ContinuumAurum Ceramic - Keeping You on the Leading Edge of Dental Technology and Aesthetics

Volume 13, Issue 3 • Fall, 2009

Maximum Effort...Incredible Results!

(See pages 8 - 9 for details)

PlusArticles on

Marketing, Technology,Finance, Leadership

and more!

Aurum’s Cristal®

Veneers – APictorial Essay

Dentistry courtesy of Dr. Ronald D. Jackson, Middleburg, VA.Restorations fabricated by Aurum Ceramic.Photography courtesy of Larry Gatz.

®

Gary Hall Jr.,Five-time Gold Medallist over three Olympic Gamesand Diabetes Advocate.

Reflections of Excellence

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CONTENTSIn the News — Congratulations Dr. Anne-Maree Cole and Dr. Sahag Mahseredjian

Advanced Esthetics — Aurum’s Cristal®Veneers – A Pictorial EssayDr. Louis Malcmacher

Technique Tip — Simple, Practical DetailsThat Make A Case A SuccessTrish Jones

About The Cover —Maximum Effort... Incredible Results!Dr. Ronald Jackson

Case SpotlightDr. Gordon Ferguson

Case SpotlightDr. Kimlan Bell

Industry News — Be An Agent of Change– Become a “Dentrepreneur”

Innovations in Dentistry —Introducing the Perio Protect Method®

Innovative Implant SolutionsDr. Alex Pavlenko

Cast Partials —Clear Graphic Communication . . .Computerized Cast Partial DesignGary Wakelam

Appliance Therapy —Posterior Crossbites in ChildrenDr. Walt Pfitzinger

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IN THE NEWS

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Aurum Ceramic Dental Laboratories wouldlike to congratulate Dr. Anne-Maree Cole onbeing elected IACA President for the comingyear and Dr. Sahag Mahseredjian on his selec-tion as 2009 IACA Alumnus of the Year. Bothof these announcements were made at therecent 2009 IACA conference in San Francisco.

Dr. Anne-Maree Cole graduated from theUniversity of Queensland, Australia withHonors in 1982. Having completed in excess of20 courses at LVI including Full MouthReconstruction and all of the Occlusioncourses, she is a graduate of the Institute, aninstructor at LVI and has been appointed theDirector of LVI Australia to teach withinAustralia. She was recently awarded the LVIMat the IACA meeting in Montreal.

Dr. Sahag Mahseredjian obtained hisdegree in Dentistry from the Université deMontréal in 1991. A graduate of LVI, he hasbeen appointed the Director of LVI Canadaand is a clinical instructor at the Las VegasInstitute for Advanced Dental Studies in LasVegas and in Montreal. He is also a member ofthe International College of Cranio-MandibularOrthopedics, the Academy Of Osseointegra-tion, the American Academy of Periodontologyand the American Academy of Sleep Medicine.

Congratulations to Dr. Anne-MareeCole, Incoming IACA Presidentand Dr. SahagMahseredjian, IACAAlumnus of the Year!

Dr. Sahag Mahseredjian acceptsIACA Alumnus of the YearAward from Dr’s Heidi and BillDickerson.

Incoming IACA President Dr.Anne-Maree Cole at podium.

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© Aurum Ceramic Dental Laboratories LLP. (2009). Reproduction of this work in whole or in part, by any means whatsoever,is strictly prohibited without the express written consent of Aurum Ceramic Dental Laboratories LLP.

AURUM CERAMIC DENTAL LABORATORIES LLP

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Aurum Ceramic is proud to be a Silver Sponsor of the 2009Meeting and a Gold Corporate Member.

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Dr. Louis Malcmacher

ADVANCED ESTHETICS

The following is a pictorial essayregarding a patient who has recent-ly had a case involving Aurum’s

Cristal® Veneers. This is an interestingcase on a number of levels. The patient’shistory is of a 42 year old female whowanted a smile makeover approximatelytwo years ago. Figure 1 shows her pre-operative smile. The patient presentedwith Class 1 occlusion and with a midlinediscrepancy. She wanted a more evenappearance to her teeth and a whitercolor. The midline discrepancy is of noconsequence to her esthetically. Her peri-odontium is healthy and she alsorequested a minimally invasive approach.Teeth numbers 8 and 9 are full ceramiccrowns, which are not the same shade asher natural teeth. Although the shadediscrepancy is minor, this did concernher. She had read about a popular mini-mally invasive veneer and was referredto a dentist for those veneers.

Figure 2 shows this same patient afterher minimally invasive veneer treatment.She presented in our office andexpressed her disappointment with theseveneers for a few reasons. She felt thatthe teeth had no character, were “deadlooking” and not lifelike at all, and thatthe cuspids especially were too bulky,both in their appearance and in the feelon the inside of her cheeks. This pictureis representative of the biggest chal-lenges and complaints that many dentistshave about no prep/minimal prepveneers – that they are too opaque andtoo bulky. At this point, the patient wasnot yet interested in further treatment tocorrect her smile, even though she wasunhappy with the results.

We see in Figure 3 this same patient afew months later. She is still unhappywith the appearance of the veneers, butnow has a much greater concern withthe fractures that have occurred withthese veneers. Figure 4 shows a retract-ed close up view of her case. The incisal1/3 of the veneer has broken on toothnumber 5, the veneer on tooth number 7has completely come off and a tempo-rary veneer was hastily placed, and the

Aurum’s Cristal® Veneers –A Pictorial Essay

all porcelain crown on tooth number 8has fractured at the gingival third. Thisis a combination of material and bondingfailures as well as poor management ofthe case from the clinical and laboratoryaspects. At this point, obviously, thepatient is in need of retreatment and wechose to use Aurum Ceramic’s CristalVeneers for this case.

Figure 5 shows the removal of all theveneer and composite materials as wellas the two all porcelain crowns on teeth

numbers 8 and 9. Here is where thiscase really presents a challenge and whyworking with a talented esthetic ceramiclaboratory really starts to pay off. Youcan imagine that the all porcelain crownswill be at least 3 to 4 mm thick circum-ferentially while some of the Cristalveneers may range anywhere from.3 mm thin in some areas to 1 mm thickin other areas, even on the same tooth.When working with a minimally invasiveapproach, the ceramist has to have anexcellent understanding of the ceramicthey are using in order to provide thedental clinician with a finished casewhere the shades of all the differentrestorations will all match together. Thisis especially true when doing no prepara-tion/minimal preparation veneers.

The right and left side views inFigures 6 and 7 show that aside from thetwo central incisors, all of the otherpreparations are minimally prepared inenamel, which will certainly pay off inthe final strength of this veneer casewhen the right materials are used.

Figure 8 shows the completed caseafter insertion. The Aurum’s CristalVeneers and crowns are excellent in

Figure 1.

Figure 2.

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terms of size and shape and have com-pletely eliminated the bulkiness that thepatient previously complained about.This is an important point – the biggestcomplaint by dentists and patients alikehave been that no preparation and mini-mal preparation veneers are too bulky,too opaque and lack the texture ordefinition which lends itself to a morerealistic result. Aurum Ceramic isknown as a highly esthetic dental

laboratory and they are now bringingtheir esthetic experience into the mini-mally invasive veneer market.

Figure 9 shows a close up of teethnumbers 7 through 10 and you can seethe excellent adaptation, texture, andcolor match that was achieved. I, as theclinician, used the exact same shade ofcement (Variolink Veneer) on everyrestoration in this case. Aurum Ceramicdid an incredible job in working with

the Cristal Veneer Porcelain to achievethis match, which makes my job seatingthese veneers incredibly easy.

Figure 10 is a lifestyle photograph ofthe patient. Comparing this to the post-operative picture of the veneers she hadpreviously, these veneers are very life-like, not at all bulky, have definition andgive this patient a great looking, naturalsmile.

Figure 3. Figure 4.

Figure 5. Figure 6.

Figure 7. Figure 8.

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Dr. Louis Malcmacher is a practicing generaldentist in Bay Village, Ohio and an internationallyknown lecturer, author, and dental consultantknown for his comprehensive and entertainingstyle. An evaluator for Clinicians Reports(formerly Clinical Research Associates), Dr.Malcmacher has served as a spokesman for theAGD and is a consultant to the Council on DentalPractice of the American Dental Association. Heworks closely with dental manufacturers as aclinical researcher in developing new productsand techniques. For close to three decades, Dr.Malcmacher has inspired his audiences andconsulting clients to truly enjoy doing dentistryby providing the knowledge necessary forexcellent clinical and practice management. Hisgroup dental practice has maintained a 45%overhead since 1988. You can contact him at440 892-1810 or email dryowza@mail.com.

You can also see his lecture schedule atwww.commonsensedentistry.com where you canfind information about his botulinum toxin anddermal filler training, building the best dentalteam ever, big case acceptance success! andsign up for his affordable monthly consultingprograms, teleconferences, audio cd’s and freemonthly e-newsletter.

Figure 9. Figure 10.

Comparing this to the post-operative pictureof the veneers she had previously,

these veneers are very lifelike, not at all bulky,have definition and give this patient

a great looking, natural smile.

Plan to Attend:

Dr. Malcmacher will be speakingat the following events:

Ann Arbor, MI, September 25, 2009Columbus, OH, October 14-15, 2009Buffalo, NY, October 23, 2009New York, NY, December 9-10, 2009

For more information or courses inyour area, please visit the CommonSense Dentistry website at www.com-monsensedentistry.com

NaturalTemps®

Superior Function. Outstanding Precision.Quick Turnaround.

• Milled with CAD/CAM technology for virtuallyperfect fit and easy seating.

• Craft temporaries directly from your digitalimpression files – or normal impressions andmodels.

• Keeps prepared teeth in stable position,preserving occlusion and contact with adjacentdentition.

• Temporize even full mouth reconstruction andimplant cases with perfect confidence.

Most Esthetic Provisionals AvailableToday

• Natural line angles, embrasures, surfacetexture and occlusion. Life-like incisal areas.

• Emergence profiles carefully developed, aidingin tissue healing and improved oral health.

• Outstanding flexural strength (95 MPa) forlong-lasting durability.

• Allows patient to perform daily functionswithout interruption, even over extendedperiods.

Improve Case Acceptance. PerfectDiagnostic Tool.

• Patients can preview restoration shape, contour,color, width and lip length.

• Evaluate esthetic options, pulp vitality, softtissue interaction, occlusion and phonetics.

• Can also serve as a high-quality treatment guide.

Look to Aurum Ceramic for exceptionally fast,accurate and beautiful long-term NaturalTempsmilled provisionals. Call Aurum Ceramic dentallaboratories TOLL FREE.

Milled ProvisionalsA Whole New Concept In Temporaries

Visit us on the web at www.aurumgroup.com

®

DENTAL LABORATORIES LLP

CALL TOLL FREE 1-800-423-6509 • In Spokane (509) 326-5885

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TECHNIQUE TIP

Simple, Practical Details ThatMake A Case A SuccessTrish Jones, RDH, BSAssistant Manager, Aurum Ceramic @ LVI

All the technology available todayfor dental offices can make clini-cian-laboratory communication

much easier. Once you sort through whataspects of these technologies are usefulto your dental practice, it can even makepatient communication simpler as well.However, the same simple, practicaldetails that have helped to make a case asuccess in the past are just as importantin achieving that result today.1. If you are looking to improve yourimpression taking abilities, have a lookat the Cadent iTero™ system. It is adigital impression system that is userfriendly, economical and best of all, iscomfortable for the patient, eliminatingthat aspect from the equation at longlast. Unlike its competitors, this systemdoes not require the use of a spray tocapture the digital image — which is abig benefit in the operatory and to thepatient. For more information, checkout www.cadentitero.com.Practical Tip: If you are not in themarket to update to a digital impres-sion system, review your impressiontechnique and materials. Use corre-sponding products and setting times.Evaluate your impression beforesending to the lab, and let us pour upthe impression!

2. Implant dentistry is growing exponen-tially. We are getting more implantcases in the lab than ever before. Ifyou are interested in placing your ownimplants, check out Dr. Leo Malin’sImplant course at LVI global.www.lviglobal.com. He has a system-atic approach to placing implantsefficiently and successfully. By utilizingCT Scans and IVS Co-Diagnostic

Software, placing your own implantsand restoring them can be a way tooffer more modalities of treatment toyour patients, and increase your valueto your clientele.

e.max® CAD restoration on a Cadent iTero™polyurethane model. The Cadent iTero™ systemoffers precision fit — minimal to no adjustmentsrequired!

Practical Tip:When you do send animplant case to the lab, communicationis greatly enhanced if you make sure toinclude the following information:• The implant company• Type or specific name of the implant• Size• Type of abutment desired• Final restoration

It helps us tremendously to have thisinformation up front as we often haveto order components to get started.Time Saving Tip: Send us the labanalog as well as the impressioncoping. We can pour up the impressionright away!

3. Shade is one of the most important fac-tors in restoring a smile. However, it isalso one of the most mis-communicatedprocesses between the dental officeand dental lab. Is there a perfectmethod to communicate shade? No,but there are technologies available toassist in taking shades, such as theSpectraShade, or by using a digitalcamera to take photos to communicateshade. Just remember to email or sendthe photo to us!Practical Tip:When evaluating restora-tions after they have been returned toyour office, do not check the shade onthe die model or the solid model, asthe shade will be inaccurate. Check the

shade by wetting the natural diematerial that replicate the preppedtooth shade and placing the restora-tions on them. Here’s something elseto think about when choosing a finalshade for restorations: if the chosenshade is darker than the temporariesplaced, your patient may be unhappy.Patients often learn to like the tempo-rary shade, and may be disappointedif the shade of the restorations isactually shaded darker than thetemporaries.

4. Use basic technology to communicatewith us! If you have an email address,please let us know. Often we can sendyou photos of cases, or email youquestions we may have or vice versa.The positive part of using email is youcan answer on your time, and wedon’t take up valuable phone time.Practical Tip: Check out our newwebsite at www.aurumgroup.com! Wehave a lot of valuable information on itto help you out including previousnewsletters, prescriptions, articles,materials updates and a lot otheruseful information.

Embrace technology and find whatworks for your practice, but always keepin mind — it is often the simple,practical details that add the most value.

Don’t judge restoration shade in the crown box.

Verify shade by placing restorations on moistenedstumphs.

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ABOUT THE COVER

Ronald D. Jackson, DDS, AFAACD, DABAD

Maximum Effort...Incredible Results!

his experience with diabetes. He is therecipient of the first and only USASwimming Humanitarian Award for hiswork on behalf of diabetes awareness.Gary is a member of the Board ofDirectors of the International SwimmingHall of Fame and the Diabetes ResearchInstitute, as well as being a celebrityadvocate for the Juvenile DiabetesResearch Foundation. He has also testi-fied on Congressional panels regardingissues such as stem cell research,diabetes awareness and funding.

exert himself more physically — fishingand diving as he had done as a child inthe Bahamas. His physical fitness gradu-ally improved, and as someone neverafraid of a challenge, he started thinkingabout competing again.

Gary’s return to competition wasaccompanied by some of the fastestswimming the world has ever seen.Silencing the naysayers, Gary won twoOlympic gold medals in Sydney in 2000,including his first individual gold as hebroke the American record to win the50-meter freestyle. Four years later,Gary defended his 50m free title at the2004 Athens Olympics, where at 29 hebecame the oldest male in 80 years towin gold for the U.S. team. His thirdOlympic appearance also made historyin another way as it made Gary Hall Sr.and Jr. the first father/son duo tocompete in three Olympic Games.

There are currently over 20 millionpeople living with diabetes in the U.S. Bythe year 2030 it is projected that over370 million people worldwide will havethe disease. Gary has given every per-son living with diabetes proof that theycan enjoy a healthy and balancedlifestyle. When he isn’t in the pool, Garytravels the world talking to parents,coaches, athletes and executives about

As a third generation competitiveswimmer, Gary Hall Jr. was bornto swim. Both his father and uncle

were Olympians; his grandfather was anNCAA champion and swimming legend.He practically grew up in the water,spending summers and holidays in CatKey, Bahamas, fishing and diving. Hisgrandfather would toss coins into thedepth of the sea to test his grandchildren.Gary would return home with his pocketsfull.

That little boy who loved to dive forcoins grew up to become one of theworlds most highly decorated and recog-nized Olympic athletes. But genetics wasalmost his downfall, dealing a blow thatthreatened not only his career, but alsohis life. In 1999, Gary was diagnosed withType 1 diabetes. Doctors told Gary thathe would never again be able to train andperform at the elite level that saw himwin four medals, including two gold, atthe 1996 Olympics. There was no prece-dence of elite athletes successfullytraining and competing at that level withdiabetes.

Gary found solace in the ocean,mentally preparing himself for life with-out competitive swimming. During hisretreat, he extensively researcheddiabetes and learned to closely monitorhis blood glucose levels. Gary started to

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Dr. Ron Jackson is a 1972 graduate of West Virginia University School ofDentistry. He has published many articles on esthetic, adhesive dentistry andhas lectured extensively across the United States and abroad. Dr. Jacksonhas presented at all the major U.S. scientific conferences as well as toEsthetic Academies in Europe, Asia and South America. He is a Fellow in theAmerican Academy of Cosmetic Dentistry, a Fellow in the Academy ofGeneral Dentistry, a Diplomate in the American Board of Aesthetic Dentistryand is Director of the Advanced Adhesive Aesthetic Dentistry and AnteriorDirect Resinprograms at the Las Vegas Institute for Advanced Dental Studies.

Dr. Jackson maintains a private practice in Middleburg, Virginia empha-

As a speaker and businessperson, Garyʼs smile is anintegral part of his overall presentation.

At age 11, he had been involved in a skateboardaccident resulting in considerable trauma to his left centralincisor; there was no pulpal exposure so his dentistplaced a bonded restoration. At age 14, the tooth becamenon-vital. A root canal was done followed by a post, corebuild-up and a crown. At age 24, enough tissue changeshad occurred that a new all ceramic crown was placed toimprove esthetics. This second crown was 10 years oldwhen Gary presented himself to me to see if the looks ofhis two centrals could be improved further and be done asconservative as possible. Besides a size discrepancybetween the two teeth and the obvious color difference, itwas noted that the incisal ½ of the natural right centralhad darkened even though the tooth tested vital. It wasdecided to replace the existing crown with a new IPSEmpress Esthetic crown and place a direct compositeveneer on the other incisor. Since it was slightly palatal inposition, this veneer could be placed without any prepara-tion other than a roughening of the surface enamel andthereby satisfy the goal of conservative treatment.

The crown was fabricated by Aurum CeramicLaboratories. The work order advised that a direct com-posite veneer was to be placed at crown placement and,therefore, it was asked that the crown be fabricated to theideal width. The veneer would widen the right central tomatch the crown at placement. The crown was bondedwith Multilink (Ivoclar Vivadent – Amherst, New York). Thecomposite resin chosen for the veneer was the new IPSEmpress Direct (Ivoclar Vivadent). Besides having theshades and opacities of dentin and enamel, the optics ofthis composite closely mimics the beauty of the IPSEmpress Esthetic ceramic. Gary was very pleased withthe results as well as the conservative way it was accom-plished. Working with a talented laboratory and withadvanced esthetic materials, both ceramic and compositeresin, makes the outcome more predictable and moresatisfying for the dentist as well as the patient.

Case History

Full face Before. Full face After.

Retracted pre-operative smile.

Postoperative smile. Right Central - IPS Empress Direct CompositeVeneer. Left Central - IPS Empress Ceramic Crown.

Gary Hall, Jr., is an advocate for theDiabetes Research Institute (DRI), thebest hope for a cure for the millions offamilies already affected by diabetes.Located at the University of Miami, theDRI is a world leader in cure-focused

research, pioneering new cell-based therapies to restore insulinproduction. For more information or to get involved, call800-321-3437 or visit www.DiabetesResearch.org.

Restorations fabricated by Aurum Ceramic.

CASE SPOTLIGHT

Dr. Gordon Ferguson graduated from the Fairleigh Dickinson Dental School with his Doctor of Dental Medicine in 1976. Aftergraduation, he joined his father Richard in private practice in Montclair, NJ. In 1997, his son Dr. David Ferguson also became apart of Ferguson Dental Associates, creating a practice covering three generations.

Dr. Ferguson has served as a clinical instructor at Fairleigh Dickinson Dental School, Institute of Oral Art & Design andLuxar Corporation. He has lectured for the Fauchard Society, Panky Mann Schuyler Study Group, Commonwealth Study Club,and American Academy of Dental Practice Administration. Dr. Ferguson is a member of the AACD, AGD, American Academyof Dental Practice Administration, ADA and is past President of the West Essex Dental Association and the AssociatedPhysicians of Montclair and Vicinity.

“This long-term patient and I hadhad several conversations aboutthe cosmetic rehabilitation of hissmile over a number of visits. Aswith many patients, he wished to“go home and think about it” eachtime. Finally, one of his youngfamily members mentioned to himthat he needed to do somethingabout his smile – that statementdid more to convince him to goahead than I ever could.

As you can see from his Before photos, he has a numberof old, deteriorating restorations and generally badlydiscolored teeth. However, other than some slightmisalignment, there was no need to change his occlusion.We decided to simply veneer teeth #4 through #13 toachieve his desired improvement in his smile.

I started off by creating an intraoral mock-up with aflowable resin. This allowed him to see and approve theproposed changes in his smile. This mock-up was alsoemployed to create provisionals that were an exact copy ofthe approved design. At the same time, we selected shades220 for the incisal 1/3 and 210 for the incisal 2/3. Wealso requested 1/2 mm incisal translucency. The canineswere to be one shade darker.

I forwarded a complete set of Before photos, photos ofthe intraoral mock-up, impressions and the detailedprescription on to Aurum Ceramic. His smile was thenrestored with ten IPS Empress veneers, all beautifullycrafted by the Aurum Ceramic AE (Advanced Esthetic)Team. The final change in his appearance is trulyamazing! In fact, I just saw this patient a few days agoand he tells me he “just can’t stop smiling!”

Gordon Ferguson, DMD

Close-up of pre-operative smile.

Close-up of new smile. Upper arch after placement of veneers.

Initial situation – upper arch.

Full face After.

Full face prior totreatment.

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INDUSTRY NEWS

Be An Agent of Change –Become a “Dentrepreneur”Anthony S. Feck, D.M.D., Chairman,General Dentist Committee, Dentcubator

In my seminars I talk often of change.After all, my purpose as an educator isto improve the lives of others. And

while not all change means improve-ment, you can’t improve without change.Growth results from positive changes. Iremind my audience that they willchange today, whether they intend to ornot. It’s inevitable. Whether they grow isa choice, I encourage them to choosewisely.

If you accept the premise that person-al and professional growth is an option,then you accept your role in choosingand controlling your destiny. Manyaccept that they can shape their future,and most believe they can impact thefuture of those they personally interactwith daily (family, friends, co-workers,and patients). It is much less commonfor a dental professional to see them-selves as an agent of change on a biggerscale. Agents of choice visualize creatingproducts, systems, or strategies that canliterally change the way dentistry isdelivered. They look beyond theirpractice. They see opportunities forgrowth multiplied exponentially byleveraging their ideas through theirprofessional colleagues.

These agents of change are entrepre-neurs. They see a need, look for a solu-tion, find the answer and seek to make itavailable to others. All of us, at one timeor another have recognized the need,many of us have sought a solution, stillfewer find the solution, and rarely dothose who find it exploit it as a businessopportunity.

This begs the question, “Why?”. Afterall, dentists, by their nature, are problemsolvers. In addition, their background,which is reinforced by their training,makes them think and act like an engi-neer. If they are in private practice, theyare independent business people. Givenall of this, they are naturally inclined tobe entrepreneurs (what I call “dentrepre-neurs”).

Because I’ve given this some thought,I’ve come to the conclusion that the dif-ference between the dentist who imple-ments the changes suggested by othersand the dentist who creates thosechanges – the dentrepreneur – is a mind-set and a little help. The mindset is sim-ply a decision to focus on looking for andtaking advantage of opportunities thatexist all around us. A good friend urgedme once to write on multiple pieces ofpaper the simple phrase, “InventSomething”, and place them where I willbe reminded multiple times a day.

The “little help” I write of is simplythe support mechanism to take a greatidea and make it the next great innova-tion. Approximately 5000 organizationsexist to provide such help. They arecalled “Incubators” and they exist toassess the validity and marketability ofideas brought to them. If the idea passesthis initial screening, the Incubator helpscreate a business plan, a marketing plan,applies for patents, obtains funding, andconnects the plan with those who canmake it a reality. In return for this, theincubator acquires an equity positionand/or shares in the profits from theproduct or service.

It’s a process that has a successfultrack record (87% of inventions and

products that have gone through a busi-ness incubator succeed in the market-place). It’s just never been formally donein Dentistry – until now. In November of2008, some of the brightest minds andmost influential agents of change in den-tistry (the list is a virtual “Who’s Who”of the Dental Profession – Buchanan,Leziy, Fradeani, Malament, McSpadden,Jackson, Massad to name a few) cametogether to form Dentcubator.

Dentcubator is focused on identifyingand acquiring proprietary interest inpromising dental products, providingfledgling dental products with manage-ment guidance, technical assistance andthe resources necessary for productdevelopment and company growth.Dentcubator’s existence and capabilitiesis a dream-come-true for dental vision-aries and entrepreneurs who previouslyhad no outlet for their creativity andproduct development and yet have want-ed to impact the global dental market.

You now have all you need to becomean agent of change in your profession –a dentrepreneur, if you will. You havefirst hand access to the problems, youhave a natural inclination to look forsolutions. And if you will develop themindset (Invent Something!), you have aplace to take your idea where it can beevaluated and potentially developed intothe next great innovation, and you thenext great agent of change.

For more information onDentcubator, email me directly attony@sunrisedentalsolutions or submityour idea confidentially and securely toideas@dentcubator.com.

Anthony Feck is an internationally recognizedclinician, consultant, lecturer and author. He isthe Dean of the Faculty of DOCS Education. Hiscompany, Sunrise Dental Solutions, providespractice management solutions through moni-toring, training, and coaching. To find out more,visit www.SunriseDentalSolutions.com, or forDr. Feck’s lecture availability contact Dr. Feck at800.750.0737.

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INNOVATIVE IMPLANT SOLUTIONS

“This long-term male patient had increasing concerns about hisoverall appearance. As a Professional Engineer who owned andmanaged his own firm, he was constantly in the public eye, bothin terms of his networking and his “sales” activities. As such, hisdeteriorating oral health was impacting not only on his smile butactually aging him perceptibly as time went on.

Yet, as a busy entrepreneur, he had always also felt he couldnot afford the time required for a comprehensive solution. Thishad resulted in a series of “quick fixes” to a series of dentalcomplaints including extractions, bridgework, crowns and otherrestorations – as his overall dental health continued to decline.In the past, he had suffered from headaches while his current sit-uation was a litany of broken teeth and rampant decay. Finally,at one visit, I outlined two different overall approaches for him.The first was the placement of crowns, bridges and cast partials,which would resolve his functional issues but would not deliverthe overall esthetic results he desired. The second was the conceptof a “non-surgical facelift” through Full Mouth Reconstruction,improving his overall appearance and well being by correctinghis vertical, his bite and creating a more comfortable jaw posi-tion. He finally decided that it was time to face his concerns headon and he selected the second option.

We began by determining his comfortable jaw position. At thesame time, we utilized Diagnostic software, in conjunction withthe Aurum Ceramic Implant Team, to determine the optimalplacement for a number of implants as the foundation for a new

fixed bridge (#12 - #14) and single crowns on #2, #3 and #19.After implant placement (by Dr. Cliff J. Revell) and healing,Fixed Lower and Upper Orthotics were placed to correct his jawalignment and calibrate his proper vertical positioning. Theseremained in place for six months. The K-7 was then employed toconfirm we had indeed created an accurate bite.

Aurum Ceramic created a Diagnostic Wax-up as per theirACCES™ system, which the patient enthusiastically accepted. Hisremaining dentition was prepared and temporized following theLVI protocol for esthetic reconstruction with the Aurum CeramicAdvanced Esthetic (AE) Team providing Prep Indices, Bite Stentand Siltec Provisional Stent. The implant-based restorations werecreated utilizing Zirconia-based Contessa™ with IPS Empress(Shade 020) crowns employed to restore the remaining dentition,all beautifully crafted by Aurum Ceramic.

This case has now been in place for one year with excellentresults in all aspects of the bite and esthetics. The patient isextremely pleased (as you can see in the After Full Face photo)with his “non-surgical facelift” and definitely looks and feelshappier and healthier. As he puts it, “People are always compli-menting me on my smile. They ask which toothpaste I use to keepmy teeth so bright. No one seems to realize that these aren’t mynatural teeth.” And, that’s what makes it all worthwhile in myopinion.”

Dr. Alex Pavlenko

Full Face Before. Smile Before. Retracted Smile Before.

Right Side Before. Left Side Before. Fixed Orthotic.

Preoperative Waxup - Front View. Preoperative Waxup - Left View. Preoperative Waxup - Right View.

15

A graduate of Poltava Dental Medical Stomatological Academy in the Ukraine in 1984,Dr. Alex Pavlenko emigrated to Canada in 1998, bringing his family with him. He spent thefirst two and a half years in the University Coordinating Council of the University of Albertaqualification program, writing and passing his exams in 2001, which granted him hisCanadian Dental license. Dr. Pavlenko set up his general practice in Edmonton at that pointwhere he continues today with an emphasis on Neuromuscular and Cosmetic Dentistry.Dr. Pavlenko and his team are active and enthusiastic participants in Continuing Education.He is a member of IACA, CDA, the Alberta Dental Association and the Edmonton DistrictDental Society.

IPS Empress - Model Front. IPS Empress - Model Left. IPS Empress - Model Right.

Retracted Smile After Seating. Left Side After Seating.Right Side After Seating.

Smile After.

Retracted Smile After. Full Face After.

16

DIGITAL DENTISTRY

Experience the Benefits ofDigital Technology for

Accurate - Fast - Strong - Cost-Effective - Beautiful

At Aurum Ceramic, we apply the latest in proven computer-based digital tech-nologies to deliver the ultimate in superior accuracy, communication and beauty.By removing imprecision at each stage in the process, the entire restorative team(doctor and technician) can cut chairtime, speed up turnaround times anddramatically reduce costly remakes.

In combination with new digital impression systems (such as Cadent iTero™)that replace conventional impressions with 3-D, computer-rendered optical scans,we can now deliver predictable, strong, functional and esthetic restorations morequickly and reliably than ever before. Superb results you can count on - fromadvanced smile design and full mouth reconstruction to veneers, crowns, inlays,onlays, bridges or implant-based restorations.

Step 1. Digital Impressions / Bite Registrations

• Dramatically reduces impression chairtime.

• Virtually eliminates need to re-impress patients.

• For unparalleled quality and turnaround time, upload impressionfile directly to Aurum Ceramic for:

• Fast, in-house milling of models and,

• Simultaneous milling/fabrication of restoration(s).

Step 2. NaturalTemps® Milled Temporaries

• Created directly from your digital impression files.• CAD/CAM milled for virtually perfect fit and easy seating.• Temporize even most complex cases.• Superior strength and esthetics for long-term function.

Step 3. Precision CAD/CAM Milling

• Metal, alumina or zirconia frameworks.• All-Ceramic restorations.• Exclusive AurumTek™ zirconia implant abutments.• Custom designed and milled in-house to meet the demands ofeach case.

• Choose from our comprehensive suite of proven materials,technologies and techniques (such as Zeno® Tec, Lava™,IPS e.max® and Procera).

Step 4. Superb Final Result

• Delivering outstanding strength, precision, function and estheticsanywhere in the mouth.

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17

Computer-aided design has beenextensively utilized in the dentalindustry for many years, particu-

larly in the production of crowns andbridges. These techniques are every bitas applicable in the design of cast partialremovable prostheses.

Clear communication is a critical partof any successful restoration. In the past,the very nature of cast partial designforced dentists and technicians to com-municate through various combinationsof verbal instructions, cryptic notes andhand-drawn diagrams. All too often theresult was misunderstandings, errors andomissions in the final case and dissatis-faction from all concerned. Now, withAurum Ceramic’s computerized CastPartial Design System, vastly improvedcommunication can be easily accom-plished.

Completely Customized DesignsUnlike catalogue systems that merely listcompleted designs, the Aurum CeramicSystem maintains a library of all thevarious components (i.e., teeth, clasps,rests, connectors and crowns) needed tocreate a custom prosthesis. The patient’scurrent situation (i.e., missing teeth) isdisplayed on the computer screen atAurum Ceramic. The technician specifiestooth condition, crown and clasp type aswell as various courses of action (e.g.,tooth extraction; insertion of clasps, restsand connectors) and then inserts acces-sory items, such as crowns or bridges, asnecessary. The computer automatically

Computerized CastPartial DesignGary Wakelam, RDT, CDT

Clear Graphic Communication . . . Great Practice Builder

Prepared in conjunction with the Aurum Ceramic Dental Advisory Board

Upper Arch Diagram NotesCast Partial Upper with Stern ERA attachments on crowned #14 & #24.

Metal anterior backings are designed to prevent tooth breakage.

Design also indicates surveyed gold crowns on #17 & #27.

Lower Arch Diagram NotesCast Partial Lower designed with metal overlays and acrylic build up

to open the vertical.

All designs manufactured using VITALLIUM® products. Major constituents: cobalt 60.6%;

chromium 31.5%; molybdenum 6%. Minor constituents: manganese, silicon, carbon.

This information is suggestive only and any diagnosis and prescription should be the decision,

and sole responsibility of the doctor utilizing this information.

g

applies one of three common clinicalmethodologies (Stress Broken, Semi-Rigid or Mixed Technique) and createsa recommended design taking everypossible configuration of the missingteeth into account. This design can befurther customized by modifying theclasps, crowns, etc.

Clear Visual CommunicationFull color plots of design alternatives aregenerated for practitioner considerationand approval before the final impressionis taken. Agreed upon case design,preparations, etc. are all clearly indi-cated. Completed designs can beemailed to the dentist office for color

printouts there or sent as hard copiesfrom the laboratory. As the system storesall designs, re-access and modification iseasy. The same plots can be used toexplain proposed treatment plans to thepatient, making them an excellent patienteducation tool.

By employing this systematicapproach, you can view different possibledesign concepts, decide on the bestapproach and save valuable chairtimethroughout the process right up to inser-tion. The skilled, experienced CastPartial Team at your closest AurumCeramic laboratory is always ready toassist you in creating the best design foreach individual case situation.

Patient: John SmithCast Partial Design

CAST PARTIALS

18

APPLIANCE THERAPY

Posterior Crossbitesin ChildrenWalt Pfitzinger, DDS, MS

According to some studies up to10% of children have eitheranterior or posterior crossbites.1

Most cases of posterior crossbites in theprimary and mixed dentition are theresult of a narrow maxilla accompaniedby a mandibular shift, which uponclosure causes a midline deviation.Factors involved in the etiology of cross-bites include heredity, sucking habitsand abnormal breathing due to enlargedtonsils and adenoids.In the case of posterior crossbites,most clinicians agree that this abnorma-lity should be corrected as early aspossible with some authors suggestingthat correction should take place nolater than age 10 in order to avoid poten-tial relapse or a dysfunction case later inlife.2 Since most children will visit eitherthe general dentist or the pediatricdental specialist prior to age 10, it isessential that the dentist make thediagnosis and either refer the patient fortreatment or treat the patient in his/herpractice.

There are many different appliancesdesigned to treat posterior crossbites,some removable and some fixed. Mypreference is to treat children early inthe mixed dentition with fixed appli-ances, usually a quad-helix, although attimes (especially in the older patient) Iwill select rapid palatal expansion as theappliance of choice.

As with all orthodontic treatment,orthodontic records should be obtainedbefore making a diagnosis. In earlytreatment cases, the records that Iobtain are a panoramic X-ray, studymodels (now digital) and photographs. Ido not feel that a cephalometric radio-graph is necessary unless there is apotential skeletal problem (i.e., Class IIor Class III malocclusion) in addition tothe posterior crossbite.

Case Study

The case study in this article is a9 1/2 year old male patient who, inaddition to a posterior crossbite,exhibits an anterior crossbite of themaxillary right central and the maxil-lary left lateral incisor (Figs. 1 and 2).I elected to treat this case with aquad-helix in the posterior segment,and simultaneously treat the anteriorcrossbites by bracketing the fourincisors and placing an arch wire intothese brackets. For this case I choseto take a maxillary arch impressionand have all appliances including thearchwires used made indirectly bySpace Maintainers Laboratory (Fig.3). Following the impression, weplaced separating elastics betweenthe second primary molar and thefirst permanent molar on the upperarch (Figs. 4 and 5).

We received back from thelaboratory the quad-helix applianceon the model (Fig. 6) and the brack-ets and archwires (Fig.7). At the initialtreatment appointment, we firstexpanded the quad-helix about12-15 mm and cemented it in place.Brackets were placed on the fourincisors and the initial arch wire(Twist) was inserted into the buccaltube (ends turned up) and ligated tothe four brackets (Figs. 8 and 9).

The patient was seen at four-weekintervals. By the end of the secondmonth the posterior crossbite wasover corrected; the appliance wasthen made passive and left in place.We continued to see the patient,

changing the first arch wire to a utilityarch (.016 x .016) provided by thelaboratory (Fig. 10). Total treatmenttime was 7 months. Note in Figure 11the over correction of the posteriorcrossbite.

I retain all posterior crossbites fora period of 10 months followingexpansion, no matter what type ofappliance I have chosen to use forthe correction. In the case of thequad-helix, I find that after we makethe appliance passive the applianceitself can be used as the retentiondevice. In the case of this patient, wemade a Hawley retainer to hold theteeth because of both the anteriorand posterior crossbite correction.

While I cannot say that this casewill not require further orthodontictreatment after the permanent teetherupt, it is certainly a necessaryservice to make this correction earlywhile the patient is still in the mixeddentition.

References:1 Cameron, A C, Widmer R P, Handbook of Pediatric Dentistry. Mosby; 2003

2 Slavicek, R, Gottlieb, E. JCO interviews Dr. Rudolf Slavicek on Clinical and

Instrumental Functional Analysis for Diagnosis and Treatment Planning,

Part 1. JCO Vol 22 Number 6, 1988: 358-370

3 Thilander, B et al. The effect of early interceptive treatment in children

with posterior x-bite. Eur J Orthod 1984, 6:25-34

Fig. 1: Patient’s right side showing posteriorcrossbite and maxillary right central incrossbite.

19

Walt Pfitzinger, DDS, MS, began his practice ofdentistry 35 years ago as a solo pediatric dentist.His practice has evolved into a group with fouroffices and consists of five general dentists,three pediatric dentists, an orthodontist, an oralsurgeon, and an anesthesiologist.

A graduate of St. Louis University School ofDentistry, Dr. Pfitzinger received his advanceddegree in pediatric dentistry from MarquetteUniversity. Always a student, Dr. Pfitzingercontinues to improve his practice and teaching.He actively participates in courses led by world-renowned specialists in appliance therapy both inNorth America, Europe and Asia. He brings first-hand knowledge on what works and whatdoesn’t with explanations and examples.Although removable appliances are an importantadjunct to early orthodontic treatment and minormovement in adults, he also practices usingfixed Straight Wire mechanics.

Fig. 2: Patients left side showing maxillarylateral in crossbite.

Fig. 3: Working model sent to laboratory. Fig. 4: Separating elastic placed withseparating elastic forceps.

Fig. 5: Separating elastic in place. Fig. 6: Quad-helix received from SpaceMaintainers Laboratory on model.

Fig. 7: Anterior brackets and arch wiresreceived from Space Maintainers Laboratory.

Fig. 8: Initial visit after cementation ofappliance, bracket placement and insertionof the initial arch wire.

Fig. 9: Initial archwire after 1st visit. Fig. 10: Utility archwire in place at 3rd visit.

Fig. 11: Anterior and posterior crossbitecorrection completed.

Plan to Attend:

Minor ToothMovement forAdults and ChildrenFeaturing Dr. Walt Pfitzinger

Spokane, WA, November 20, 2009(with the Spokane District Dental Society)Richland, WA, November 21, 2009

For more information or courses in your area,check out “Upcoming Courses” off the NEWS &EVENTS Menu at www.aurumgroup.com or con-tact the Aurum Ceramic/Classic DentalLaboratories Continuing Education Department at1-800-363-3989 or email: ce@aurumgroup.com.

Dates subject to change. Please call to confirmcourse dates.

®

DENTAL LABORATORIES LLP

www.aurumgroup.com

DentistrycourtesyofDr.MichaelAdler,Boulder,CO.RestorationsfabricatedbyAurum

Ceramic.

Reflections of ExcellenceAn Olympic Gold Medal...AnAurum Ceramic Smile

Cyclist Tyler Hamilton has them both.See how his unique dental situation wasrestored by Dr. Michael Adler in the “CaseStudies” section (off the Education Menu) at

Or Call our Advanced Esthetic Hotline forbeautiful smiles that “perfectly reflect” on eachpatient.