Level 2
June 12-13 2012
1
What I learned...
Powdering Techniques
Modified preparations
Imaging do's and don't s
All the new design tools
Multiple restorations
Material selection
Proper bonding technique
New secrets: fast fire cycle
for emax only 12:40 and
can use blocks more than
once !
2
preferred spray but vita
spray can be used in
conjunction for hard to
reach inter proximal areas
Powdering
Small cans preferred for
ease of manipulation and big
cans not a big cost savings
Use optragate in
conjunction with isolite for
the optimal lip,cheek,tongue
retraction
Used one continuous spray
moving
3 can over area as
you or your assistant can
take opposing images and
buccal bite images
Imaging
As soon as you take
images, always take
mouse to top bar menu
and hit " SAVE
CASE" . This will
prevent you from losing
images should your unit
freeze or have issues while
designing
You can open and work
on more than one case at
a time using windows
mode. Go to top bar
menu and select window
mode and then minimize
4
save time
Do not need buccal bite images for
biocopy or if using Biogeneric individual
for inlays
Buccal Bite Images
Can use foot pedal to capture images to
overcome movement from the tongue
For small mouths you can remove the black
cover to camera to give more working room
Take more than one shot anterior to prep if
you are imaging buccal bite before prepping
( if using rubber dam). Capture opposing
gingiva
If taking buccal bite after prepping, capture
5
Camera Positioning
Toe of camera faces distal of mouth when
imaging
Center prep shot over long axis of tooth,
capturing clear shot of margins with no
shadows
Can do a slight roll mesial and distal to prep
to capture contact area data from adjacent
teeth
Can do slight buccal roll as you come
anterior to and a few teeth away for prep to
capture buccal ging/cervical
1/3 of tooth
6
More about Imaging..
Do you need opposing and buccal bite
images for Biogeneric Individual for inlays??
7
NO!!!!!!!!!
You can take images of
your inlay prep ! That is
all you need :)
8
If your images turn red with an
"!" DO NOT TRASH
THEM. The red exclamation
means you missed an
overlapping image so your
images didn't stitch. Simply go
back and take the missing
image and they will all stitch and
turn green.
More Imaging tips...
Right click on an image catalog
if you want to delete an entire
catalog
Right click in an image within a
catalog to "ignore"it instead of
trashing
To move images taken
accidentally in wrong catalog,
9
for best retraction
Scan from posteriors first up
to centrals/laterals
How to Image a full arch
Go to advance tab and hit "
add a quadrant"
Flip the isolite to the other
side
Then scan then other
quadrant starting with the
posteriors and come across
the central and laterals and
overlap...making sure the same
centrals/laterals are in10both
Other ways to image
multiples
Can do quadrants
and stitch together as
shown in previous slide
Can flip the camera once you get to
anterior midline, walking the camera from the
distal forward
Can also keep toe of camera facing back of
the mouth when imaging the anteriors as
long as your data is good. Then you must
correct the image positions at the insertion
axis step.
11
Biocopy
Use for all anterior cases
whenever possible
Can combine Biocopy
and Biogeneric Individual
Modes by taking
opposing and buccal bite
catalogs if you only want
to copy part of the
original tooth
12
If you are using Biocopy for posterior
crown preps, you do not need opposing and
buccal bite images...how do you check the
occlusion then??
Biocopy continued..
...by overlaying the Biocopy image on top
of your proposal and checking to see the
silver and white lines up
When doing a multiple restoration case in
Biocopy upper and Biocopy lower ( ex of
dr doing max rt molar and many left molar
used) if you combine them in the admin
phase into one case, then the software will
require you provide the buccal bite images
13
and opposing catalog... So in this case, do
14
You always have less thickness in your final
restoration and you have always prepared
less than you think you have. This is
because of the spacing and occlusal offset
parameters
Preparation
Emax is going to be publishing that you
now only need 1mm of reduction but for now
still stick with 2mm
Always prep interproximally at the gingival
margin. This allows for proper emergence
profile in designing contacts.
Modify your preps to
increase enamel
15
Lingual flat top prep
Buccal shoulder
continues interproximally
onto lingual extending
past contact areas
Lingual occlusal
reduction only. No Axial
wall or shoulder there.
Make transitions smooth
with #8 low speed round
bur...think of a "
skateboarder" on a ramp.
Don't let him fall!!
16
17
Inlay Preps
Start on occlusal surface making depth cut
and extend into interproximal to drop your
box
Use a narrow chamfer bur parallel to long
axle of tooth and come from the outside in
on the MB/ML line angles, buccal and
lingual to the contact areas for flaring and
creating divergent mesial box
All preps must be divergent
Use the pointed flame bur on 45 degree
angle to refine and get
rid of traditional "s"
18
Prepping Multiples
When preparing multiples apply same
principles as if preparing a fixed bridge
Make preps parallel
Make preps have same path of draw
19
Design Tools
Use your "macro" tools first
always ie
shape,move,dimension
Then go in with your "micro"
tools. ie form- add, remove,
smooth
20
Circular
2D
Use circular 2D in its largest mode( right
click while hovering over
proposal and
scroll
Everyone's
favorite
tool
trackball up to increase size of orange glow)
Use this tool on occlusal aspect hovering
over marginal ridges to increase contact
area
Use this tool to broaden contacts and
close embrasures
To use the tool and not end up with an
alien head on your proposal left click and
move ball in direction21you want to move in a
Clicking on occlusal or proximal contacts
tool will automatically change your contacts
to the same strengths in you have set in
your global parameters
Contacts tool
Use can modify contacts further using form
minus or smooth tool set to size similar to
overall size of contact area and again losing
a sweeping motion to modify as opposed to
multiple clicking
Leave contacts strength to have green , not
yellow or red as long as you are confident
you have good data in your images of your
contact area.
If you are missing data in your contact area
22
Smooth Tool
Use in largest mode and sweep over
proposals buccal and lingual contours to
get a polished look after done editing
Can use to reduce high occlusion and
reduce contacts
Can use to smooth ovate pontic sites that
can be created for bridges in edit model
mode
23
For Bad Proposals..
Check the
unadapt tool box
Use the move
tool and
dimension tools
to improve
shape, size,
position of
proposal
24
Then hit
recalculate
25
propose teeth together
If doing two teeth in same quadrant that are
not adjacent, then you can propose one
while you begin marginating designing the
second one.
Designing Multiples
Define the insertion axis for each tooth
individually
If you set insertion axis along long axis of
the tooth you will get great proposals
In order to design multiples you must first
got to Configurations , then go to options
menu and select multiple restorations and
26
hit " yes"
bridge with an
ovate Pontic in
an extraction
site, use the
edit model tool,
trace out the
area for the
pontic, then use
form remove
tool to creat
depth of pontic
and smooth
tool to finish it
Provisional Bridges
•
Make sure
27
Material
Recommendations
3M Lava Ultimate
Ivoclar Emax
Empress Multi
Vita Real Life
Ivoclar telioCAD
28
Lava Ultimate
Nano ceramic classification
It can now be billed as a ceramic
Use for all inlays/onlays in non
esthetic zone
Use for temporary crowns (cement
with durelon and cut off)
Do not HF etch when bonding
Do sand blast with microetcher (
Danville )and silane
Always bond lava restorations
29
Lava blocks come in sizes 12
and 14
You
CAN
use
blocks
Stock size 14 blocks
more
once !...
Can mill more
than onethan
small
restoration with the same
block....
After milling first restoration cut
off "fins" using model trimmer
Measure using your analyzing
tool length of next restoration
and make sure it fits in size of
remaining block
You Do NOT need to alter
position of the second
restoration in the mill preview.
Position as you normally do and
30
Ivoclar Emax Blocks
Used as material of
choice for all molar crowns
Use as material of choice
for onlays in an esthetic
zone
Can also be used for
anteriors
31
NEW 12 min FAST
Dr. Rela Christianson
1
CYCLE
year study concluded fast
cycle is safe to use
For Emax oven
Can download how to
manually program oven for
12:40 cycle
If two restorations then
use 19 min cycle
If three restorations use
26 min cycle
Only effect noticed was
some color changes on
HT restorations, so on
esthetically demanding
32
Tips for Emax using fast
cycle
Always use a very thin coat of glaze
Do not apply glaze on the contact areas.
This will help avoid any shrinkage and loss
of contacts
Place crown on a " pillow" of putty directly
in honey comb and allow putty to come up
onto mesial and distal contact areas.
33
Empress Multi Blocks
Use for full coverage
crowns on bicuspids and
anteriors
34
Ivoclar Telio CAD
Used for provisional
bridges for up to 12
months of wear
35
Vita Real Life
Blocks
Use for single
anteriors not
multiple
anteriors
36
Cementation Technique:
Always Bond Whenever
possible
Leave triple zero cord
soaked in hemodent until
cement sets
Do NOT tack cure the
cement - allow it to set for
30-40 seconds , and get
to the gel state on its own
and cleanup excess
After 60 seconds then
can do final cure
37
Selective Etch bonding
Selective Etch: Apply
phosphoric etch technique:
to
enamel only for only 5
ToothandPreparation for
SECONDS
RINSE
Bonding
Benefits of selective etch
is an increase in bond
strength
A Negative to selective
etch is an increase chance
of sensitivity
Apply Gluma: 30
seconds and rinse and air
dry
Apply A& B and
SCRUB into tooth for
38
Selective Etch Bonding
Emax Restorations:
Technique:
HF etch:
Restoration
Preparation
If using 4.5% : etch for 20 seconds ONLY
If using 9% : etch for 13 seconds ONLY
Take care NOT to over etch!!!
Apply monobond plus only ( not another
silane also)
Load tooth preparation with cement for
onlays
Load Emax crowns with cement for full
39
Lava Ultimate
Restorations:
Tooth Preparation
Selectively etch tooth enamel with
phosphoric etch for 5 seconds and rinse
Apply A&B and scrub for 20 seconds.
Do NOT light cure!
Place multilink cement into preparation and
do not tack cure
40
Lava Ultimate
Restorations:
Lava
Restoration
DO NOT HF
etch
Preparation
sand blast
restoration with
microetcher
Apply Monobond
plus
41
Time Management
Time yourself during
your next CEREC and
write down how long it
takes you for each step,
from anesthetic,
prep,powder,image,
design, Mill, and bond
Analyze your times and
look for areas to improve
Do more than one tooth
in a quadrant at one
appointment
If your images and preps
are good there is no need
to try in Crowns before
42
Tips for second molars
Extract them all...Just kidding
If you see an open contact on a recall on a
maxillary second molar on recall you can try
a technique called " walking the second
molar"
You adjust the occlusal forces from the
lower opposing molar to drive the maxillary
second molar mesially
Takes an average of 4 to 5 weeks to
accomplish and multiple occlusal
adjustments. Refer to
Dr.Kurthy article to
43
44