todd snyder, dds, faacd, fiadfe, asda › fa57ee0a-1796-4501... · 2020-05-15 · accredited...

5/15/2020

Accredited Fellow, American Academy of Cosmetic Dentistry

Fellow, International Academy for Dental Facial Esthetics

Member of The American Society For Dental Aesthetics

Former Faculty, UCLA Center For Esthetic Dentistry

Speaker, Catapult Education

LEGIONpride.com, Online Training Challenge for Dentists

Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA

Aesthetic Dental Designs®

doc@tcsdental.com

5/15/2020

IDENTIFY THE PROBLEM

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TMJ SIGNS & SYMPTOMS▪ Wear facets

▪ Pot holes

▪ Abfractions

▪ Gingival recession

▪ Mobility

▪ Occlusal & Incisal wear

▪ Linea Alba

▪ Tongue scalloping (Crenations)

◼ Muscle hypertrophy

◼ Muscle tension/tenderness

◼ Muscle rigidity

◼ Limited opening

◼ Guarding on CR closure

◼ TMJ noise

◼ Head and Neck aches

◼ Tooth sensitivity

◼ Ear problems, ringing, buzzing, fullness

◼ TMJ locking history or other

◼ Orthodontics history

OCCLUSAL & INCISAL WEAR

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WEAR FACETS

Pot Holes

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GINGIVAL RECESSION & ABFRACTION LESIONS

ABFRACTION LESIONS• Sometimes it presents as single teeth due to excursive interferences or as a

pivot, fulcrum or “teeter totter” tooth.

• Other times there are more in a quadrant and there is severe wear to the occlusion.

• Other times it maybe on the facials of anterior teeth, where there is wear on the incisal edges or wear facets on the linguals, however little to no wear on posteriors.

• Occlusal guards should be fabricated along with an occlusal analysis in CR on models.

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Flowables?

Microleakage and missing fillings from high occlusal loads on teeth can cause large cervical stress concentrations resulting in disruption of the bonds between the hydroxyapatite crystals and the eventual loss of cervical enamel and dentin.

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ABFRACTION LESIONS & CLASS V RESTORATIONS

LATIN WORDS, AB – “AWAY”, FRACTION – “BREAKING”

• Pathological loss of tooth structure caused by biomechanical loading forces.

• Static and cyclic flexural overloading of tooth structure ultimately leading to fatigue and failure of tooth structure away from the point of loading.

RESIN MODIFIED GLASS IONOMERS(RMGI)• Light cured

• Dual cured

• High flexural strength

• Lower compressive strength than conventional G.I.

• Good polishability

• Excellent wear

• Hydrophillic

• Fluoride release

• No microleakage

• No adhesives

• Acid resistant layer

• Reduces sensitivity

• True chemical adhesion

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GC FUJI AUTOMIXLC

• Resin bonding is mostly due to the intertubular dentin.

• Deep preparations have less intertubular dentin.

• More moisture present due to odontoblastic tissues and fluid

• Higher risk of post-op sensitivity

• Use a New Advanced Adhesive and Flowable

• Glass Ionomer (GI)

• True adhesion to tooth structure

• Bonds to moist dentin

• Less technique sensitive

• Fluoride release

• Decreased gap formation and cusp deformation

• Coefficient of thermal expansion is similar to dentin

• No post operative sensitivity

• Use on dentin & cementum

• Base out deep areas

• Place resin/composite on top of GI

Replacing Existing Restorations & Decay

Dentin Bond Strengths of Simplified Adhesives: Effect of Dentin Depth. Compendium June 2006, p.340-345

Using Cavity Liners with Direct Posterior Composite Restorations. Compendium June 2006, p.347-351

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RESIN MODIFIED GLASS IONOMER RESTORATIONPost-Op Photo – notice unlike typical class V composite RMGI restorative material.

Typical treatment involves the placement of a #00 retraction cord on each tooth followed by a shade selection. Roughen tooth structure with air abrasion. Place cavity conditioner on all areas to be restored for 10 seconds, then wash and dry.

Restorative Therapy- Case TIP

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Mix RMGI and syringe into place. Utilize hand instruments to shape and remove gross excess. Cure each tooth for 20 seconds. Remove excess and contour using a handpiece with fine diamond burs. Teeth should be isolated from saliva.

Restorative Therapy- Case

After contouring the restorations can be coated with a self etch adhesive coating, and cure for 10 seconds.

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Ten year post-op photos show the integrity of the material is still

excellent. Note the lack of marginal microleakage stain often

present with composite restorations.

RESIN MODIFIED GLASS IONOMER

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Fig. 15 – Graph representing the mean annual failure rates

per adhesive class, determined according to a systematic

review of Class-V clinical trials of adhesives during the

period 1998–2004 [2].

Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent

Mater (2009), doi:10.1016/j.dental.2009.11.148

Deep Preparations◼ Bonding Agent, Flowable & a Layered NanoHybrid Composite

◼ Conventional Glass Ionomer, Bonding Agent & then Composite ◼ Fluoride Release

◼ High compressive strength

◼ Hydrophillic

◼ Insoluble

◼ True chemical adhesion

◼ Minimizes microleakage

◼ No sensitivity

◼ Acid Base Resistant Zone

◼ Decreased gap formation & C Factor

◼ Coefficient thermal expansion similar to

dentin

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• Bioactive material

• affinity to tooth structure. when placing a glass ionomer a weak acid or conditioner is used to aid in releasing calcium and phosphate ions from the tooth structure. These calcium and phosphate ions combine into the surface layer of the glass ionomer and form an intermediate layer called the interdiffusion zone. This bond layer can be very strong and significantly reduce the microleakage that would occur at the margins of the restoration.

• Very good fluoride and ion release helps remineralize tooth structure in the remineralization–demineralization process that naturally occurs in the oral cavity.

• They chemically bond to enamel and dentin.

Why Glass Ionomers?

• They produce good marginal integrity.

• They shrink only one ninth the amount of composite material.

• They are fluoride-rechargeable.

• There are no free monomers in the material.

• The cavity preparation can be bulk-filled, making the materials easy to place.

• They exhibit excellent biocompatibility.

Why Glass Ionomers?

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GLASS IONOMER SANDWICH

•Class I, II, III & V posterior restorations

•Open & Closed Sandwich

techniques

•Composite replacement •Amalgam replacement

•High caries risk patients

•Pediatric patients •Geriatric patients •Special needs patients

•Long term resistance to microleakage

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RESIN TO DENTIN HYBRID ZONE

GLASS IONOMER INTERFACE

lysis (TE

CARDOSO et al. J Dent 2010

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EQUIA FORTE™HT is a complete system that is an ideal solution for posterior restorations:

•Class I, II, III and V posterior restorations •Composite replacement •Amalgam replacement •High caries risk patients •Pediatric patients •Geriatric patients •Special needs patients •Buildups•Long term provisionals/Emergencies**

EQUIA FORTE HT

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EQUIA FORTE HTCaries control/quadrant dentistry

(Class II, III, V & core buildup)

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Resin modified glass ionomer materials placed in abfraction lesions have been proven to have better longevity than traditional composite resin restorations.

When dentin is missing on occlusal loading restorations, use conventional glass ionomers to replace it. It is the best dental material available today that virtually mimics dentin. No adhesive is required, and sensitivity is non-existent. Like dentin, conventional glass ionomers have a very high compressive strength, ensuring it will withstand long term mastication forces and a capping composite can be placed on top of it to replicate enamel.(Equia Forte HT-GC America is my go-to buildup material unless only two walls remain in my preparation)

CENTRIC OCCLUSION DENTISTRYOR MIP

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Red Blood Cells 2 – 5um

200-500nm

Human Hair 60 –120um

6,000 – 12,000nm

SHIMSTOCK & ARTICULATING PAPER

What do you use…..

.…and why?

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SHIMSTOCK & ARTICULATING PAPER

• Parkell Accufilm II is 21µm for dentistry

• Great Lakes articulating ribbon 12µm

• 8µm Almore Shimstock foil

• 8µm articulating paper??

What do you use…..

.…and why?

8µm articulating paper

Available in blue

And red too!

Mark the bite before prepping teeth!!

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TROLLDENTAL-8ΜM ARTICULATING PAPER

G-AENIAL BULK INJECTABLE –

AVAILABLE SHADES

A1 & A2 shades available

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• Injectable high strength nanoparticle composite with ideal viscosity handling and adaption characteristics that may be used as a one step application for bulk filling up to the occlusal surface without the need for capping or veneering with another composite

G-AENIAL BULK INJECTABLE

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WEAR RESISTANCE

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Minimally Invasive

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Selective Etch Enamel Only

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• Bis-GMA free / Radiopaque

• High Strength & Wear Resistance

• High density uniform dispersion nanofiller technology

• Sculptable

G-aenial BULK

Injectable“operates like a flowable but

performs like a restorative”

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• Verify bite• Shimstock

• Over Impression

• Preparation

• Bite Registration• Dead soft Delar Wax

• Firm, Hard Bite Reg

• Shimstock

• Facebow

• Full Arch Impression

• Provisional

• Lab Articulation

Indirect Restorations & Bite Registrations

PDL & OCCLUSAL RECORDSThe range of PDL width: 0.15mm ~ 0.38mm

• Average PDL width by age:

o 11 ~ 16 years old: 0.21mm

o 32 ~ 52 years old: 0.18mm

o 51 ~ 67 years old: 0.15mma

• The PDL width decreases with age.

• The PDL width is thinnest around the middle 1/3 of the root.

• Tooth with more function has bigger PDL space

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Occlusal Testing Hold

No Hold (None)

SHIMSTOCK

• Holds• Means that when biting firmly in C.O. the shimstock can not be

pulled out

• Drags• Means there is resistance on the shimstock but it can be pulled

out slowly

• No Hold• There is no resistance what so ever when pulled between

occluding teeth.

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BUILT IN ERRORS!Thickness??Rotation?? Rocking??

Function & Failures

• Closed Bite Trays (most common)

• Lack of rigidity may cause distortion

• Spring back after impression potential

• No cross arch stabilization

• Thin spots or perforations can cause distortion

• Impression material shrinks towards bulk

• Unable to recreate excursive movements

• Potential for errors & adjustments extremely high

Impression Trays

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QUAD TRAY EXTREME (CLINICIAN’S CHOICE)& BITE REGISTRATION

PEER REVIEWED

The Catapult Group rated the Quad-Tray Xtreme as better than, just as good, or tied with other available closed bite trays.

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QUADRANT & DISPOSABLE ARTICULATORS

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Bite Registration & Occlusal IndexingTIP

LITHIUM DISILLICATE (EMAX)

• Simple

• Fast

• In Occlusion

• Minimal or No Adjustment

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CEMENTATION

REASONS WHY OCCLUSION IS SO IMPORTANT

1. You are changing bite pressure by not having adequate occlusal pressure

2. You can cause more damage to other teeth from occlusal forces

3. You can cause tooth movement and shifting in the dentition due to pressure.

4. You can cause a jaw positional change that upsets the TMj.

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Disposable Articulators

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Semi Adjustable

not on Hinge Axis

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Semi Adjustable

not on Hinge Axis

is a zinc-oxide non-eugenol, automix temporary cement with a unique polycarboxylate resin

The addition of polycarboxylate optimizes adhesion, soothes the tooth, and provides an

excellent seal, while allowing the material to be easily removed from the tooth preparations

when desired.

Cling 2 (Clinician’s Choice)

30 second working time, 60-90 second set time

Good adhesion, easy removal

Low film thickness

Excellent marginal seal

Biocompatible – protects the gingival tissue

Resists forces of mastication

2 year shelf life

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Utilize an accurate preliminary over impression

Maintain over impression

Check contacts and occlusion

Place temp cement only on margins

Do not fill temp with cement

Or vent holes

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TRY-IN / NO ADJUSTMENTS…

• A few steps makes a big difference

• Patients notice the difference.

• Do you want to be like everyone else?

KEY TO ADJUSTMENTS

• Full Arch Impressions

• Facebow

• Bite Registration

• Semi Adjustable Articulator

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ASAP INDIRECT + POLISHERS(CLINICIAN’S CHOICE)

CERAMIC ADJUSTMENT

• Jiffy Ceramic Polishers (Ultradent)

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OCCLUSAL RECORD/BITE REGISTRATION

Fast Setting Rigid PVS

MODEL ARTICULATION & EQUILIBRATION

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INCISAL PINS

Selection Process

◦ Open Bite Trays

Plastic-full or quadrant

Metal-full or quadrant

Custom Trays

Non-perforated or perforated (metal or plastic)

Rigidity can eliminate tray distortion and rebound

Spring back after impression is possible with plastic

Cross arch stabilization

Ideal occlusal stops for proper model articulation

Able to recreate excursive movements if mounted on a semi or fully adjustable articulator.

Potential for errors & adjustments are low

IMPRESSION TRAYS

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STOCK TRAY SIZES

Impression Trays

DIFFICULT FOR IDEAL FIT

Impression Trays

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IMPRESSION TRAYS

• Custom trays create more ideal placement

• Thinner material creates less distortion

• USE TRAY ADHESIVES for all open bite trays, not just custom trays.

• Only negative is time

Selection Process

Custom Tray

HEATWAVE TRAYS BY CLINICIAN’S CHOICE

• 4 upper & lower trays

• 60 sec. @ 158°F

• Fast, efficient

• Virtually custom

• 30% less impression material used

Impression TraysTIP

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Impression Trays

HeatWave by Clinician’s Choice

Impression Trays

HeatWave by Clinician’s Choice

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Large Volume Mixers

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Dry all teeth in arch

Place tip in most difficult area first

Keep tip on margin and immersed in material

Go around entire margin first

Next go to adjacent teeth

Then do coronal aspect of teeth

Double Mix Single Impression is the most accurate

Syringe Placement

5/15/2020

Special offer from GC America!

Buy 3 G-aenial Sculpt® refills or G-Premio BOND™ products, Get 1 FREE!

Please reference Promo Code #2424 to take advantage of this special offer! Offer good from 4/1/2020 through 6/30/2020.

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Customize Teeth

Checking Occlusion is the Key to Aesthetics

Interferenc

Case Example: #1B

Checking Occlusion is the Key to Aesthetics

WHAT, WHY, HOW, APPLY

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What is the perceived problem?

WHAT IS THE ACTUAL PROBLEM?

Can we find the true cause of the problem?

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◼ Aesthetics

◼ Occlusion

◼ Excursives

◼ Restorations

◼ Wear

◼ Solutions

HOW DO WE FIX THE PROBLEM? What

options are available to fix the problem?

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TMJ SIGNS & SYMPTOMS

• Wear facets

• Pot holes

• Abfractions

• Gingival recession

• Mobility

• Occlusal & Incisal wear

• Linea Alba

• Tongue scalloping (Crenations)

◼ Muscle hypertrophy

◼ Muscle tension/tenderness

◼ Muscle rigidity

◼ Limited opening

◼ Guarding on CR closure

◼ TMJ noise

◼ Head and Neck aches

◼ Tooth sensitivity

◼ Ear problems, ringing, buzzing, fullness

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Case Example: #5

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Silginat - Kettenbach

Counter FIT- Multipurpose Replication Silicone

(Clinician’s Choice)

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Counter FIT- Multipurpose Replication Silicone

(Clinician’s Choice)

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Wear Facets & Interferences

Mounted and Equilibrated

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Custom Incisal Guide Table

GC Pattern Resin

Duralay

Sil-Tech (Ivoclar) -

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▪ Slow unperceivable changes

▪ Diagnosing once it’s a problem

▪ What about prior signs & symptoms

◼ Round, Brachyfacial often

◼ Limited smile appearance

◼ Worn teeth or deep bite

◼ Enlarged Masseters

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POSTERIOR INTERFERENCE (PREMATURITY)• Centric Occlusion

• Natural growth patterns

• Orthodontics

• Dental work

• Trauma

JOINT REPOSITIONED AND

STABILIZED (CRSTABILIZED)• Splint Therapy

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What happens to a Condyle when there

is an Occlusal Prematurityon a 2nd molar?

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A Veneer Case?

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CHANGE!

• Larger amounts of tooth augmentation can create potential shifts in bite

pressure on teeth, CR-CO slides, and excursive interferences.

• Material properties must become more resilient to increased wear and

pressure demands.

• Higher risk of post operative complications due to occlusal modifications,

jaw positioning, and/or adhesive techniques and materials.

• A different approach to typical Restorative Dentistry

Not a veneer case!!

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What did the patient’s teeth look like

prior to veneers? Did she have any

symptoms? Braces? Dental work?

Trauma? Etc…

Case Example: #10

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BUILD IN STRENGTH, RETENTION, AND

CREATE A GUARD

• Patient needs to understand limitations

• Sign off on doing short cut and wear an

occlusal guard

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Simplified Provisionals**

Siltech Putty Matrix

Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.

Duplicate waxup model in stone

Scribe a 0.5-1mm line with a sharp instrument into the

model where the tissue and tooth come together.

Provisionals (Bead Line Technique)

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Duplicate model with a fast setting polyvinyl impression material.

I have used light and medium body washes with a heavy body tray

material.

The scribed line creates the Bead Line in the over impression of the cast.

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The Bead Line in the over impression creates pressure along the tissue

and preparation margin. This causes a thin cut or separation of the

acrylic flash from the provisionals for easier clean up.

Typically the excess acrylic can be removed with fingers, a spoon or discoid instrument. Minimal

to no effort is required to remove excess flash. If a void or a margin is exposed simply fill the

void with a flowable. Etching and a bonding agent are not required as the flowable will adhere to

the air inhibition layer of the temporary acrylic and you do not want to adhere to the tooth.

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The Bead Line Provisional Technique creates less work and risk of damaging tissues and tooth

structure. Typically the process takes 5-10 minutes to make provisionals. Consepsis (Ultradent)

can be placed on the teeth and dried prior to fabricating provisionals.

Cosmetic Provisionals (Bead Line Technique)

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Scribe a 0.5mm-1mm groove into tissue & a little on tooth

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PROVISIONALS

• Utilize an accurate preliminary over impression

• Maintain over impression

• Check contacts and occlusion

Provisionals

-Visalys (Kettenbach)

-Inspire (Clinician’s Choice)

-Luxatemp Ultra (DMG)

-Pro V (Bisco)

-TempSmart (GC America)

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No Polish Necessary if you use a good model

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Minimally Invasive Veneers…. Why? Benefits??

Mockup

Preparation

Provisional

Bonding to Enamel

Material Options

Minimal Prep Case: 3

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Beadline Provisional Mockup

Mockup

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Depth Cuts

Photos for Laboratory Technician

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Provisional Restorations

Final Restorations

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Provisionals Mimic The Final Restorations

LuxaTemp Ultra (DMG)

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Promo code: 50OFF5 Offer expires: 5/31/2020

20% OFF!Dr. Todd Snyder: 20SNYDER

1-800-247-3368 • www.bisco.com

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Cementation Material Options

Restoration Placement? Bonded

Margin placement Moisture Control Technique Sensitive Materials

Self Adhesives

Bonding agent (TE or SE) & luting resin

Cemented Margin placement

Moisture Tolerant Retention Required

Materials RMGI

Calcium Aluminate

Resin Modified Calcium Silicate (RMCS)

Cement Selection

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CEMENTATION CONSIDERATIONS

ISOLATION

PREP DESIGN / TAPER / AXIAL WALL HEIGHT

RETENTION OF RESTORATION (FIT)

RMGI moisture tolerant, needs good retention

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GC FUJICEM 2

BIOACTIVE CONSIDERATIONS

ISOLATION IMPORTANT BUT LESS CRITICAL

PREP DESIGN / TAPER / AXIAL WALL HEIGHT

RETENTION OF RESTORATION (FIT)

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Zirconia Restorations- Tryin

- Sandblast

- Clean w/ phosphate

scavenger

- Rinse- MDP Ceramic Primer

- Tooth etching is not necessary

- No bonding agent necessary

- Theracem (Bisco)

Phosphate Scavengers

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Ceramic Primers w/ MDP

Theracem (Bisco)

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Cement Selection

Cement SelectionJournal of Esthetic & Restorative Dentistry March 2015

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(If Sandblasted by Lab)Try-in

Sandblast

Decontaminate

Cement

Try-in

Decontaminate

Cement

Zirconia Cementation

Sandblasting ZirconiaSize: 50 micron Aluminum Oxide

Pressure: 40 PSI or 2.8 Bars

Time: 20 seconds

Angle: 60º

Distance: 2 cm

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DUAL CURED OR LIGHT CURED

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RESIN CEMENT COSMETIC CASES….

COSMETIC CASES….

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COSMETIC CASES….

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COSMETIC CASES….

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COSMETIC CASES….

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COSMETIC CASES….

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PROVISONALS

PROVISIONALS

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CERAMIC TRY-IN

• Make sure it is etched properly from lab

Try-in

Decontaminate

Cement

Silanes

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TRYIN APPROVAL

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SELECT HV ETCH IS A 35% HIGH VISCOSITY PHOSPHORIC ACID

ETCHANT AVAILABLE WITH BENZALKONIUM CHLORIDE (BAC)

AND IS DESIGNED FOR PIN-POINT ACCURACY.

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• Light-Cured Dental Adhesive

All-Bond Universal is a universal adhesive it can be used with direct and indirect restorations and is

formulated to be compatible with light-, dual- and self-cured materials. The versatility of All-Bond

Universal makes it an indispensable part of any dental practice.

• Unique Benefits:

• Not moisture sensitive use on wet, dry or moist tooth structure

• Impressive bond strength to ALL substrates

• Use with ALL direct and indirect restorations (<10 micron thickness)

• Ideal chemical balance for both total- and self-etch adhesion from one bottle

• Compatible with ALL resin cements (no additional activator required)

• Virtually no post-operative sensitivity

• Clinical Significance:

• All-Bond Universal offers the flexibility for total-, self- and selective-etch procedures

• All-Bond Universal is compatible with all light-, self- and dual-cured resin composite and cement

materials for all direct and indirect procedures

• All-Bond Universal works with dual cure resins, NO activator is required

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CHOICE 2 VENEER CEMENT (BISCO)

- Light-cured luting cement designed for cementation of porcelain veneers.

- Color stability.

- Corresponding try-in pastes (sold separately)

- Choice 2 is specifically formulated for color stability (Delta E <1.2**) resulting in high esthetics

-Highly filled resin cement enhances the overall strength of the restoration

-Low film thickness ensures veneers are completely seated

-Corresponding try-in pastes confirm shade selection prior to cementation

-Choice 2 cement will not change (shade shift) over time, a problem that can occur with dual-cured systems

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LITHIUM DISILICATE & SILICATE, LEUCITE, FELDSPATHIC &

ZIRCONIA RESTORATIONS

- Dual Cured

- Quick Clean Up

- High Conversion

- Low Film Thickness

- Radiopaque

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FINAL RESTORATIONS

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Veneer Finishing System

Send CONTACEZ to 24587 to request a sample.Using the code SNYDER20 on their website will get attendees 20% off their next order!

ContacEZ Restorative strip system

• NEW Gold Narrow Strip 0.10mm single sided medium diamond grit Sub Gingival Trimmer w/ Blank Clear Gateway

• Black Diamond Strip 0.06mm fine diamond single sided

• Orange Serrated Diamond Strip 0.05mm extra fine diamond single sided

• White Serrated Strip 0.035mm

• Blue Serrated Strip 0.065mm

• Gray Final Polishing Strip 0.05mm ultra fine diamond single sided

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ContacEZ IPR Optional Strips

• Clear IPF Single Sided Opener 0.10mm med-fine diamond

• Cyan IPR Single Sided Widener 0.12mm med-coarse diamond

• Purple IPR Super Widener 0.25mm

coarse diamond

• Brown IPR Mega Widener 0.30mm coarse diamond

Example-Centric Occlusion

▪ Anteriorly positioned condyles

▪ Occlusion is not ideal Appears to have canine guidance

Weak centric stops and limited number

▪ Patient okay for a few months

Now has joint pain, noise, muscle pain, teeth are sensitive

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Centric Relation

▪ Joint in proper position

▪ Occluding only on second molars

▪ Restorative dentistry & orthodontics (aligners too)

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Normal Disc Reducing Non-ReducingNormal

Remodeling DJDRemodeling

Adolescent

Facial GrowthDecreasedInterruptedNormal

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Aesthetic Opportunities:

Developing Beautiful Smiles

Case #24 (Complex Occlusion)

Developing Beautiful Smiles

Assessment:Joint NoiseFacial Muscle PainPoor OcclusionInvisalign Done/RetentionAnterior WearWants to Keep Appearance

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Cause & Effect Diagnosis• Functional Wear on Anteriors

• Masticatory Muscle Pain

• Headaches

• Jaw Relationship / TMJ Disorder

• Obstructive Sleep Apnea (OSA)

• Combination

Aesthetics & Occlusion

Supplemental Tests:Sleep StudyCone Beam CT (CBCT)Airway Evaluation

AIRWAY VOLUME

-50mm2 and below have an association with OSA

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TMJ EVAL/Diagnosis

CBCT-Pathology-Jaw position-Bone Appearance-Active DJD/Remodeling

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Orthotic: Superior Repositioning Appliance (SRA)

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Nociceptive Trigeminal Inhibition Tension

Suppression System (NTI-tss)

Jaw Position

NTI type appliances

Jaw Position

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NITE BITE

• 5 minutes to make a Nite Bite appliance for relief of most TMJ

discomfort

• Fast fabrication

• Force distribution

• Minimal opening

SRA FABRICATION:Try-in

Check Bite

Adjust Posterior

Shallow Ramp

Trim Trough

Occlusal Reline

Passive Centric & Hold

Mark Depth of Fossa

Trim Excess

Polish

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• Patient wears just at night the first 2-5 days

• Understands they will wear 24/7

• Patient comes back for evaluation every 2-4 weeks

• Passive reline to achieve equal contacts

• Once the bite is stable follow for another 2-4 weeks

Orthotic: Superior Repositioning Appliance (SRA)

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Occlusal Analysis

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Aesthetics & Occlusion Impression Trays

HEATWAVE BY CLINICIAN’S CHOICE

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The Nuts & Bolts of VeneersAesthetics & Occlusion

5/15/2020

TISSUE AND MOISTURE CONTROL

A laser is more precise, causes less pain, and

prevents bleeding better than traditional tools used

on soft tissues. The highly focused laser light

cauterizes nerve endings, coagulates blood

vessels, sterilizes the surgical site, and increases

the speed of healing. Instantly cauterizing nerve

endings greatly reduces pain during the procedure

and after. Healing times can be as low as a few

days where traditional surgical approaches can take

several weeks.

5/15/2020

Simplified Provisionals

Provisionals (Duplicate models)

Scribe a 0.5-1mm line with a sharp instrument into the

model where the tissue and tooth come together.

5/15/2020

• Verify shape

• Display at rest

• Protrusive

• Excursives

CEMENTATION OPTIONS• Glass Ionomers

• Resin Modified Glass Ionomers

• Self Etch Resin Cements

• Bonding Agent w/ Resin Cement

• Calcium Aluminate

• TriSilicate Cement

5/15/2020

CERAMIR (CALCIUM ALUMINATE CEMENT BY - DOXA)• Alkaline pH 8.5

• Moisture Tolerant

• Self Sealing

• Apatite Formation

• Insoluble

• Stronger with time

• Semi / Translucent

• Biocompatibility-Excellent

• Bioactivity-Apatite formation

• Sealing Quality-Excellent

5/15/2020

Pre-op

Post-op

5/15/2020

Review Patient with Problems-Sleep Study Questionnaire-Sleep Study?-Cone Beam CT (CBCT)

-TMJ Diagnosis (Beamreaders.com)-Airway Evaluation

-Superior Repositioning Appliance (SRA)-Reline as needed.

-Hinge Axis-Diagnostic Model Workup-Discuss Options with Patient

Questions?

5/15/2020

Lecture Handout

www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers

Digital Handouts

5/15/2020

• Reduce Your Stress & Build A Better Life

• Better Business & Communication Skills

• Incredible Marketing & Advertising

• Front Office Simplification

• Insurance Independence

• Office Metrics/KPI

• Responsive Websites, Social Media

• Enhance Diagnostic Skills & Procedures

• Photography

• Elective Dentistry

• Cosmetic & Restorative Dentistry

• New Materials, Techniques, Technology & more..

Online Training For Dentists.www.LEGIONpride.com

TODD SNYDERtsnyder@legionpride.com

www.legion.dentist

www.aestheticdentaldesigns.com

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