today GNYDM 25 Nov

By Michael C. DiTolla, DDS, FAGD n Glidewell Laboratories continues to test what the dental laboratory can do with BruxZir® Solid Zirconia crowns and bridges as it works to improve the esthetic nature of this zirconia material. As BruxZir crowns now account for 15 percent of the anterior crowns fabricated at the lab, the lab’s research and development department is committed to working to increase the material’s ability to be predictably prescribed in anterior situations. This photo essay illustrates a recent case where a patient’s tooth #8 and #9 were prepped for BruxZir crowns. Fig. 1 The patient presented with a PFM crown on #9 that he wanted replaced, and #8 had a fractured incisal edge with a failing composite and recur- rent decay. We decided to place BruxZir crowns on #8 and #9, tak- ing advantage of this high-strength, cementable, all-ceramic material while avoiding possible metal mar- gins. Fig. 2 Before I do anything else, I take the shade to keep the teeth from dehydrating and appearing higher in value than they actually are. I use the VITAEasyshade® Compact(Vident)to determine the shades of the adjacent teeth. I try to position the tip of the deviceinthemiddlethirdofthetooth, avoiding the increased chroma in the gingival third and the increased translucency in the incisal third. Fig. 3 Then I place the PFG gel (Steven’s Pharmacy), an important first step in giving a pain-free injection. Placing the gel with an Ultradent syringe makes it easier to “sneak” some of the anesthetic into the sulcus, so that the patient does not feel the insertion of the needle through the attachment. After60seconds,wewashthePFGgel off #8 and #9 and begin the injection. Fig. 4 The STA Single Tooth Anesthesia System® device (Milestone Scientific) allows me to predictably get pulpal anesthesia with a pain-free PDL injec- tion. I slide the 30-gauge extra short needle into the sulcus without going through the attachment. I step on the STA foot pedal and give a few drops of Septocaine into the sulcus prior to going through the attachment. I con- tinue to express the Septocaine while the needle tip is advanced through the attachment until it reaches the crest of the bone. Fig. 5 After removing the existing PFM crown using the Razor® Carbide bur (Axis Dental) and a Christensen Crown Remover (Hu-Friedy), I start prepping #8. Because this tooth has not yet been prepared, I am able to take advantage of the reverse preparation technique. The mesial contact is already broken from when I removed the adjacent crown, so I now break the distal contact with a #55 bur. The reason we break the con- tacts first is because this technique requires the first retraction cord to be placed immediately. Fig. 6 The first cord I use is an Ultrapak cord #00 (Ultradent). This is a plain cord that has not been soaked in any medicaments, and I floss it into place on the mesial and distal. With the two interproximal portions of the cord locked into place, I pack the facial segment subgingivally. This bottom cord provides about 0.5 mm of vertical retraction of the tissue. This allows me to prep the gin- gival margin right at the free margin of the gingiva. exhibitors42 Greater New York Dental Meeting — Nov. 25, 2012 The pursuit of BruxZir anterior esthetics: part 1 Here at the GNYDM For more information on BruxZir Solid Zirconia crowns and bridges, stop by the Glidewell Laboratories booth, No. 4400. Be sure to pick up a copy of the today GNYDM Daily on Wednesday to read Part 2. Here at the GNYDM Michael DiTolla, DDS, FAGD, graduated from the University of the Pacific School of Dentistry and was awarded his fellow- ship in the Academy of General Dentistry in1995.In2001,hebe- came director of clini- calresearchandeducationatGlidewell Laboratory.DiTollaiseditorinchieffor ChairsideMagazine,hasamonthlycol- umn on restorative dentistry in Dental Economics and has been lecturing on restorativedentistrytopicssince1995. As a self-proclaimed “average dentist,” he has created techniques that give him great restorative results with a very average set of hands. His mission is to share these techniques with den- tists to help them improve their preps, impressions and restorations. 5 Fig. 1 (Photos/Provided by Glidewell Laboratories) 5 Fig. 2 5 Fig. 3 5 Fig. 5 5 Fig. 4 5 Fig. 6