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Online Continuing Education / Course Details

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

Exploring the Problem of Dental Root Resorption: The Silent Tooth Killer

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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:
• Review the physiology of root resorption
• Understand physiologic vs pathologic root resorption
• Classify pathologic root resorption (Schwartz Classification) 
• Diagnosis of pathologic root resorption
• Management options for 4 types of pathologic root resorption

Abstract

Dentoalveolar trauma has many sequelae, and one of those sequelae is tooth root resorption, a poorly understood and untoward outcome of many dental traumas. Dental root resorption has many contributing factors, but dental trauma remains the most significant. This webinar is designed to take some of the mystery out of root resorption. We will consider the physiology of the resorptive process, talk about early identification of resorption through examination and imaging, classify root resorption and discuss management of the problem. Many teeth are lost to dental root resorption, most due to missed diagnosis. Dental root resorption, by its nature is a hidden problem. This presentation will attempt to shine a brighter light on the problem of resorption with the goal of saving teeth, especially in growing patients. Technology, superior dental materials and awareness will allow us to recognize who may be susceptible to dental root resorption and to look for this hidden problem in our everyday dental practices. 

 

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

Course 136 of 151

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Minimally Invasive, Comprehensive Treatment in Everyday Dentistry

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Date: 02-18-2021 09:27:40 am


The term “minimally invasive” has been used in dentistry for decades. And while economic factors or lack of confidence can impede clinicians from fully making the switch to minimally invasive dentistry, most of us would agree that enamel and periodontal preservation are paramount in achieving a lifetime of optimal oral health.

Modern bonding systems and materials have transitioned minimally invasive dentistry from concept to reality—but can this protocol work for simple, everyday cases as well as comprehensive ones? And is the minimally invasive approach truly healthier for the patient? The answer to both questions: Absolutely.

The Catalyst to Comprehensive Care
Thanks to the omnipresent power of Facebook and Instagram, patients are becoming more aware of what common dental issues look like—for example, inflamed gums from subgingival margins. Social media has become a catalyst for consumers seeking less-invasive options.

In this regard, minimally invasive dentistry acts as a vessel, helping patients understand the stakes and accept comprehensive care. And by offering more choices, both in the areas of prevention and treatment, clinicians can increase the possibility of case acceptance. With a growing consumer demand comes the tremendous opportunity for practice growth.

So, how can you start applying a minimally invasive approach to not just the everyday cases, but all clinical scenarios? The good news is that managing comprehensive cases, such as full-mouth rehabilitations, with minimally invasive techniques doesn’t require expensive equipment. The only thing a clinician needs is a good understanding of sound occlusal and adhesive principles combined with restorative material knowledge.

Case in Point
A patient who presents with excessive incisal wear on the lower anterior teeth and fracture lines will most likely have a lack of anterior guidance or a deep bite and parafunctional habits. A conventional treatment approach would be to recommend a nightguard to prevent further wear of the teeth. But comprehensive dentistry goes a step further to correct the deep bite and set up a functional relationship for anterior guidance by using clear aligner therapy.

Once the deep bite is corrected, if anterior guidance is still inadequate, veneers or bonding can be recommended. A good bonding technique can brace the fracture lines and restore worn enamel, while re-establishing anterior guidance to strengthen weakened teeth and decrease destructive forces on those teeth. Most dentists avoid doing crowns on lower anterior teeth at all costs due to the aggressive size of the preparation. Fortunately, there’s no need to do crowns on such teeth. By understanding the principles of a healthy stable occlusion, the neuromusculature can be better managed to minimize loading forces.

With the proper occlusal principles, bonding techniques, and dental materials, minimally invasive dentistry options can be incorporated seamlessly into any practice. And by leaving the supragingival margins of the restorations as is, we can also decrease the frequency of chronic gingival inflammation. It’s that simple.
Article 46 of 48

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CASE PRESENTATION: Smile Update: Maximum Results with Minimum Treatment

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Date: 02-17-2021 11:34:13 am


It is so rewarding to make a dramatic improvement in a patient’s smile with relatively conservative and economical treatment. With otherwise good oral health, a 47-yearold female presented unhappy with her smile. She was reluctant to show her teeth when she smiled because of the poor gingival shape that created a gummy smile, as well as a cosmetically unappealing crown on tooth No. 9. The patient decided, after being given all of her cosmetic options, to do laser-assisted gingival recontouring and to have the existing crown replaced.

Initial Appointment
At the next appointment, the patient was anesthetized and we took an over-impression with a stock tray and Template Ultra Quick Matrix Material (Clinician’s Choice). This would be used to fabricate the provisional.

After removing the crown, we took a base shade photo of the prep and surrounding teeth along with VITA shade tabs (VITA North America). This image will let the ceramist see the tooth shade prior to dehydration.

Next, I used a diode laser to perform a bloodless gingival contouring and troughing. This eliminated the need for cord or a hemostatic agent. We then took additional photos with the polar_eyes Cross Polarization Filter (PhotoMed), which eliminates unwanted reflections on the teeth from the flash. This image gives the lab an unobstructed view for enamel subsurface mapping of nuances and characterization.

For the definitive impression, I prefer to use a custom tray. With HEATWAVE thermoplastic moldable trays (Clinician’s Choice), we can easily achieve a custom fit. Aquasil Ultra Cordless material (Dentsply Sirona) was placed in the tray with tray adhesive, and we took the impression.

We fabricated the temporary using INSPIRE temporary material (Clinician’s Choice), and Cling2 temporary cement (Clinician’s Choice) was used to cement the provisional in place.

Seating Appointment
We received a beautiful zirconia crown from the lab, which was seated with Ceramir cement (Doxa Dental). Ceramir offers an alkaline pH and bioactivity for long-term antibacterial action and biocompatibility. Another plus is easy cleanup of the excess.

The patient was thrilled with the esthetics of her new smile.




GO-TO PRODUCTS USED IN THIS CASE

TEMPLATE ULTRA QUICK MATRIX MATERIAL

Specially designed for provisional fabrication, Template is an ultra-quick, ultra-accurate silicone matrix material that flows into embrasure areas and into the finest morphology to capture superior detail. Also ideal for the lingual matrix technique for Class III and IV restorations, the material sets in 30 seconds and, once cured to a rigid 68 durometer, releases easily and maintains its stable form.

CLING2
Cling2 is a zinc-oxide noneugenol automix temporary cement with a unique polycarboxylate resin in a paste-paste format. Ideal for cementing provisional crowns, bridges, inlays, and onlays, the cement mixes automatically to provide a bubble-free, 1:1 base:catalyst mixture. Cling2 contains unique properties that make it bacteriostatic, reducing gingival plaque retention and inflammation in the sulcus.
 
Article 48 of 48

Online Continuing Education / Course Details

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

Bonding to Zirconia

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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:
Identify what zirconia is and its classifications
Decipher if the chemical bond to zirconia is a myth or reality
Recommend bonding protocols to the zirconia surface 

Abstract

Due to its multiple clinical applications and enhanced esthetics, zirconia has become a popular restorative material. This material can be used in restorations such as crown, bridges, full arch structures, dentures, and veneers.
This lecture will provide insightful information regarding the current and most updated bonding procedures and protocols to be applied to the zirconia surface.

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

Course 129 of 151

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CASE PRESENTATION: Collaborative Care for Successful Single-Tooth Replacement

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Date: 01-18-2021 11:25:07 am

  Even seemingly straightforward cases require open communication among the clinical team members, precise diagnostic imaging, and detailed treatment planning to ensure a good outcome for the patient. As a prosthodontist who doesn’t place implants, I work closely with a periodontist who does all of the surgeries. In addition, I have a dental lab in my office staffed with experienced technicians. By combining the expertise of these 3 professionals with intraoral scans, CBCT images, and treatment planning software, we’re able to proceed with treatment fully prepared with all of the information we need to deliver the best result possible.

  In this case, documented in the images on the following pages, a patient presented with a congenitally missing tooth No. 12, which he wanted replaced. We started by capturing the images we needed to treatment plan the case—intraoral scans (Figures 1 to 3) taken in my office using 3Shape TRIOS and CBCT images taken in the periodontist’s office. We then integrated these images using 3Shape Implant Studio software (Figure 4), which supports 70 different implants from a variety of manufacturers. We identified key landmarks in the CBCT images and paired them with the intraoral scan. When we merged the two data sets, we had a view of the patient’s teeth, gingiva, and bone.

  The treatment planning process included a meeting between me (the prosthodontist), the periodontist, and the dental lab technician. Sometimes these meetings are held remotely, but in this case we met in person. The dialogue began with an explanation of the tooth being replaced and its optimal position. The surgeon explained that given the position, and the fact that the ridge was extremely narrow, the bone would need to be leveled to create a better platform for implant placement. Also, because the roots were close together, the surgeon chose the narrowest implant (Straumann Narrow Platform Implants).

  In discussing the removal of some soft and hard tissue, it was noted that we would create a disparity in the gingival margin of the implant for tooth No. 12 and tooth No. 11 (Figure 5). However, I pointed out that there also was a big disparity between teeth Nos. 11 and 13. The replacement tooth No. 12 would serve as a transition from the high margin on the canine to the low margin on tooth No. 13. The surgeon, technician, and I agreed.

  To transfer the information about implant position to the mouth, we used the data captured with the intraoral scans and the CBCT with the Implant Studio Software to a create a surgical guide (Figure 6). Then, with a two-stage surgical approach, the surgeon used the guide to place the implant and the site was sutured. We did not uncover the implants for 4 to 6 months after surgery (Figure 7).

  Using state-of-the-art technology and providing opportunities for open communication among all of the dental professionals involved in the case, we identified challenges, developed solutions, and provided the patient with an excellent outcome (Figure 8).