Oral Arts Newsletter 2012

Oral Arts Select Limited Time Special Offer $199 per Unit* For a limited time only, try Oral Arts Select for $199/unit. Select is the high-end cosmetic department of Oral Arts Dental Labs. When using Select you partner one-on-one with our highly trained ceramist. The Select Department takes every measure to deliver the highest possible quality such as:

• Cut-Back and Layer Technique • Finest Quality Porcelains Available • 8 Power Magnification Quality Control • Internal Staining and Color Modifications Choose “Select” on your most demanding patients regardless of material choice.

Select can be applied to any crown and bridge case except BruxZir Solid Zirconia and full gold crowns.

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IPS e.max Select Crowns 6-11.

Dentistry performed by Dr. Myra Stafford.

Select in-lab turnaround time for 12 units or less is 10 working days. Please call to schedule larger cases. *Send this letter with your next Select case in order to receive special pricing of $199/unit until February 28, 2013.

Regular price $260/unit.

BruxZir Lingual/Occlusal & BruxZir Crown Under Partial Case Dentistry By Dr. Mark McOmie, DMD - Chattanooga, TN One of the more difficult cases for the clinician and laboratory to complete is a crown under partial combination case.

This case highlights the use of BruxZir Solid Zirconia, BruxZir Zirconia Lingual/Occlusal, and Cast Vitallium 2000 Partial with implants and attachments.

Before: Patient presented with decaying PFM restorations and a Cast Partial with visible metal clasps.

After: Completed BruxZir Zirconia Lingual/Occlusal bridges were placed over maxillary implants. A mandibular Cast Partial was placed over GPS implant attachments and a BruxZir Solid Zirconia Crown #31.

Before: Decayed teeth were replaced with implants on #4, 5, 9, 10, 20, and #28.

After: #31 BruxZir Solid Zirconia worked well under the Cast Vitallium Occlusal Rest.

A 56-year-old white female presents to our office wanting to have comprehensive dental care. She is healthy with an unremarkable health history other than she smokes half a pack of cigarettes per day. Her chief complaint is “I would like to have my smile back and have some teeth to chew on.”

She was missing all maxillary right posterior teeth. Teeth 6,7, and 8 have PFM crowns with decay at the margins. The gingiva has receded making the margins visible. The maxillary left has a long span PFM bridge double abutted to 9,10, and 14.

The mesial abutments of 9 and 10 are decayed throughout; no tooth support remained for these two teeth. The mandibular left side is edentulous posterior to #21. #21 has a PFM crown that is serviceable and the anterior teeth are in satisfactory condition. On the mandibular right side there is a PFM bridge from tooth #28 and 31. Tooth #28 is decayed and is not

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attached to the bridge. Tooth #31 has no decay and is solid holding the entire bridge in place. Teeth #9,10, and 28 were condemned due to extent of the decay going below bone level.

All options and risks were presented to the patient to understand. She decided to replace teeth #4 and 5, with implants. The molars on the right side were not replaced due to the location of the sinus floor, which would require a sinus lift.

Teeth #9, 10, 20 and 28 were replaced with implants.

Appointment 1 (Implant Placement): Implants were placed immediately after removing the old bridgework and faulted teeth, #8,9, and 28. During this appointment implants were also placed in #4, 5, and 20. Final titanium abutments were placed on #4 and 5. #14 and 31 were re-prepped and temporized and the patient left wearing a flipper partial as a temporary.

Before: Old PFM crowns and bridges presented with decay.

Edentulous maxillary right side and mandibular left.

After: Implants with Titanium Abutments were placed on #4, 5, 9, 10. Implants with GPS attachments were placed on #20 & #28.

Before: Patient sought improved function and esthetics.

After: Enhanced esthetics was achieved by layering porcelain on the buccal/labial surfaces of BruxZir Zirconia.

Function was achieved through the use of a Cast Partial using implant attachments.

Appointment 2 (Impression): At the impression visit the crowns on the maxillary left anterior were all removed and reprepped.

Zirconia abutments were placed on implants #9 and 10. A full arch PVS impression was made. On the mandibular a full arch closed tray analog impression was made. A stick bite was also done. Integrity temporary material was used to construct the temporaries on all the prepared teeth and the implants.

Lab Collaboration At this time the case was sent to Oral Arts Dental Laboratories Inc. in Huntsville, Alabama along with Pre-Op photos. I requested a phone conference with the various department managers who would be involved with the case. Before the phone conference the maxillary and mandibular crown & bridge designs were emailed to me from their CAD software program. During the phone conference we discussed as a team the various material options and potential case designs and approved a final prescription. Viewing the case design on my office computer during the phone conference was very helpful in planning the final case.

An open line of communication between clinician and laboratory is critical to achieving the best possible outcome for the patient.

Approved Prescription Appointment 3 (Crown Cementation, Insert Cast Partial with wax rims): All the restorations and the mandibular partial were tried on the models and fit perfectly. The patient was brought in and we seated the maxillary arch entirely as well as crown #31.

We placed GPS attachments on the mandibular implants and tried in the partial with wax rims, which fit perfectly. A bite registration was made and the partial was sent back to Oral Arts Laboratories for processing using Lucitone 199 acrylic and Ivoclar Blueline Premium Teeth.

Appointment 4 (Completed Partial Insertion): The partial was inserted with no adjustment necessary.

Conclusion The patients response to her new smile was incredible, “I never dreamed it would turn out so nice!” Her husband expressed his gratitude as well and tears of happiness were shed. That day we did an in office bleaching and made take home bleach trays, which allowed her mandibular teeth to match the shade she had chosen for the crowns and partial.

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Increasing Vertical Dimension using “Monolithic” IPS e.max and BruxZir Restorations

By Dr. Samuel L. Corey, DDS - Fort Wayne, IN Fabricating successful restorations requires detailed and accurate communication between the dentist and the dental laboratory.

When increasing the VDO or any full mouth rehabilitation considerable diagnostic tools are required such as; preoperative photographs and radiographs, study models, centric relation bite registration (CRBR) and accurate measurements of the existing and desired length of the anterior teeth. The lab will then fabricate a diagnostic wax-up to the proper VDO along with a two stage putty wash matrix.

Photographs of the prepared teeth and provisionals, stump shades, a detailed diagram of the blending of shades for the permanent restorations, master impressions and accurate occlusal records are sent to the lab. This level of collaboration between the dentist and laboratory is absolutely necessary to achieve consistently successful results.

Before: Patient presented with severe occlusal wear and lost vertical dimension.

After: IPS e.max was the ideal material for the anterior due to it’s translucency and esthetics.

BruxZir Solid Zirconia blended well esthetically in the posterior without sacrificing strength.

Before: Patient desired improved esthetics and function by increasing vertical dimension.

After: IPS e.max #5-12 BruxZir Solid Zirconia #2-4, #13-15

Case Presentation: 55-year-old man presents with severe wear on all of his teeth, which developed over years due to a combination of age and bruxism. After the initial consultation, the patient agreed to re-establish a new VDO with a two-phase treatment plan that will rehabilitate his appearance, speech and function by treating the maxillary and mandibular arches with metal free restorations comprised of IPS e.max™ lithium disilicate and BruxZir™ Solid Zirconia.

IPS e.max™ Press Monolithic crowns were chosen for the anterior teeth due to the lack of tooth structure to support veneers. The posteriors were to be restored with BruxZir™ Solid Zirconia for the greater strength and fracture toughness that the solid zirconia provides. The treatment will finish with the fabrication of a night guard.

Treatment Plan: Phase I: Restore the maxillary arch.

Phase II: Restoring the mandibular arch will be planned later date due to financial considerations.

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Diagnostics: Periodontal charting and a complete series of pre-operative photographs and radiographs were taken. Alginate impressions were taken to fabricate the diagnostic models and duplicated.

A centric relation bite registration (CRBR) was taken and measurements were made of the existing teeth. This information allowed the laboratory to produce a precise diagnostic wax-up of the patients new VDO.

Before

Provisionalization: This treatment involved more of an additive technique due to the bruxism; therefore minimal tooth structure was removed.

Duplicating the wax-up and fabricating a vacuform clear template (Ivisacryl C® Great Lakes, Orthodontics, LTD) assisted with the preparation. Impressions were taken using full arch impression trays (COE® disposable spacer trays), and Vinyl PolyEther Silicone (VPES) heavy tray and light body material (EXA’lence™ GC America). Stump shades and shade selection (Chromascop shade guide by: Ivoclar Vivadent) were chosen along with digital photography to assist the laboratory. A stump shade is needed when using IPS e.max due to it’s translucency and dark stumps will need to be compensated for by the laboratory during ceramic ingot selection. Provisionals (Integrity® DENTSPLY) were sectioned into right posterior, left posterior and anterior segments. The segments were used to create a CRBR that matched the diagnostic wax-up and maintained the VDO that was created. Provisionals were then cemented, (GC TEMP ADVANTAGE®) cleaned, and polished.

After: The patient was extremely pleased with his new smile.

Conclusion: Monolithic restorations such as IPS e.max and BruxZir are becoming extremely popular due to their reliability and esthetics.

Unlike PFM’s or porcelain fused to zirconia restorations, monolithic restorations are one solid material throughout.

This significant difference nearly eliminates the risk of porcelain chips and fractures that are common when using PFM’s and porcelain fused to zirconia restorations. The combination of these two monolithic materials covers nearly every indication that is needed in the fixed restorative arena while providing improved reliability and esthetics.

Final Seating: The provisionals were removed and the preparations were cleaned using a chlorhexidine rinse (Oris® Chlorhexidine oral rinse 0.12%) and a toothbrush. The patient was isolated with cotton rolls and the final restorations were placed to confirm marginal integrity, occlusal contacts, shading and patient approval. Cementation protocols were followed (GC FujiCEM Automix) and post-op photographs were taken. Alginate impressions were made of the cemented final restorations to fabricate an occlusal night guard.

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PANAVIA™ SA CEMENT Sample Campaign All BruxZir and/or IPS e.max users will receive a FREE sample kit of Panavia SA Cement Doctors frequently inquire what is the best cement for zirconia-based crowns such as BruxZir Solid Zirconia or Forte YZR in addition to Lithium Disilicate IPS e.max crowns. Oral Arts recommends Panavia SA Cement due to its simplicity, Kuraray terms it the “Everyday Panavia”. In addition to indications for zirconia and lithium disilicate, Panavia SA can also be used on metal-based PFM’s and Full Cast Crowns as well as IPS Empress.

PLEASE NOTE: A Silane Coupling Agent such as Clearfil Ceramic Primer must be used on IPS Empress & IPS e.max.

For more information regarding Panavia™ SA Cement, please visit: www.kuraraydental.com *One sample per account, Offer expires Dec 31, 2012

Oral Arts Offers Customized Retainers With Oral Arts’ selection of acrylic colors, your patients can custom design their retainers. Choose from a variety of solid colors, decals, and glitters.

Now Offering TAP 3 Elite TL Oral Arts has added the Thornton Adjustable Positioner® (TAP®) to the line of Sleep Apnea devices. The TAP® is a simple, patient-friendly treatment solution for snoring and sleep apnea.

The TAP® holds the lower jaw in a forward position so that it does not open during the night and cause the airway to collapse. It maintains a clear airway to reduce snoring and improve breathing.

Advantages of the TAP 3 Elite TL • • • • • •

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Comfortable, custom fit Durable construction Easy to use Adjustable while in the mouth Patient can adjust at home Smaller and less bulky than other oral appliances No masks or straps involved