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Advanced Technology Raises the Level of Care

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Date: 02-22-2021 10:58:16 am


New technology seems to surface every day in the world of dentistry. This case report will document two very impressive new technologies used with the same case. A 70-year-old male presented with a full dentition, including third molars and no contraindications to dental treatment. His chief complaint was intermittent pain on the lower left posterior area with biting pressure. Intraoral examination revealed prior amalgam restorations on tooth No. 18 (Figure 1). Removal of the distal amalgam revealed a mesial-distal fracture line below the amalgam (Figure 2). This was consistent with “Cracked Tooth Syndrome,” and it appeared the fracture may have extended into the pulp area.

It seems that endodontics has always struggled with finding methods to instrument and cleanse the internal canal morphology, given the commonly convoluted shape. The GentleWave System (Sonendo) uses broad-spectrum acoustic wave energy with advanced fluid dynamics to create a vacuum effect of fluids to help cleanse the canals to a microscopic level of bacterial removal. The obturation was done with a single solid gutta-percha cone that was used to drive the obturation medium into the inaccessible areas.

A preop image was extracted from a 3D CBCT taken by Mobile Imaging Solutions and did not show any striking abnormality for tooth No. 18 (Figure 3). After a discussion of the treatment options, alternatives, benefits, and complications, the patient agreed to endodontic treatment for No. 18 using the Gentle- Wave technology. The postop radiograph shows the remarkable obturation (Figure 4).

Same-Visit Restoration
Immediately following the endodontic procedure, the access was filled with CLEARFIL DC CORE PLUS light-cured core material (Kuraray) and the tooth was prepped for a full-coverage zirconia restoration (Figure 5). The restoration would be performed using the glidewell.io In-Office Solution, which includes the iTero Element intraoral scanner (Align Technology), the fastdesign.io Software and Design Station, and the fastmill.io In-Office Mill (Glidewell Dental).

An intraoral digital scan was taken using an iTero Element scanner, and the STL file was exported directly to the fastdesign.io Software and Design Station. The fastmill.io In-Office Mill technology provides an excellent solution to immediate in-office restorations. Crowns can be made in an hour, as was done in this case. The fastmill.io can mill Obsidian (lithium silicate), Camouflage (nanohybrid), PMMA (BioTemps), and BruxZir (fully sintered zirconia) (Figure 6). Crowns made with the fastmill.io do not need to be sintered in an oven after milling. This eliminates the shrinkage that occurs with post-mill sintering. The crown was separated from the sprue and the area polished (Figure 7). The CAD design software is made to be fast and functional through its extensive library of proposed crown shapes and useful software tools.

Final polishing is not required after milling, but can be done easily using sequential slow-speed polishing wheels. Following the manufacturer recommendations, Ceramir (Doxa Dental) was used to lute the final restoration to the prepped tooth structure (Figure 8). As an empirical observation, it has been noted that the tissue surrounding zirconia restorations tends to adapt exceptionally well to the zirconia.

Conclusion​
As we seek to raise the level of care for our patients, we are learning that technology can often provide a much-desired boost to the level of care we provide. This case demonstrates the value of cutting-edge technology to a dental practice and our patients (Figure 9).




GO-TO PRODUCT USED IN THIS CASE
fastmill.io In-Office Mill
Manufactured in the United States by Glidewell Dental, the fastmill.io In-Office milling unit is a 4-axis computer-controlled mill that encapsulates technologies originally developed for the laboratory production floor in a form that fits comfortably in the dental practice. The fastmill.io makes it possible to prescribe and deliver same-appointment BruxZir Solid Zirconia restorations, with no sintering oven or dental laboratory required. The unit features a quick, electric-powered spindle and quiet operation.
Article 47 of 48

Online Continuing Education / Course Details

ADA Credits: | AGD Credits: 1 | Cost: $19.00

A Paradigm Shift in Intraoral Scanning for Better Clinical Results

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this webinar, participants will be able to:
•Determine if this technology is right for you and your practice
•Develop an understanding of intraoral scanners and their clinical applications
•Recognize that not all IOS scanners are equal

Abstract

Digitizing your impressions comes with amazing benefits for clinicians and patients. An intraoral scanner will not only simplify your current workflow, but also increase your overall production. It will provide you and your lab with more accurate information than traditional impressions, and give you the ability to design and manufacture: crowns, aligners, surgical guides, and a variety of other devices in office. 
When purchasing an intraoral scanner there are many things to consider, and with the growing number of products on the market, making a decision can become a daunting task. 
Dr. Justin Moody will walk you through a typical day in his practice and show how this technology has changed the way he practices and the impact it has had on his patients and staff. 

ADA Credits: | AGD Credits: 1 | Cost: $19.00

Course 126 of 153

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Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Maximizing CEREC Efficiency by Utilizing Your Team

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this webinar, participants will be able to:
•Define responsibilities for an efficient workflow
•Identify tools for preparing the tooth, finishing techniques, and cementation procedures
•Develop your own practice and your clinical team
 

Abstract

Dr. Butterman and his assistant, Dani Huntsman, talk about a commonly overlooked resource: your assistant! They will discuss their journey and share the predictable workflow they were able to achieve as a team. You will learn all that is involved in treating a patient using CAD/CAM technology. Efficiency is a critical component to achieving single-visit dentistry that is profitable and not stressful. Therefore, a division of responsibilities, an armamentarium of tools, the software’s capability to design the final restoration, and materials used for finishing and cementation must all work in concert. The webinar hosts will share advanced procedures that will help you get the most out of your CAD/CAM system. Get ready to be entertained as they impart tips to help you develop your own practice and your clinical team.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 123 of 153

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Kuraray Noritake 2 Day Symposium - Day 2

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Date: 10-20-2020 08:40:25 am

This session will be a critical review of the latest improvements of dental bonding systems and modern tooth preparations for optimizing minimally invasive adhesive techniques. The chemical background and physical characteristics of the adhesives will be assayed to understand their clinical capabilities. The role of the clinician will be reviewed in order to obtain the highest bonding performances in terms of improved bond strengths, extended durability, and reduced post-operative sensitivity. Also, the mechanisms that affect the stability of the adhesive interface over time will be clarified. An analysis of what factors contribute to the degradation of the hybrid layer will be discussed. Furthermore, the session will provide clinical step-by-step procedures for non-retentive bonded restorations along with biomimetic restorative principals.

 Fill out the form below to watch Day 2!
Article 39 of 48

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Kuraray Noritake 2 Day Symposium - Day 1

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Date: 10-19-2020 08:08:08 am


This session will outline clinical results of using self-etching adhesives for bonding all-ceramic crowns and onlays at the Prosthodontics Graduate Program and Center for Esthetics and Implants. It will provide a clear and structured understanding of their applications based on practical clinical experience and contemporary research bonding to lithium disilicate and zirconia. Furthermore, this session will focus on how to optimize your crown preparations for maximum efficiency and productivity utilizing CAD/CAM technology.

 Fill out the form below to watch Day 1!
Article 38 of 48

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CASE PRESENTATION: A Quick Solution for the Best Long-Term Temporary Possible

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Date: 09-18-2020 07:45:24 am



The patient presented to my office with a painful tooth No. 4 (Figures 1 and 2). On further examination, I was able to determine that the tooth/crown complex on No. 4 was mobile. We booked the patient an appointment for a 1-hour exploratory procedure to remove the composite crown that was on the tooth and to determine what needed to be done. 
When the patient came back in for her appoint­ment, I removed the composite crown and exam­ined the tooth. The post below was intact and the mobility was coming from insufficient bony support of the root. We determined that the tooth needed to be extracted. During this 1-hour appointment, the patient’s tooth had already been taken apart and she did not want to leave the office without having a tooth in the site of No. 4. With the use of the Planmeca Emerald scanner, we were able to place a temporary bridge so she did not have to walk around suffering the embarrassment of a miss­ing tooth. 
Using an ELECTROtorque Plus (KaVo), I was able to prepare tooth No. 3, which had a large metallic onlay with a poor mesial margin. We used the Solea laser (Convergent) for retraction of the margins around teeth Nos. 3 and 4. Tooth No. 3 was prepared for a full crown and pontic was cantilevered off No. 3 into the site of tooth No. 4 so that our patient could heal adequately from the extraction. 
To facilitate our design, when I prepared tooth No. 4 I cut it even with the gumline (Figure 3). I drew the crown margin for tooth No. 3, and then drew a pontic margin around the base of the re­maining root of tooth No. 4. We then designed and milled a Telio CAD temporary bridge (Ivoclar Viva­dent), and polished it so that it would be smooth and hygienic (Figures 4-7). The design was done with the Planmeca PlanCAD Software and milled with the Planmeca PlanMill 40 S (Planmeca) (Figures 6 and 7). Before inserting the bridge, we extracted the remaining root and placed some gel foam. The temporary bridge was cemented over the gap with TempBond (Kerr Restoratives) (Figures 8 and 9). 
Because we have the Planmeca Emerald, we were able to remove the patient’s tooth, restore her smile, and relieve her pain in an efficient manner—all while seeing other patients throughout the day. There is incredible flexibility in having the Planmeca Emerald scanner and the ability to mill chairside in my practice. Again, we had only scheduled her for an hour, and the goal was to give her a long-term temporary. Staff utilization for design and mill was critical to accomplishing this.
Traditionally, we would have had to take an impression, send it to the lab, get a temporary shell made, and then retrofit it in. This is a messy process that typically does not have great margins. But in this case, we were able to use digital technology to design an esthetic, fully functional, temporary bridge that had perfectly adapted margins.
Because the digital impression has already been captured and we have a digital model of what her teeth looked like before we started, we have another option, and will construct a full, 3-unit e.max bridge (Ivoclar Vivadent) when healing is complete, restoring the arch to full function. All of this will be completed conveniently in 1 additional appointment.



GO-TO PRODUCT USED IN THIS CASE

PLANMECA EMERALD 
The Planmeca Emerald is a lightweight, ergonomically designed intraoral scanner that quickly captures vivid color images in real time. A compact, slim design provides the clinician with a comfortable feel and superior control while scanning the patient and capturing an impression. Automatic fog prevention embedded into the seamless, streamlined scanner tip enables continuous scanning while the autoclavable tip prevents cross-infection and increases patient safety.
Article 35 of 48

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

New Technology to Improve Diagnostics

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this webinar, participants will be able to:
-Create a patient’s database efficiently and effortlessly
-Discern the importance of doctor-patient communication and why patients might not proceed with treatment
-Determine how to increase ROI when using an intraoral scanner
-Discover near-infrared imaging (NIRI) technology as a new standard in cavity detection and patient compliance

Abstract

Intraoral scanners have been around for quite some time. These valuable tools were first designed to facilitate the impression process for both dental practitioners and patients. Advancements in technology have increased the applications of intraoral scanning over time. Dr. Frederic Poirier uses digital scanning on almost every one of his patients to increase case acceptance and improve diagnostics. Learning about new technological developments in intraoral scanning will allow clinicians to better understand the multitude of benefits offered from these devices.

Supported through an unrestricted educational grant from Align Technologies

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 100 of 153

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Prep, Scan, Mill, Fire, and Seat 8 & 9 with Absolutely No Experience—A Real-life Success Story!

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

Topics covered:
·         An introduction of digital dentistry
·         Dispelling fears about doing same-day crowns
·         Establishing a criteria for when to “pull the trigger” to invest in new technology
·         Case study: How I successfully restored #8 and #9 with no experience
·         Measuring ROI and how my general practice may benefit financially

Abstract

Digital dentistry has evolved. What was once complicated and difficult to learn has now become intuitive and user friendly making success predictable. CAC/CAM technology eliminates concerns about margins, fit, occlusion, and esthetics. New CAD/CAM users can confidently take on cases easily with digital dentistry. See step-by-step how Dr. Cotant went from prep to seat on teeth #8 and #9 mearly 4 days after the equipment was installed and without any training or experience.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 91 of 153

Online Continuing Education / Course Details

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Abutment Workflow using a CAD/CAM Software System

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

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Educational Objectives

After completing this webinar, participants will:
»      Examine some of the options and contraindications to consider during abutment selection and learn the steps required to digitally design and submit an implant case
»      Learn the process for designing a crown restoration from a core file
»      Discuss the benefits of using a zirconia material for crown fabrication and the process of bonding the crown restoration to the abutment

Abstract

Dr. Daniel Butterman will guide webinar attendees through a digital abutment workflow using a CAD/CAM software system, including how to design a crown restoration from a core file. He also will examine the advantages of using zirconia to fabricate the final crown restoration due to the material’s strength, esthetics, and ideal fit to the abutment. Dr. Butterman will then demonstrate how to create a hole in the unsintered crown for screw-retained, pre- and post-sintering polishing, and enhancement with a paste stain. Lastly, he will discuss the process of bonding the zirconia crown to the abutment using a universal self-adhesive resin cement.

ADA Credits: 1 | AGD Credits: 1 | Cost: $19.00

Course 89 of 153

Online Continuing Education / Course Details

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

INTRAORAL SCANNING: Improving Efficiency and Advanced Workflow

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Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

Educational Objectives

After completing this course, participants will be able to identify the potential advantages of digital impression systems over conventional impressions, as well as be able to:
  1. Comprehend how digital impressions are being used to fabricate dental restorations
  2. Understand how digital impressions are impacting orthodontics
  3. Learn how digital impressions are being used in implantology
  4. Recognize the potential benefits of CAD/CAM technologies
  5. See the potential in diagnostics and communication with patients.

Download this course PDF
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Abstract

Digital impressions are reshaping the way modern dentistry is being practiced. They are able to eliminate some of the issues found with conventional workflow and provide clinicians with unique advantages compared to traditional impression techniques. With various implications in the field, digital scanners are making their mark on the profession. This article will review some of the advantages of digital impression systems over their conventional counterparts, as well as review how they are currently being used in practice today.

COMMERCIAL SUPPORTER: This educational activity is made possible through an unrestricted educational grant from Align Technologies.

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Course 77 of 153