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Please have an idea of which restorative materials you want to use and which teeth are being treated when scheduling cases. We usually schedule a diagnostic wax-up before preparation on more complex cases. Using the silicone matrix of the wax-up to fabricate the provisional restorations saves clinical time, and serves as a template for the final case.
When scheduling full mouth reconstruction cases, be sure to communicate the sequencing of treatment; my personal preference is to do the anterior 20 teeth first, then the posterior 8 as a final phase of treatment. It is important to know this when completing the diagnostic wax-up to have the matrix fabricated to work with this sequence. We are also happy to schedule full-mouth reconstructions as a single-phase treatment if you prefer; we work with many different philosophies of treatment.
Once we schedule preparation and delivery dates for all phases of treatment for your patient, it is important to notify us of any changes in scheduling; we can only honor the return dates if all of the needed components of the case arrive at our dental lab promptly. We will take the same care to ensure your patient’s case arrives back in your office when expected.
Beth is always happy to discuss options and alternatives if you have questions regarding the scheduling of a case. By pre-scheduling cases, we control the workflow in our lab and ensure your restorations receive the time and dedication they deserve.
2.) Detailed impression or model of the provisional restorations.
3.) Pre-operative models for patients undergoing comprehensive treatment.
4.) Bite registrations for master models: indicate if the bite is taken at MIP, CR or a neuromuscular position. This helps us evaluate the mounting of your casts.
5.) Bite registrations to cross mount provisional restorations to the prepared tooth models. This is extremely important and needs to be accurate! We check the position of the final restorations relative to the position of the provisional restorations; if this isn’t accurate, then the mounting of the provisional model is compromised.
6.) Face bow transfer for full arch cases.
7.) Stick bite for all multiunit anterior cases.
8.) Photos for communication: The sample set provided below explains the need for each. You can also download the PDF of this to have a checklist in the operatory.
9.) Detailed lab slip.
10.) Some clients include a PowerPoint or Keynote presentation detailing the clinical condition and goals of the case. If you are good at this, it can be very effective communication. Short video clips of the patient talking about their goals for the treatment give me a good perspective. Videos of simple phonetic tests in the provisional restorations can also be helpful. Avoid feature length films.
Our lab prescription is set up for complex, comprehensive cases; if you are treating a simple clinical situation with one or two teeth, it isn’t necessary to fill out everything on the form, just what is about the clinical situation being treated. If you have questions, feel free to call and ask us for clarification.
e-max® lithium disilicate pressable material (Ivoclar-Vivadent) is the hottest new development in dentistry today. It is a high strength pressable that can be pressed as thin as .2mm and comes in a variety of opacities to handle various clinical applications. This is as close to a universal restorative material as we have seen in dentistry. It works well for minimal thickness, “no prep” veneers; it works equally well for full coverage, very thick molars, and everything in between those two extremes. It is etchable and can be bonded with a total-etch technique, but, can also be cemented with Multilink or Panavia in full crown posterior applications. Flexural strength is in the 400mpa range. The latest studies out of NYU by Dr. Van Thompson’s group rated this “the most robust “ restorative material in dentistry today. Their study simulated chewing forces with a variety of different types of restorations. The comparison between monolithic lithium disilicate and zirconium crowns was compelling: at 100,000 cycles with a load of 350n, 90 % of zirconium-based crowns had failed, mostly by chipping of the layering ceramic; at 1,000,000 cycles and 1000n of force none of the lithium disilicate restorations had failed! For single unit restorations with nice underlying tooth color, this is my first choice for a restorative material. Anterior bridges in low-stress areas I’m approaching cautiously. I would also prefer to see the restorations bonded rather than cemented, but the manufacture is ok with cementation as long as there are sufficient restorative thickness and retentive form to the preparations. We are still slightly limited by the availability of some colors in this system, which may result is the use of Empress® or feldspathic material for some cases.
Lucite reinforced pressed ceramic restorations have been used successfully for veneers, inlays, onlays, and full crowns for the last 20 years. Although there are many different manufactures represented in this category, we have chosen Empress® (Ivoclar-Vivadent) as our primary product. We have used this product successfully for thousands of restorations. Flexural strength is in the range of 175mpa, which allows thicker restorations with areas of ceramic unsupported by underlying tooth structure. Empress works great for anterior veneers as well as posterior restorations. Preparation depth of .7mm is necessary to use Empress restorations; more thickness is needed to mask darker colors of underlying tooth structure. This material has been almost completely replaced with the higher strength e.Max LiS2. We now use empress only for shade matching previous empress cases.
Pressed to Zirconia restorations have gained popularity over the last ten years. Applications include full crowns, bridges, and implant abutments. These restorations require full preparation and the same reduction requirements as PFM restorations (1.5mm axially and 2mm occlusal). Conventional cementation is recommended. Flexural strength of the Zirconia core material is 1200mpa, which makes it a good support for bridge applications. Unfortunately, the ceramic that is layered or pressed over Zirconia only has a flexural strength of 85mpa, leaving it very vulnerable to chipping and fracture. We do not offer pressed over zirconia restorations.
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