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VLC Record Bases Increase Predictability in Removable Prosthodontics
Regenerate Your Crown/Bridge Processing Introduction to GC One Body Concept
May 2010
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In this issue‌ Smiles is the official journal of the Dental Laboratory Association of the State of New York
Executive Board and Staff President William Baum, MDT, CDT Bill Baum Dental Studio Inc.
Editorial ......................................................................... 4 Ettore Palmeri, MBA, AGDM, BA, B.Ed
VLC Record Bases
Increase Predictability in Removable Prosthodontics ............ 6 Allen Schneider, DDS
Regenerate Your Crown/Bridge Processing
Introduction to GC One Body Concept ............................. 14 Vice President, Education Technician Relations Raymond Rayeski, CDT Highland Acres Dental Labs Inc.
Luke S. Kahng, CDT
Secretary Mark Viscusi Viscusi Dental Lab
How to contact us Congress Gary Spadaro, Jr. Liberty Dental Laboratory 518-344-5372
Membership Gary Spadaro Sr. Liberty Dental Laboratory
Professional Relations Gail Broderick, MDT Jason Kim Dental Laboratory
Publisher Ettore Palmeri, MBA, AGD, B.Ed., BA, Palmeri Publishing Inc.
Treasurer/Budget & Finance Paul Federico, MDT
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Design & Layout: Samira Sedigh Lindsay Hermsen B.Des.Hon.
SMILES is published four times a year by Palmeri Publishing Inc. Known office of Publication, 2424 Niagara Falls Blvd., Niagara Falls, NY 14304 USA. Application to mail at Periodicals Postage Rates is pending at Niagara Falls, NY 14304 USA. Postmaster send address correction to Palmeri Publishing Inc., Box 1068, Niagara Falls, NY 14304.
Contributions from clinicians, lab owners, suppliers, readers, etc., are solely the opinion of the writers and do not constitute the endorsement of this publication or its staff. SMILES makes every effort to report clinical information and manufacturer’s product news accurately but cannot assume responsibility for the validity of product claims or for typographical errors. The publishers also do not assume responsibility for product names, claims, or statements made by advertisers.
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Editorial
Ettore Palmeri, MBA, AGDM, BA, B.Ed
The Future is Ours‌ ith retirement savings decimated and jobs and houses lost during the panic of 2008-2009, fear and anger are understandable. We all want someone to blame and there is plenty of blame to go around. However, upon reflecting on the overall economic situation, I feel that there are also many good reasons to be optimistic today. We live during a period of unbelievable technological progress in all job sectors. The combination of technology and entrepreneurship is pushing many of us toward great new inventions right now, as it has for hundreds of years. Productivity is booming once again, we continuously hear that the potential of the Internet has barely been realized and that new drugs and medical equipment are being created at a frenetic pace. It is evident that the rate of change is not going to slow down. Knowledge, technology and competition seem to multiply, increasing yet again the speed of change to almost breathtaking levels. To ensure that your life stays on a trajectory of increasing success, your goal should be to become a master of change rather than a victim of change; thus we need to embrace the opportunities change brings. I cannot count how many times I have heard dentists discuss their business and their career strategies and say that they wished they had acted more decisively on what they were facing, regardless of the external circumstances. They all feel that this action would have allowed them to take immediate control of a situation rather than waiting for an event or someone else to be their catalyst. The most successful people in life are those who recognize that an opportunity is generally disguised as challenge and are willing to invest their time, effort and money to face the challenge and embrace the opportunity. I am often asked how we can recognize an opportunity when it is not clearly evident. My best suggestion is to practice looking at your life, career, and business as an optimist. We need to be aware that life and business experiences uncover different situations and thus different learning opportunities. Now, as in the past, we need to engage in social and professional events within our communities. This broadens our horizons and expands our minds, ultimately helping us find those hidden opportunities we are looking for. The optimistic characteristic mentioned above has to be supported by self awareness. It is extremely important that we understand our strengths and weaknesses, our values and our vision for the future. At this stage, we can be in a position to recognize opportunities when they present themselves. A characteristic that most successful and happy people have is that they are intensely future oriented. They think about the future most of the time. They refuse to dwell on what has happened in the past or on things that cannot be changed and are willing to learn from them. At the same time, the same individuals focus on factors that are under their control and on the actions they can take to create the kind of future they desire.
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Allen Schneider, DDS
VLC Record Bases Increase Predictability in Removable Prosthodontics Abstract
Case Study
Management of partially edentulous patients can still be a prosthodontic challenge. Replacing the missing teeth with conventional removable partial dentures (RPDs) is the traditional method for the treatment of partial edentulism.1 The development of sophisticated nar row diameter implant tec hniques to produce satisfying results improves prosthetic rehabilitation.2 Visible Light Cured (VLC) resins significantly increase the predictability of a restoration, contributing to the precise planning of bot h implant placement and subsequent esthetic and functional rehabilitation. In t his case, a patient presenting wit h anter ior mandibular restoration needs was rehabilitated with a reinforced VLC partial denture, supported by locator implants. This proved to be a clinically predictable and cost effective treatement for the partially edentulous patient.
The prosthodontic rehabilitation section of this case study begins with a patient presenting as in figures 1, with three implants (Locator, Zest Anchors, Escondido, CA) in place. Two of these were in the root canal of anterior mandibular teeth, and the third in the mandible itself (Fig. 1a).
Fig. 1a: Patient at presentation
Fig. 1b: Marked Master Model
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VLC Record Base as a Lab Communication Tool To initiate the prosthodontic rehabilitation, a final impression was taken using a VPS material and a disposable tray (Exafast and COE, GC America, Alsip, IL) with locator analogs in place. Putty VPS was placed in the palate to create a box rim analog. The master cast was poured using a fast setting gypsum composite (Earth Stone, TAK Systems, Wareham, MA). The boundaries of the record base were marked on the model (Fig. 1b), after block out was accomplished using a contrast-colored modeling compound (Play-Doh, Hasbro, Pawtucket, RI).
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Fig. 2a: Triad Gel Outlining
Fig. 2b: Triad Transheet Record Base
Fig. 3a: Cured Record Base on Model
Fig. 3b: Gingival Aspect of Record Base
Fig. 4a: Record Base with Retention
Fig. 4b: Final Jaw Relation Record
Visible Light Cured resin Gel (Triad, Dentsply Prosthetics, York, PA) was then used to follow the outline (Fig. 2a). A length of about an inch at a time was laid out following the markings. The Triad Gel was tack-set with a handheld light (Coltolux, Coltene Whaledent, Cuyahoga Falls, OH) to increase stability in handling, though the manufacturer’s directions do not call for this step. This step offers a clear boundary to fabricate the record base in the next step. Transheet VLC record base material (Triad, Dentsply Prosthetics, York, PA) was adapted to the boundaries marked by the Triad gel (Fig. 2b). Note that the record base is kept 2DLANY Smiles
3mm below the plane of occlusion, and notches are created in it. The record base is then cured according to directions in the Triad 2000 VLC curing unit (Figs. 3a, 3b). The cured record base then becomes an effective lab communication tool.3 The Triad record base fabricated in the previous step can be enhanced by the addition of a simple bite registration step. The notches placed in the record base act as a mechanical retention. Recall that the record base is fabricated to fit well below the plane of occlusion by 1-2mm (Fig. 4a). The final jaw relation record can then be picked up with a VPS registration material (Fig. 4b) with a mousse-like viscosity 7
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Fig. 5a: Bite Registration with Record Base
Fig. 6a: Cast Vitallium Framework
Fig. 7a: Adapting Eclipse to Model
(Access Blue, Centrix, Shelton, CT). The bite registration (Fig. 5a) can then be transferred into mounted casts (Fig. 5b), giving the laboratory comprehensive information about the case, including all relevant spatial relationships.4 Overall, this process cuts down a process of 2-3 appointments to 60-90 minutes.
Partial Denture Fabrication and Delivery Given the span of the partial denture and the flexure constraints imposed by the implants, I decided to prescribe a hybrid partial denture – one created of a visible light cured denture base resin (Eclipse, Dentsply Prosthetics, 8
Fig. 5b: Mounted Casts
Fig. 6b: Framework in Mounted Cast
Fig. 7b: Reinforced Eclipse Baseplate
York, PA) reinforced with a durable chrome-cobalt alloy (Vitallium 2000, Dentsply Prosthetics, York, PA). The contour and set-up resin areas on this RPD would be fabricated using a conventional high-strength acrylic (Lucitone 199, Dentsply Prosthetics, York PA). The design and fabrication of the cast partial framework is illustrated below (Figs. 6a, 6b). The framework was microetched and coated with a primer (Metal Primer II, GC America, Alisp IL). The choice of VLC resin systems for the partial denture base is also significant. Processing of the dentures with traditional methods has been a time consuming procedure. This normally delays delivery of the finished dentures following the try-in appointment.
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Fig. 8a: Record Base with Wax Fig. 8b: Patient Try-In
Fig. 9a: Finished RPD
Fig. 9b: Finished RPD – Alternate View
Fig. 10a: RPD Insertion
Fig. 10b: RPD Insertion – Alternate View
Utilizing the new lightcurable system, Eclipse (Dentsply Prosthetics, York, PA), baseplate processing time can be shortened to less then thirty (30) minutes.5 A further advantage to the system is that the resin is processed directly on to the model, reducing the possibility of distortion in injecting (Figs. 7a, 7b). The processed Eclipse base plate is used with wax and highly cross-linked acrylic teeth (Portrait IPN, Dentsply Prosthetics, York PA) for try-in (Fig. 8a). The patient expressed satisfaction with the occlusal scheme after minor modification (Fig. 8b). Functionality was verified with phonetic excursions.6 A high impact strength denture base acrylic (Lucitone 10
199, Dentsply Prosthetics, York, PA) was used to create the contour and set-up areas of the partial denture using a conventional flasking process. The finished denture was esthetic, and created an excellent fit (Figs. 9a, 9b). The manufacturer recommended tool (Zest Anchors, Escondido, CA) was used to remove the locators. Male locator retention options were evaluated, and straight locators (3-1.5lb torque) were selected. The male locators were inserted into the RPD, and the final result delivered to the patient (Figs. 10a, 10b). The patient expressed esthetic and functional satisfaction. He was subsequently instructed in home care and dismissed. DLANY Smiles
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Summary Implant supported RPDs deliver many of the combined advantages of fixed and removable partial dentures to t he patient. The use of an expedited clinical and laborator y sequence, featuring visible light cured systems (Triad, Eclipse, Dentsply Prosthetics, York, PA) enhances efficiencies in delivering patient care. The predictability of the prosthodontic rehabilitation, in the author’s opinion, was significantly increased by use of the VLC record base and final RPD base.
About the Author Allen L. Schneider, D.D.S., F.A.G.D., D.I.C.O.I., is a graduate of Georgetown University School of Dentistry, and maintains a prinvate practice in Springfield, VA. He is an adjunct instructor in the Restorative Department; Tufts University School of Dental Medicine, and also services as a consultant to t he V.A. Hospital General Practice Residency Program in Martinsburg, West Virginia. He lectures nationally and internationally and has articles published in the field of Dental Implantology.
References 1. Chikunov I, Doan P, Vahidi F., Implant-retained partial overdenture with resilient attachments, J Prosthodont. 2008 Feb;17(2):141-8. 2. Aydin M, Yilmaz A, Kâtiboğlu B, Tunç EP, ITI implants and Dolder bars in the treatment of large traumatic defect of mandible: a clinical report, Dent Traumatol. 2004 Dec;20(6):348-52. 3. Har vey WL, Brada BJ, An update of a one-appointment master impression and jaw relation record technique, Quintessence Int. 1992 Aug;23(8):547-50. 4. Fish SF, Partial dentures. 2. Jaw relationships, Brit Dent J. 1970 Mar 17;128(6):289-92. 5. Kurtzman GM, Melton AB, Full arch removable prosthetics with Eclipse, Spect. Denturism 2008 Mar 2(1), 1-8. 6. Pound E. Controlling anomalies of vertical dimension and speech. J Prosthet Dent. 1976;36(2):124-135.
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Luke S. Kahng, CDT
Regenerate Your Crown/Bridge Processing Introduction to GC One Body Concept hat is One Body Concept? It is feldspathic based, blended porcelain which gives the option of A, B, C and D shade possibilities. The product was invented with the goal of saving your laboratory time but still delivering high accuracy and fewer remakes through repetition in shading. How is it different? One Body offers a one-color porcelain build-up powder so it does not require an enamel translucency build-up. Instead, those characteristics will be yielded with GC Initial IQ Lustre Paste, a porcelain particle with stain, since One Body is not meant to be applied on the incisal area. One Body Concept works with conventional porcelain alloys, but by using only one porcelain powder. As we have all noticed, the field of dentistry has been flooded with new computer technology. The latest
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inventions are CAD/CAM and digital impressions, all revolutionary and intended to improve the working lives of clinicians ever ywhere. But what about dental technicians? Has all this technology changed the way they create their restorations? For the most part, no, it hasn’t affected the way they are layering porcelain at all. Technicians are using a tried and true system and since it works, there has been no reason to change. And frankly, in my opinion, layering porcelain is still the best way to create life-like restorations most of the time. But what about t he rest of t he time? Has anyone invented another way to get the same results? That is what we will discuss in the following case studies, along with how to communicate better information regarding patient shading.
Case 1
Fig. 1: Pre-operatively, the crowns on central teeth numbers 7 and 8 did not match the shape and color of the crowns on numbers 9 and 10.
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Fig. 2: The new LSK shade guide is used to check the A2 dentin color of prepped tooth #9.
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Fig. 3: The clear incisal tip is checked with the shade guide, which reminds the technician to mimic that appearance with the final restoration.
Fig. 4: Opaque porcelain creates this appearance on the cast model.
Fig. 5: Build-up in “A” shade is applied to the body of the restoration for #8.
Fig. 6: The next step is One Body “A” shade build-up on tooth #7.
Fig. 7: Firing at 900º C creates this bumpy surface appearance.
Fig. 8: Before glazing, contour and surface texture are added to the bisque bake stage.
Laboratory Procedures
new GC One Body Concept was also a possibility. So why not try it and see if we could save our time and effort? If the results are the same, what difference could it make? A prep view of tooth #9 compares with the LSK shade guide A-2 dentin color (Fig. 2). The incisal tip is clear and after checking it with the same shade guide, it reminded us to mimic that appearance (Fig. 3). A-2 Opaque color was applied to #8 (Fig. 4) followed by the build-up of “A” shade to the body of the crown (Fig. 5). Again, a GC One Body build-up is applied in shade “A” but this time to tooth #7 (Fig. 6). After firing at 900º C, the crowns’ appearance is very bumpy – almost like the concrete surface of a sidewalk (Fig. 7). Contouring and surface texture are created and put into the bisque bake stage before glazing (Fig. 8).
In the first case we will talk about teeth numbers 7 and 8. They were covered by crowns made with very nice enamel overlay to the dentin, which created a natural and life-like appearance, but were not a match with the adjacent teeth (Fig. 1). This is because teeth numbers 9 and 10 were restored using PFM crowns which had grown old over time and were opaque in color. The prescribing clinician had chosen shade A-2, which all alone will create that opaque look. We were being asked to match those ten year old crowns and the question was: how? We could have used opaque dentin and less translucency but the DLANY Smiles
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Fig. 11: Final restorations are shown on the cast model.
Fig. 9: GC Initial IQ Lustre Paste in “A” stain will be used to modify the crowns.
Fig. 10: Clear incisal edge is created with light gray color.
GC Initial IQ “A” Lustre Paste is applied next to create the A-2 color (Fig. 9). Subsequently, the clear incisal edge is created with a light grey color paste (Fig. 10). The final restorations are displayed on the cast model (Fig. 11). Next the final view (Fig. 12) in the mouth is photographed.
Case 2
Fig. 12: In the mouth, final restorations blend harmoniously with the adjacent teeth.
Fig. 13: A surface texture check is performed on tooth #10, an old crown, with the LSK shade guide.
Fig. 14: Preparation view for tooth #10.
Fig. 15: The A-1 base is opaque.
Fig. 16: The One Body Concept build-up is applied.
In the next case, we were presented with an old crown on tooth #10. The first custom shade check was to determine the patient’s surface texture with the LSK shade guide (Figs. 13 and 14) displays the clinician’s prep design.
The base shade for the restoration is A-1 opaque (Fig. 15) with the One Body build-up applied next (Fig. 16). The Lustre Paste application in a “B” color will create incisal translucency (Fig. 17).
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Fig. 17: Lustre Paste in a “B” shade is next applied to create incisal translucency.
Fig. 18: Vibration with a dental instrument helps spread the paste evenly, before firing at 780º C.
Fig. 19: The lustre paste was applied in a thin layer because if it had been thicker, it would not have matched the patient’s texture.
Fig. 20: GC Gradia polish is applied next to produce proper texture.
Fig. 21: With the help of a Robinson brush, the crown is polished and ready for seating.
Fig. 23: The restoration is seated and photographed in the patient’s mouth.
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Fig. 22: A try-in is completed on the cast model.
With a dental instrument in hand, vigorous vibration helped spread the paste evenly on the restoration (Fig. 18) after which it was fired at 780º C. The patient has surface texture which had to be a consideration in the final preparation, so the Lustre Paste was not applied too heavily. If it had been, the texture would not have matched with the patient’s adjacent teeth (Fig. 19). In the final step, the surface was polished using GC Gradia (Fig. 20) and a Robinson brush (Fig. 21). The final restoration is displayed on the cast model (Fig. 22) and in the patient’s mouth (Fig. 23). DLANY Smiles
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Case 3
Fig. 24: Before preparation, tooth #5 will be a Maryland Bridge.
Fig. 25: Prepped occlusion view.
Fig. 26: Final inlay/onlay GC Milling Center bridge.
Fig. 27: Final restoration in the mouth.
Our last case presentation involves a Maryland bridge for tooth #5, with before prep view (Fig. 24). Next is an occlusal view of the prep (Fig. 25). The GC Milling Center in Costa Mesa, CA, fabricated the final inlay/onlay Maryland Bridge (Fig. 26). The final restoration is shown in the mouth (Fig. 27).
It is not limited to either posterior or anterior teeth; you can use it with both. The product recommends itself – give it a try.
Conclusion As you can see from the case photographs, GC’s One Body Concept will give us esthetic results when the circumstances are right, especially for the molars. Porcelain layering still works best under most conditions, but why waste time and product unwisely if you don’t need to? How do you know when that is the case? Look especially for the cases when you are asked to match a fake crown or a surface texture. Building up your porcelain is not required with those types of restorations and the One Body Concept, along with the porcelain particle staining will work very well. DLANY Smiles
About the Author Luke S. Kahng, CDT has been a dental technician for over two decades; founded Capital Dental Technology Laboratories, Inc., parent company of LSK121, Oral Prosthetics laboratory in 1996. He has been published extensively in dental magazines including The Journal of Aesthetic Dentistr y, Practical Procedures and Aesthetic Dentistr y, The Journal of Cosmetic Dentistry, QDT Book, Spectrum dialogue, Contemporary Esthetics, Inside Dentistry and Functional Esthetics, and TeamWork. He is a Section Editor for PPAD magazine as well as a Spectrum dialogue board member. A strong proponent of collaborative dentistr y, Mr. Kahng stresses education, communication and a team approach to patient care, resulting in maximum function, comfort and esthetic appeal.
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Smiles Announcements & Products Vident – Winner of Inaugural Prescribevita.com Contest
David Guichet, DDS and Debra Wasky, CDT of Providence Prosthodontics Dental Group are the inaugural winners of Vident’s prescribevita.com contest. Doctors and technicians were invited to submit their best before and after case study to prescribevita.com, Vident's interactive website that provides a place to share before and after case photos, explore the entire line of VITA restorative materials and gain access to specials and discounts. A panel of independent experts reviewed the cases submitted based on dental esthetics and selected the case from Providence Prosthodontics Dental Group as the winner. The winners received a $1,000 check and a special commemorative plaque. For more information, call 800-828-3839 or visit www.vident.com.
____________________ GC Advanced Technologies & Precise Structures Create Strategic Partnership
allow both companies to design and GCAT to mill custom abutments including multiple Zr shading. While abutment design will utilize Precise's expertise, the milling of custom abutments will take advantage of GC's materials and milling technology. Both scanning and designing will also take advantage of 3 Shape scanning and software. For more information, contact Mr. Brian Sanchez, National Sales Manger, GCAT at 866-925-4228, Mr. Kim Karpowitz, President, Precise Structures at 949-582-1824, or visit www.gc-at.com or www.precisestructures.com.
Additional features include a new program structure that offers 120 Ivoclar Vivadent programs and 500 individual programs, a color touch-screen with modern user interface and color graphic display, Thermo Shock Protection (TSP) to prevent thermal shock of the ceramic if the furnace head is closed while it is too hot as well as Cooling Shock Protection (CSP) to prevent tension within the ceramic with a special furnace head opening process. For more information call 800-533-6825 or visit www.ivoclarvivadent.com.
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DTI Appoints Lee Culp, CDT, as Chief Technology Officer
Dentsply TruRxTM - Digital Denture Solutions
Dental Technologies, Inc. (DTI) announced the appointment of Lee Culp, CDT to the position of Chief Technology Officer (CTO). Mr. Culp brings more than 30 years of laboratory and technology experience to DTI. Prior to joining the company, he served as Vice-President of Dental Technologies at D4D Technologies, where he guided the development of a variety of technologies for use in both dental practices and dental laboratories. He will continue to serve as a consultant to D4D Technologies, as well as to lecture and lead advanced training courses on the E4D CAD/CAM system.
____________________ Ivoclar Vivadent – Fire and Save
GC America’s newest division, GC Advanced Technologies Inc. (GCAT) is proud to introduce a new strategic partnership. GC Advanced Technologies Inc. and Precise Structures, Laguna Hills, CA. are sharing digital technologies that will
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Ivoclar Vivadent is introducing the new power-saving, secondgeneration Programat 500 ceramic furnace at the Chicago Midwinter meeting. The furnace's new power-saving technology is said to reduce power consumption in the stand-by mode by 40%.
A new, integrated approach to tooth mould selection and denture prescription, TruRx Digital Denture Prescription software shows great promise in improving process ease-of-use and clinical outcomes. TruRx is a chairside, digital prescription tool that facilitates the denture consultation while addressing key therapeutic considerations, helping to make the denture process easy, consistent, and profitable for denturists and dental professionals. TruRx guides the dental professional and the patient through the key denture considerations with interactive screens. The unique strengths of the TruRx Digital Denture Prescription software lie in built-in intelligence to select suitable dental restoration options interactively with a patient and view the results live with them. The win for patients, dentists, and laboratories is improved information, selection accuracy, efficiency, esthetic outcomes, and overall satisfaction. For more information, please contact 1-800-263-1437 or email prosthetics.canada@dentsply.com.
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AESTHETICS AND TECHNIQUES FOR NEW MATERIALS Author: Paolo Smaniotto, 214 pages , 9.5” x 13.5”, hard cover. Price: $179.00 plus S&H. For more information, visit www.spectrumdialogue.com
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KNOWLEDGE IS THE BASIS; SUCCESS IS THE RESULT Author: Paul Giezendanner, 88 pages , 8.25” x 9.5”, soft cover. Price: $69.00 plus S&H. For more information, visit www.spectrumdialogue.com
SMILE SELECTION Author: Luke S. Kahng, 117 pages, 8” x 10.875”, hard cover. Price: $169.00 plus S&H. For more information, visit www.spectrumdialogue.com
ANATOMY FROM NATURE Author: Luke S. Kahng, 62 pages, 11” x 9” x .5”, hard cover with full colour images. Price: $99.00 plus S&H. For more information, visit www.spectrumdialogue.com
ESTHETIC GUIDE BOOK Author: Luke S. Kahng, 60 pages, 9” x 11”, hard cover with full colour images. Price: $99.00 plus S&H. For more information, visit www.spectrumdialogue.com
AESTHETIC & RESTORATIVE DENTISTRY Author: douglas A. Terry, DDS, 770 pages, 8.5” x 12”, glossy hard cover with full colour images. Price: $330.00 plus S&H. For more information please visit www.spectrumdialogue.com
SURFACE TEXTURES - The Theory of Surface Marks Author: Giuseppe Spina, 96 pages, 8 3/8” x 9 3/8”, glossy hard cover. Price: $99.00 plus S&H. For more information, visit www.spectrumdialogue.com
THE INCISAL EDGE: The Strong Point in the Expression of an Incisor Author: Attilio Sommella, 176 pages, 8” x 10”, glossy hard cover. Price: $139.00 plus S&H. For more information please visit www.spectrumdialogue.com
Mail orders to: Palmeri Publishing Inc., 35 145 Royal Crest Court, Markham, ON Canada L3R 9Z4 Phone Orders: 905. 489.1970 • Fax Orders: 905. 489.1971 • Online Orders: www.spectrumdialogue.com
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