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Replacing Old Veneers with Celtra Press Crowns - Lori Trost, DMD

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Date: 08-30-2021 19:09:08 pm


A 57-year-old patient presented with 18-year old veneers that were failing (Figures 1 and 2). Marginal breakdown, abfractions, and decay—particularly on the lingual aspect—were present. The treatment plan was to replace the veneers with full-coverage crowns to reduce the possibility of recurrent decay and marginal breakdown. The case called for esthetics, but also involved the selection of a ceramic material that would provide strength and resiliency for proper restorative demands.

Shade Matching and Crown Prep
Before beginning the crown preparations, a VITA shade guide (VITA North America) was used for shade matching (Figure 3). As shown, this patient had coloration fluctuations of A1 and B1. When determining which ceramic material would be used to fabricate the crowns, Celtra (Dentsply Sirona) was at the top of the list for not only the strength it provides, but also because of its chameleon esthetics.

To anesthetize the patient, 4% Septocaine (Septodont) was selected and an OptraGate facial dam (Ivoclar Vivadent) was used for retraction. The teeth were prepped using a minimum of 1 mm equigingival shoulder preparations (Figure 4). Care was taken to round all preparation angles per the laboratory and manufacturer’s guidelines. The preparations were also smoothed with fine diamonds and polished to remove any roughness and set the stage for improved impression capture. Knit-Pak retraction cord, size 0 (Premier Dental) was gently tucked into the sulcus of the tooth.

To aid the impression making, Traxodent (Premier Dental) was circumferentially syringed on top of the retraction cord/sulcus moat. After approximately 4 minutes, the retraction cord was removed and the preparations rinsed off and dried. A single step impression was made using Aquasil Ultra Heavy in the tray and Aquasil Ultra XLV Wash (Dentsply Sirona) syringed around each preparation. After the recommended 5-minute set time, the impression was removed, evaluated, and approved for lab submission.

The process of fabricating temporary crowns began. Before the preparation phase, an impression model was made of the patient’s initial presentation using an anterior tray filled with Algin-X (Dentsply Sirona). This impression served as a model for his anterior temporaries. Figure 5 shows the temporaries fabricated with Integrity Multi-Cure (Dentsply Sirona) and cemented with Integrity TempGrip (Dentsply Sirona).

Seating and Final Outcome
When the patient returned a week later for the final crowns, the temporaries were removed and each tooth preparation was cleansed with a generic chlorhexidine 0.12% scrub, with care taken to keep the dentin moist. Each Celtra crown was tried-in and slight adjustments were made interproximally.

A selective etch method was applied to the enamel of the exposed shoulder preparations using a 35% phosphoric acid for 15 seconds. The phosphoric etch was copiously rinsed for 5 seconds and a high vacuum suction was blanketed on each prep for 1 to 2 seconds, allowing each to remain moist. Prime & Bond Elect (Dentsply Sirona) was dispensed and agitated on each preparation for 20 seconds, followed by a gentle, clean air stream for 5 seconds. Each preparation was then independently light-cured for 10 seconds. Calibra Ceram (Dentsply Sirona) was expressed to an even flow and loaded into each Celtra crown (Figure 6). The crowns were seated in order of the centrals and then lateral teeth, with each receiving a tack or wave cure at the gingival margins—both facial and lingual aspects—for 5 seconds using the SmartLite Focus LED curing light (Dentsply Sirona).

The crowns were left undisturbed, and after 2 minutes, the Calibra Ceram was gently peeled off the margins using an explorer. All margins cleaned nicely without needing to use a finishing bur to remove any residual cement. All of the crowns were flossed and the occlusion was re-verified (Figure 7). The patient was dismissed and instructed to return soon for pictorial evaluation and for nightguard fabrication using Kombiplast (Denstply Sirona) (Figure 9). Both the patient and I were very happy with the results.

Article 48 of 54

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HOT TOPIC: Practice Building with Oral Conscious Sedation

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Date: 07-15-2020 08:18:02 am

At first I didn’t hear it, but then it happened again...A giggle. Then another giggle. We had just completed a 1 ½ hour restorative appointment. I was taking off my gloves in preparation to talk to the patient’s driver in the waiting room when I first heard it. The third giggle became a cascade of giggles that quickly dissolved into laughter.

At first I didn’t hear it, but then it happened again...A giggle. Then another giggle. We had just completed a 1 ½ hour restorative appointment. I was taking off my gloves in preparation to talk to the patient’s driver in the waiting room when I first heard it. The third giggle became a cascade of giggles that quickly dissolved into laughter. The patient’s laugh was beginning to affect my assistant, who now was starting to laugh herself. I glanced at the patient with an inquisitive look.

“Doc, that was awesome,” she chuckled, “I can’t believe how easy that was.”

Now, I was smiling….

Welcome to oral conscious sedation. The laughing patient had been a nervous wreck when we sat down to treatment plan her condition a few weeks ago. She had avoided dental treatment her entire adult life because of a bad experience in the dental chair as a child. She was so anxious that she could not sit in the operatory when we met to plan out the phases of her treatment. She had shown up for the preoperative appointment in tears. Now, however, she was laughing.

Stories like this are commonplace in a practice that uses oral conscious sedation. Multiple studies have shown that roughly one-third of all Americans will not go to the dentist due to fear and anxiety. There are 3 main barriers to a patient seeking dental treatment: time, money, and fear. By removing one of those barriers, fear, a practice can expand.

Relieving patient anxiety is one of the big benefits of oral conscious sedation, but there are several more. We’ve all experienced a nervous patient who interferes with the quality of the treatment by moving around, talking, or being overly sensitive. By using oral conscious sedation, many of these factors are mitigated and the practitioner can concentrate on providing a high quality of care. Additionally, by removing some of the patient’s fear and anxiety, the practitioner can provide expanded services and procedures for the patient.

Retrograde amnesia is also a big practice builder. Many of the sedation drugs used in oral conscious sedation will cause amnesia of the procedure. Quite frankly, most patients would prefer not to have lasting memories of procedures such as crown preps, extractions, implant placement, and endodontic therapy. If a patient can walk away from the procedure without concrete memories of the treatment, they are more likely to let their friends know of the positive experience they had at your office.

Anytime a patient is going to be sedated, safety must be the most important item on the dentist’s mind. Oral conscious sedation is very safe when a dentist strictly follows rules about patient selection, patient monitoring, and dosing protocols. When these are closely followed, oral conscious sedation can be both rewarding and reliable.

If a dentist is considering incorporating oral conscious sedation into their practice, they should begin by taking a course that checks off all their state board’s regulations for minimal sedation/anxiolysis. A good oral conscious sedation course should leave the dentist respectful of how to sedate patients safely and confidently while providing this remarkable service to their patients.

You may even get your patients laughing.

Article 24 of 54

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

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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.

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 35 of 167

Online Continuing Education / Course Details

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

Recurrent Aphthous Stomatitis

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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

Recurrent Aphthous Stomatitis 

The overall goal of this article is to provide the reader with information and scientific data on recurrent aphthous stomatitis. On completion of this course, the participant will be able to do the following:
1. List and describe the different types of recurrent aphthous ulcers;
2. Differentiate between recurrent aphthous ulcers and herpes simplex ulcers;
3. List and consider the different types of ulcers and associated conditions that must be part of the differential diagnosis for recurrent aphthous ulcers; and
4. Provide an overview of the types of treatments available for the different categories of recurrent aphthous ulcer patients.

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Abstract

Recurrent aphthous ulcers are commonly found in the general population. They consist of minor, major, and herpetiform types. A number of factors are considered to be possible etiological factors for recurrent aphthous ulcers; however, their exact etiology remains unclear. Several systemic diseases and conditions associated with oral ulcerations and other causes of oral ulcerations must be considered during the differential diagnosis. Once a definitive diagnosis for recurrent aphthous ulceration has been made, the patient can be given palliative care for the lesions as well as advice and recommendations on nutrition, oral hygiene practices, and other factors that may be associated with his or her recurrent aphthous ulcers.

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

Course 4 of 167