Let s Stick it Together

Transcription

1 Let s Stick it Together Let s Stick it Together: 1. Let s Grow Tooth 2. Cementation Sanity 3. Most Durable Aesthetic Indirects EVER 4. Regenerative Aesthetics 5. Implants, bridges, rehab cases eurekasmile.com 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, it never hurt until you FIXED it Let s Grow Some Tooth Bioactive [bi o-ak 0v] having an effect on or elici0ng a response from living 0ssue. Regenerative To provide an environment that promotes dentin repair Let s Grow Some Tooth To provide an environment that promotes tissue repair Optimal ph Anti-microbial 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 A resin inomer that release and recharges calcium phosphate and fluoride A bioactive resin matrix and bioactive glass filler. High polymerization Ca, phosphates, fluoride release Better looking than GI s Slightly opaque Great GI substute Not polishable like composite Not as aesthetic as giomers 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 ion release by S-PRG: A stable glass ionomer family of restorative which allows ion release and recharge. The surface layer is protected giving great physical properties. The glass core is protected from moisture. Jack D Griffin Jr DMD 1

2 Let s Stick it Together Margin Perfect Matrix. com Perio Protect system Problems with posterior composites? Contacts Shrinkage Depth of cure Sensitivity Longevity Time Can t afford to re-use burs Fl & Giomers slow release "re-charge "re-release Regenerative Dentistry Providing an environment where tissues can heal Microcopy No direct pulp capping if Caries indicator Sable Seek Ultradent A source of reparative ions Alkaline environment Promote dentin healing Bacteriostatic Dentin tubule sealant Thermal insulation NOTE: Polyacrylic acid of GI inhibits HA formation Spontaneous pain Throbbing PA problem Bleeding hard to control Jack D Griffin Jr DMD 2

3 Let s Stick it Together Micro Etcher Prep Star 50 micron aluminum oxide Danville Engineering Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable Advantages Decrease sensitivity Non-invasive Esthetic Root seal Predictable Profitable Does killing bugs matter? Enamel: Bevel Etch DBA Dentin: Sand DBA Matrix metalloproteinases = MMP s enzymes that may break down the hybrid layer between dentin and resin Cured giomer Where It Matters Most Where it matters most Margins Dentin Where our technique is most critical bioactive/regenerative material location Regenerative environment Jack D Griffin Jr DMD 3

4 Let s Stick it Together Beautifil Bulk flowable or packable Shofu 4mm depth Somewhat clearish Good color Low shrinkage Good strength Easy to form contacts Giomer bulk fill Fluoride release The splint GrandTEC VOCO Cementation Sanity The most durable aesthetic Cementation restorations EVER. Sanity (and how to stick em in) mon o lith ic [mon-uh-lith-ik] Adjective NO layering porcelain What changed? "E.max changed everything. "Zirconia added security. "Better adhesion made it more efficient. Use the strongest material that meets the minimum cosmetic need of the patient. e.max zirconia PFM gold 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 Microcopy Single use burs mm clearance, 0.5-1mm chamfer 0.8-1mm rounded 1.5-2mm 0p Jack D Griffin Jr DMD 4

5 Let s Stick it Together Cement? Bond? Etch? No Etch? Dry? Wet? Moist? Light cure? Self cure? Great bonding CANNOT overcome a poor prep Cementation Sanity Cementation sanity Non-Adhesive GOOD 1. Resin Modified GI most popular RelyX Lu0ng (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) Beau0Cem (Shofu) 2. Moderate bond to denhn 3. Strengthens restorahon moderately Cementation sanity CERAMIR Doxa DBA + Dual Cure Resin BEST 1. Universal DBA All Bond Universal (Bisco) Scotchbond Universal (3M) Mul0Link Primer A&B (Ivoclar) 2. Dual cure resin cement DuoLink Universal (Bisco) Rely X Ultimate (3M) Mul0Link(Ivoclar) 3. Highest bond to denhn 4. Highest restorahon strengthening GI plus calcium aluminate Regenerative 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 Cement for: regeneration easy clean up efficiency Cement Bond Emax 95% bond Zirconia 95% cement Bond for: more retention stronger porcelain better aesthetics Z-PRIME PLUS Single bottle Metal primer Sand blast Apply then air thin NO bonding on crown Highest bond to zirconia Works with dual cure, self cure, or light cure resin cements 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 e.max No sandblasting 5% HFl 20 secs Rinse well Silane Dry Frosty Not chalky Jack D Griffin Jr DMD 5

6 Let s Stick it Together Porcelain prep 4-5% HFl 20 seconds Rinse Dry Silane Brush in 60 seconds Dry Frosty Tooth prep Isolate All Bond U Massage in Air thin Cure Zirconia: Good prep: Anything is good "Cements Ceramir, RMGI "Self Adhesive BeautiCem "Adhesive DuoLinkU/ABU Less than ideal prep: Need adhesion "Zironia primer Z Prime Plus "Self Adhesive BeautiCem, SpeedCem "Adhesive DuoLinkU/ABU Cementation sanity Lithium Disilicate: Good prep: Anything is good "No esthetic concern:cement Ceramir, RMGI "High esthetics " "Self Adhesive BeautiCem " "Adhesive DuoLinkU/ABU Less than ideal prep: Need adhesion "Self Adhesive BeautiCem "Adhesive DuoLinkU/ABU Cementation sanity Implant Crowns RestoraHon success Bio-friendly cements Thorough clean up Good reten0on Soa 0ssue tolerance Air abrasion Frosted Supra G Impression coping Nobel Snappy Closed tray Panasil (Kettenbach) Anutra Lidocaine Buffered Less discomfort Intense Block in 4-5 minutes 5.0mm Nobel Biocare Titanium abutment Implant Direct Jack D Griffin Jr DMD 6

7 Let s Stick it Together Monolithic Bridges E.Max Anterior only 3 unit max 3mmX3mm connectors Zirconia Esthetics the limit Length no matter 3mmX3mm connectors Conservative success Single path of insertion Boxes Maximize enamel Parallel to path of closure Zr primer Total etch Dual cure resin Graft Collagen tape Zone Free (Dux) zinc oxide temp cement Pumice 2% Chlx Panasil Futar Kettenbach Consult Wear Rehabilitation Zirconia E.max Veneers The porcelain: Visco Stat Clear Try in Rinse Ivoclean Rinse Silane Veneers The teeth: Isolate Pumice Rinse Cavity Cleanser Rinse DBA Variolink LC Jack D Griffin Jr DMD 7

8 Let s Stick it Together 3 pillars of occlusion: Simultaneous centric Anterior disclusion Cuspid rise Questions? esmilecenter@aol.com Jack D Griffin Jr DMD 8