Dental Tribune United Kingdom Edition

9Event ReviewMay 2014United Kingdom Edition BOC Healthcare Customer Service Centre, Priestley Road, Worsley, Manchester M28 2UT, United Kingdom www.bochealthcare.co.uk The following emergency resuscitation drugs¹ are available from BOC Healthcare → Glyceryl trinitrate (GTN) spray (400 micrograms/dose) → Salbutamol aerosol inhaler (100 micrograms/dose) → Adrenaline injection (1:1000, 1 mg/ml) → Aspirin (300 mg) → Glucagon injection (1 mg) → Oral glucose gel → Midazolam 10 mg (buccal) Features of the complete drugs kit → Supplied in a bespoke bag for easy storage and transport² → Supplied with algorithms on management of medical emergencies → Items can be bought individually or as part of a combination³ → No intravenous access required for the drugs ¹ All drugs are only available to prescribing medical professionals ² Bag is an optional extra and will incur a charge ³ Only applies to certain products We also supply medical oxygen with prices from £197 +VAT per annum and Automated External Defibrillators from £799 +VAT only. For further information or to place an order call 0161 930 6010 or email bochealthcare-uk@boc.com BOC: Living healthcare Are you prepared for a medical emergency in your dental practice? Emergency drugs from BOC Healthcare. Prices from £29.99 +VAT 506970-Healthcare Drugs Kit Advert-Full Page 07.indd 1 10/02/2014 17:12 After creating an acceptable mock-up you take two impres- sions; one impression of the mock-up and one impression of the existing teeth. By comparing the two the laboratory can do a wax-up to mimic the results. The resultant wax-up will have the perfect outline. This then enables you to create a silicone key either within the laboratory or chairside. Step 2 – The old way! Use the silicone key to create the perfect APT (Aesthetic Provision- al Temporary) mock-up using an appropriate temporary crown and bridge material. GG uses DMG’s Luxatemp because it is simply the best. This is then used to as- sess everything before you start to prep the teeth. At this stage you can evaluate the aesthetics, oc- clusion, phonetics, etc. Because the patient is not yet anaesthetised you can still assess the smile-line etc too. How much space is required for the veneer? The minimum must be 0.5mm, but the actual thickness entirely depends on the amount of shade change required. As a rule of thumb, on av- erage you require 0.15mm per shade change with a minimum of 0.5mm, though this does depend upon the lab and the materials they will be using. Therefore a shade change of four requires a minimum reduction of 0.7mm. Consequently, after remov- ing the APT use the silicone key to assess which parts of the teeth to prep and which to leave alone. Prep if <0.5mm gap between sili- cone template and tooth and leave if >0.5mm gap between silicone template and tooth. However it is very difficult to perform this by simply looking at the two things and attempting to judge the size of the gaps. Normally results in over-prepping as a precaution, with all the complications this en- tails. Step 3 – Galip’s way! GG realised that you actually don’t need to be able to see the teeth to prep them. He realised that when you have an APT to demonstrate the aesthetics to the patient, and they like it, you can simply leave the APT over the teeth and prep through it using an appropriate 0.5mm depth drill. If the gap is <0.5mm the drill will penetrate the enamel. If the gap is >0.5mm it won’t and the teeth don’t need prepping. To make this even easier GG uses a pencil to high- light the grooves on the tooth. Then, once the APT is removed, it is simply a case of reducing the enamel in the appropriate areas until all the pencil lines have been eliminated. Research proves that if veneer preparations are entirely within enamel there is a 99 per cent suc- cess rate, but that if the dentine is involved in any way the suc- cess rate drops to just 68 per cent. Typical failures are fractures, discolouration, marginal leak- age etc. This research includes a retrospective study by GG himself in which he followed his own ve- neer retention results. It was pub- lished in two articles in the JPPD in November 2012 and February 2013. It showed that in enamel you only get failures due to frac- tures, you don’t get microleakage or debonding. These fractures are mainly due to occlusal problems relating to new crowns, changes in chewing patterns etc. You then do a simple butt joint across the incisal edge to a depth of 1.5 mm. This is the strongest type of joint. Look out for part II of this arti- cle series in the next issue of Den- tal Tribune. DT