Let’s Grow Tooth 2016 - Cosmetic Dentistry Eureka St ...
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Let’s Grow Tooth 2016 Jack D Griffin Jr DMD 1 Jack D Griffin Jr DMD Master Academy of General Dentistry Accredited American Academy of Cosmetic Dentistry Diplomat American Board of Aesthetic Dentistry Let’s Grow Tooth Excellence with bioactive/regenerative materials Let’s Grow Tooth: 1. Bioactive –vs- Regenerative 2. Direct restoratives 3. Indirect restorations 4. Cementation to heal margins 5. Regenerative Aesthetics New burs Water Isolation Effective decay removal Bioactive/ regenerative materials Selective etch Thorough rise Moist surface Universal DBA Evaporate solvent Shrinkage management Effect curing Proper adjustment Let’s Grow Some Tooth… Bioactive [bi″o-ak´,v] having an effect on or elici,ng a response from living ,ssue. Regenerative To provide an environment that promotes tissue repair Let’s Grow Some Tooth… Regenerative To provide an environment that promotes tissue repair Optimal pH Bacteria inhibition Void free Moisture tolerant Bio-friendly Well sealed Tooth-like physicality “regenerative” materials: TheraCal LC (Bisco) – a liner Activa (Pulpdent) – a base/restorative Ceramir (Doxa) – a cement Giomers (Shofu) – a class of restorative materials
Transcript of Let’s Grow Tooth 2016 - Cosmetic Dentistry Eureka St ...
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 1
Jack D Griffin Jr DMD Master Academy of General Dentistry
Accredited American Academy of Cosmetic Dentistry Diplomat American Board of Aesthetic Dentistry
Let’s Grow Tooth Excellence with bioactive/regenerative materials
Let’s Grow Tooth: 1. Bioactive –vs- Regenerative 2. Direct restoratives 3. Indirect restorations 4. Cementation to heal margins 5. Regenerative Aesthetics
New burs Water Isolation Effective decay removal Bioactive/ regenerative materials Selective etch Thorough rise Moist surface Universal DBA Evaporate solvent Shrinkage management Effect curing Proper adjustment
Let’s Grow Some Tooth… Bioactive[bi″o-ak´,v]havinganeffectonorelici,ngaresponsefromliving,ssue.
Regenerative To provide an environment that promotes tissue repair
Let’s Grow Some Tooth…
Regenerative To provide an environment that promotes tissue repair
Optimal pH Bacteria inhibition Void free Moisture tolerant Bio-friendly Well sealed Tooth-like physicality
“regenerative” materials:
TheraCal LC (Bisco) – a liner!Activa (Pulpdent) – a base/restorative!Ceramir (Doxa) – a cement!Giomers (Shofu) – a class of
"restorative materials!
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 2
TheraCal LC (Bisco)
What it is!A Resin Modified Calcium Silicate (RMCS) Stimulates apatite formation and 20 dentin MTA (Mineral Trioxide Aggregate) chemistry Early high alkalinity (high pH = 11) Neutralizes over weeks Self-sealing minor bond to dentin Anti-microbial
Clinical use!Liner to protect pulp Place on moist dentin prior to DBA Keep 1mm deep or less Opacity prevents deep cure Direct pulp cap possible Keep 1mm from enamel May show through less opaque composite
Giomer Shofu !
A class of restorative materials!
Giomer ion release by S-PRG:
A stable glass ionomer which allows ion release and recharge. The surface layer is protected giving great physical properties. The glass core is protected from moisture.
Margin Perfect Matrix
Remin Pro (Voco) Fluoride!Hydroxyapatite!Xylitol!
MI Paste (GC) Fluoride !Ca phosphate!Xylitol!
Perio Gel!Antimicrobial!No stain!Decent taste!Perio Protect system!
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Jack D Griffin Jr DMD 3
Problems with posterior composites? Contacts Shrinkage Depth of cure Sensitivity Longevity Time
Best polishers !Disposable. Super Snap Singles One Gloss (Shofu)
Can’t afford to re-use burs
Microcopy!NeoBurr NeoDiamond
Regenerative Dentistry…Providing an environment where tissues can heal!
CariesindicatorSable Seek Ultradent
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 4
A source of reparative ions Alkaline environment Promote dentin healing Bacteriostatic Dentin tubule sealant Thermal insulation
NOTE: Polyacrylic acid of GI inhibits HA formation Source of reparative ions
Alkaline environment Bacteriostatic Dentin tubule sealant Thermal insulation
= apatite!
Liner Moist Dentin Light cure Etch DBA Restore
Nodirectpulpcappingif…Spontaneous pain Throbbing PA problem Bleeding hard to control
“Universal” Dentin Bonding Agents
Regardless of etch technique, they work well
Total etch No etch Selective etch
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 5
Practice building 101… Aging population Recession Abfraction Repeatable success
Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable
Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable
Micro Etcher Prep Star 50 micron aluminum oxide Danville Engineering!
Anesthetic? Enamel Bevel Sand Selective Univ DBA Giomer Flowable
Advantages… Decrease sensitivity!Non-invasive!Esthetic!Root seal!Predictable!Profitable!
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 6
Does your etch matter? Texture Rinse-ability Color Long term antimicrobial? Phosphoric acid kills NOW Bezalkonium Chloride kills LATER
Isolation is critical Dam Isolite DentaPop/DriTip Cotton rolls Gauze Damphobia?
www.isolitesystems.com!
TheraCal Sectionals Wedge Ring Burnish All Bond U Flow Bulk
Does killing bugs matter?
Matrix metalloproteinases = MMP’s enzymes that may break down the hybrid layer between dentin and resin
Cured giomer!!
Where It Matters Most
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 7
Trans-enamel curing !20 seconds each after
“Where it matters most” Margins Dentin Where our technique is most critical
Regenerative environment!
Beautifil Bulk Shofu 4mm depth Somewhat clearish Good color Low shrinkage Good strength Easy to form contacts Giomer bulk fill Fluoride release
Activa:!Dual cure 15 second total etch DBA optional Decent color Ion exchange Calcium, phosphates, fluoride release Re-chargeable
Glass ionomer replacement!
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 8
New burs Water Isolation Effective decay removal Bioactive/ regenerative materials Selective etch Thorough rise Moist surface Universal DBA Evaporate solvent Shrinkage management Effect curing Proper adjustment
“Doc, that tooth never hurt until you FIXED it!”
Jack D Griffin Jr DMD Master Academy of General Dentistry
Accredited American Academy of Cosmetic Dentistry Diplomat American Board of Aesthetic Dentistry
Let’s Grow Tooth Indirect restorations
FULL day !
Cementation Sanity
The most durable aesthetic restorations
EVER. (and how to stick ‘em in)
Cementation Sanity
“Doc, that tooth never hurt until you FIXED it!”
New burs!Water!Isolation!Selective etch!Universal DBA!Air thin well!Regenerative!Flowable 0.5mm cure!Dentin replacement!Max polymerization!Polish well!
NO layering porcelain! !
mon·o·lith·ic [mon-uh-lith-ik] Adjective
PFM gold
e.max zirconia
Use the strongest material that meets the minimum cosmetic need of the patient.
Let’s Grow Tooth 2016
Jack D Griffin Jr DMD 9
Monolithic zirconia… J Very durable J Prep similar to gold J CAD/CAM made
J Digital impression perfect for it J Cement or Bond
J Fast turn around from lab J Total PFM replacement?
J Inexpensive
Monolithic zirconia… C Treat as a metal C Meets aesthetic demands of
80-90% of molar crowns C Wear similar to enamel and
less than feldspathic porcelain if polished well
C ADJUST: Fine diamond, concentric burs, light pressure,
water, polish
1.5-2mm,p
0.8-1mmrounded
1.0-1.5mmclearance,0.5-1mmchamfer
Non-Adhesive…GOOD 1. ResinModifiedGImostpopular
RelyXLu,ng(3MESPE)FujiPlus(GC)NexusRMGI(Kerr)
2. Easymix,easycleanup3. LowsensiHvity4. DoesnotstrengthenrestoraHon5. GoodifretenHveprep
Cementation sanity
1. Dualcureresincementwithprimer/sealerinside
RelyXUnicem(3MESPE)Maxcem(Kerr)SpeedCEM(Ivoclar)SmartCem(Dentsply)Beau,Cem(Shofu)
2.ModeratebondtodenHn3.StrengthensrestoraHonmoderately
Cementation sanity Self-Adhesive…BETTER
1. UniversalDBAAllBondUniversal(Bisco)ScotchbondUniversal(3M)Mul,LinkPrimerA&B(Ivoclar)
2. DualcureresincementDuoLinkUniversal(Bisco)Rely X Ultimate (3M)Mul,Link(Ivoclar)
3. HighestbondtodenHn4. HighestrestoraHonstrengthening
DBA+DualCureResin…BEST !
Cementation sanity
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GI plus calcium aluminate… Bioactive cement – apatite formation Easiest clean up ever!Least sensitivity of any cement tested NO RESIN!Alkaline pH Hydrophilic!No silane, no primer, no bonding agents Awesome for metal, zirconia, implants!No bad taste!
Compare margin sealing:!!Rely X Luting!Rely X Unicem!Fuji GI!!Ceramir!ProRoot MTA!!
Cement Bond
Retention Material
Aesthetics
Zr adjsutments Fine diamond High speed Light pressure Concentric turbine Rubber polishers Polish paste?
Ceramaster !Shofu!
Prep not ideal… Zr primer! Z-Prime Plus Bisco Self adhesive resin ! BeautiCem Shofu
Monolithic lithium disilicate…
J Very durable, versatile
J 1.5-2.0 mm clearance
J Monolithic esthetics good for 95% of posterior restorations
J Cementation good if prepped well
J Adhesive cementation may result in higher ceramic strength
J Slightly better esthetics than zirconia, more translucency
Let’s Grow Tooth 2016
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RestoraHonsuccessBio-friendlycementsThoroughcleanupGoodreten,onSob,ssuetolerance
Implant Crowns
Air abrasion Frosted Supra G
5.0mm Nobel Biocare Titanium abutment Implant Direct
E.max!J Isolate J Try in J Ivoclean 20 seconds, J Rinse J Silane J BeautiCem
J Isolate J Try in J Ceramir J Clean up
Zirconia (Implants and retentive preps)!
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GI plus calcium aluminate… 2 zirconia crowns!
Cementation Soft tissue
enhancement soft tissue regeneration!
Probe to !sulcus depth…!!Margins 2.5-3.0mm from bone crest to prevent biologic width violation
“Sounding” the bone
Plan…!1. Get pt a tooth brush 2. Perio Protect 3. Records 4. Wax up 5. Extraction #19 6. Length determination 7. Long term mock up 8. Establish bite 9. Restore lower posterior 10. Restore the rest
CheckBite!Microcopy
