 S M I L E M E N U

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135 Pre op Donator/Inspiration The patient's younger smile Final Design Pre op Donator/Inspiration The patient's daughter Final Design Digital smile Donator Pre op Donator/Inspiration A third party Final Design Donator/Inspiration A celebrity

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141 Set 1 Set 2 Set 3 Set 4 Set 5 Set 6

142 Amann Emax Exocad Emax 3shape Empress HD Emax Set 1 Set 2 Set 3 Set 4 Zirkonzahn Zirconia Cerec Empress HD Creation Set 5 Set 6 Set 7

143 lab truck

144 lab truck

145 Original Photo

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147 DSD Photo

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156 Amann E.max CAD - HT BL3 Set 1

157 Set 12

158 Set 3

159 Set 4

160 Set 5

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162 Set 6

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164 Pre op Donator/Inspiration The patient's younger smile Final Design Pre op Donator/Inspiration The patient's daughter Final Design Pre op Donator/Inspiration A third party Final Design Digital smile Donator Donator/Inspiration A celebrity

165 Pre op Donator/Inspiration The patient's younger smile Final Design Pre op Donator/Inspiration The patient's daughter Final Design Pre op Donator/Inspiration A third party Final Design Digital smile Donator Donator/Inspiration A celebrity

166 Digital smile Donator

167 Digital smile Donator

168 Digital smile Donator

169 Digital smile Donator

170 Digital smile Donator

171 Digital smile Donator

172 Digital smile Donator

173 Outsourcing 3D Design I.O.S. Printer Immediate Motivational Mock-up W O R K F L O W

174 the smile donator

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180 Clinical work: Jonathan Levine Smile Design: DSD Planning Center Lab Work: Angelo Raphael & Rafael Santrich

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182 natural Monolithic CAD/CAM Restorations with Natural Shapes following the DSD Project Translucent Zirconia (Anterior Zirconia from Zirkonzahn) Emax CAD LT A1 + Scoop Technique Empress CAD Bl 4

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185 Clinical work: Jonathan Levine Smile Design: DSD Planning Center Lab Work: Angelo Raphael & Rafael Santrich

186 DSD PLANNING CENTER

187 Case performed by Dr Jeff Shapiro, TechSquared Lab, Christian Coachman and DSD Planning Center

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199 The 3D Facially Driven Smile Design project using the images and 3D files. The DSD project inside the CAD/ CAM software Restorations are milled Case performed by Dr Jeff Shapiro, TechSquared Lab, Christian Coachman and DSD Planning Center Occlusion is tested and adjusted in the virtual articulator High definition printed models of the preps are made for final adjustments of the restorations. The final design with natural algorithms is exported as a STL DSD project overlapped to the preps The files are exported from 3shape into NemoDSD 3D Prep file inside the CAD/CAM software Designing the restorations in the CAD/CAM software, respecting the DSD outer surface and the inner prep surface and finishing line. Restoration design is finish and the files are ready to be exported to the milling machine. The final handmade procedures are performed (fitting, contact and occlusion adjustments, emergence profile, stain, glaze and polishing) Digital files of the Upper/ lower arch and bite. Immediate provisionals are done using the vacuum tray and bis-acryl resin Preps are done, scanned and exported to the Lab Final outcome after bonding The pre-op situation. 4 minimally invasive anterior veneers are planned. The project is printed so the dentist can perform the motivational mock up, prep guides and immediate provisionals. Vacuum tray matrix done over the printed model of the final project Case performed by Dr Jeff Shapiro, TechSquared Lab, Christian Coachman and DSD Planning Center

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201 Outsourcing 3D Design I.O.S. Printer Immediate Motivational Mock-up W O R K F L O W

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205 DSD Lab Madrid DSD Lab Madrid TechSquared NYC Well Lab Sao Paulo Avila Mañas Madrid

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208 the modern digital technician The future of Anterior Esthetic Restorative Dentistry is moving into digital for sure. Smile Designers will become Digital Designers as well. Milling and printing machines will substitute analogue procedures as manual layering, waxing, setups, cut backs, shaping, etc But This new professional, the Digital Designers, will only be able to explore the full potentiality of this beautiful technology if understanding the principles of shaping and morphology, layering and colors, facial integration and arrangement. Analogue principles that will become the key of this learning process. So, practicing handmade procedures, will definitely be the best and only way to become a Digital Smile Designer expert. The ability of an artist is not only in his hands but mainly in his eyes. So understand how the visualize beauty in 3D is the key. Becoming a very good modern digital technician is not easier than it use to be to become a traditional good analogue technician, the challenges just changed. The 5 factors for successful modern digital restorative dentistry that technicians should specialize on: 1. Facially Guided Digital Smile Design: the 3D position and arrangement of teeth and gingiva, related to the face and lip dynamics. 2. Manipulating Natural Algorithm Digital files. 3. Material selection for printing, milling and pressing. Since the restorations will be monolithic, the key is to select the right value so the restorations will blend in. 4. 3D software knowhow 5. Adjusting, finishing, fitting, polishing, staining and glazing. THE MODERN DIGITAL TECHNICIAN WILL BECOME EXPERT ON 3 THINGS: IMPORT, EXPORT AND OVERLAP FILES, CONNECTING DIFFERENT SCANNERS WITH DIFFERENT SOFTWARE AND DIFFERENT MILLING AND PRINTING MACHINES, RELATING THE DESIGN OF ALL DEVICES AND RESTORATIONS TO THE INTIAL PROJECT APROOVED. At this moment I would say that 60-70% of anterior restorations can be solved with monolithic CAD/CAM restorations beautifully. We still have situations where conventional layering and/or pressing techniques are the best choice. These are the situations where I believe we still have to rely on a very good, old school ceramist, performing traditional procedures (but this is rapidly changing): 1. Ultra thin veneers ( mm) 2. Matching single anteriors to adjacent natural teeth. 3. Side by side anterior restorations with very different substrates. 4. Partial restorations/ceramic fragments. I was, for 18 years of my life, this traditional ceramist and I m definitely very proud about it. Started in 1994 working for my father.

209 natural restauration The ideal restoration needs to fulfill certain characteristics as adequate: MARGINAL FIT to the finishing lines and no excessive CEMENT SPACE. EMERGENCE PROFILE to generate good soft tissue support and inter proximal contact points without a biologically harmful ledge. INTERPROXIMAL CONTACT AREAS with minor intra oral adjustments, without leaving black triangles on the anterior area or food trap areas on the posteriors. OCCLUSAL CONTACTS with minor intra oral adjustments. SHAPE following the principles of natural morphology, function and esthetic integration. STRENGTH, achieved with minimal thickness following the proper physical properties to resist long term the stresses demand by the stomatognathic system. COLOR, to blend in with the remaining dentition and to be in harmony with the patients physical and emotional needs. For sure, the correct VALUE is the most important aspect of the color to be matched, to generate a restoration that is not to bright (high value) or to grey (low value). EASY of REPLACEMENT in case of early failures All these parameters are known since ever. The new digital workflow brings 2 new characteristics that need to be fulfill by successful restorations: COPY the approved initial project. This means that the technician understands the digital workflow and how to import, export and overlap files to respect the shapes and facial integration achieved by the initial 3D design and mock up. Of course all these designs need to be performed utilizing libraries of natural shapes (natural algorithms). Of course modifications can be made but in a controlled and conscious way, changing only what is desired. MONOLITHIC ESTHETICS, this means achieving beautiful outcome with NO BUCCAL/INCISAL SHAPING, allowing that the natural algorithms are respected and complex handmade procedures are avoided.

210 natural restauration OPEN LIBRARY OF NATURAL SHAPES IT'S NOT ABOUT THIS OR THAT LIBRARY OF TEETH, IT'S ABOUT ANY LIBRARY OF ANY NATURAL TEETH that can fit our patient's smile better and fulfill his/her emotional needs. It's the era of customization and real natural restorations. We can rehabilitate the mother with the teeth of the daughter, we can rehabilitate the older guy with the younger beautiful smile he used to have, we can rehabilitate our patient with the smile that he/she likes from anybody. We can even use the beautiful 3D shapes of a celebrity. We just need to scan the donator and upload into NemoDSD 3D, export the project into any CAD/CAM system, overlap to the preps/implants and design de restoration copying the buccal/incisal surface of the donator project. Pre op Donator/Inspiration The patient's younger smile Final Design Case performed by Dr Miguel Stanley and DSD Lab Madrid THE DSD CAD/CAM RESTORATION WORKFLOW is: Completely Digital Facially Driven Interdisciplinarily Integrated Esthetic-Functionally Negotiated With Natural Algorithms from Open Tooth Library of Natural Shapes Achieved with Monolithic esthetic Materials Pre op Donator/Inspiration The patient's daughter Final Design Case performed by Dr Eduardo Dantas and Well Lab Sao Paulo COMPLETELY DIGITAL, Simplifying the process by removing complicated handmade procedures. FACIALLY DRIVEN, Reducing intra oral esthetic adjustments by designing the smile based on dynamic facial and lip dynamics analysis. INTERDISCIPLINARY INTEGRATION, Test driving digitally the ideal final restorative project with ortho, perio and orthognathic procedures. ESTHETIC-FUNCTIONAL NEGOTIATION, Using Digital articulators and Jaw tracking devices to manage conflicts that can appear when integrating the esthetic design to the occlusal principles. NATURAL ALGORITHMS, Using natural morphology to design restorations, no handmade or computer suggested shapes. OPEN LIBRARY OF NATURAL SHAPES, Bringing the possibility of using any natural tooth morphology, not only the pre suggested ones from the CAD/CAM system. SO NO COMPUTER SUGGESTED SHAPES OR HANDMADE SHAPES, but instead, perfect copies of beautiful natural dentition. MONOLITHIC ESTHETIC MATERIALS, Utilizing monolithic, multi colored materials through milling and/or printing technology. From the machine to the mouth with minimal adjustments. Pre op Donator/Inspiration A third party Donator/Inspiration A celebrity Final Design Case performed by Dr Manuel Nani and DSD Lab Madrid

211 natural restauration Pre op Donator/Inspiration The patient's younger smile Final Design Pre op Donator/Inspiration The patient's daughter Final Design Pre op Donator/Inspiration A third party Final Design Donator/Inspiration A celebrity

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214 natural restauration Pre op Donator/Inspiration The patient's younger smile Final Design Pre op Donator/Inspiration The patient's daughter Final Design Pre op Donator/Inspiration A third party Final Design Donator/Inspiration A celebrity

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224 Obrigado

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226 The AMAZING things that can happen when having an

227 1848 Ohio Dental School 1895 Dental School of Pensilvania 1976 University of Sao Paulo Rio de Janeiro Medical School 1936 University of Sao Paulo University of Sao Paulo Dr John Keyes Dr Hentz Coachman Dr Robert Coachman Dr John Coachman Dr Charles Coachman Dr Christian Coachman Coachman Tradition in Dentistry since 1848

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