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American Academy of Cosmetic Dentistry Accreditation Workshop

Part 7 - Case Type examples continued

Dr. Bradley Olson, DDS
Dr. Olson will review examples of each case type and share what the examiners are looking for.

Let's look at a couple of ways to handle case type 4. Case type 4 can be done either by closing the diastema but I'm going the wrong way. Case type 4 can be either done with a fractured central incisor, lateral incisor whatever anterior tooth or it can be done by closing a diastema. So the first one we have is closing the diastema but they also did a crown. Why would they have done a crown, because they got a big yellow tooth right over in here. So when you were talking before I told you this case was coming, you were talking about what, can I use this patient for more than one case type And the answer actually is yes cause the ceramist uses it for this one and the dentist uses it for that one. They can still pair together and use this case. The dentist can't use it for both though. Okay, dentist can't use it. Pick which way you're going to go with it. Alright, so they closed the diastema and they did a single unit here. Okay. Handling that resin and closing that space, what are you thinking Handling it pretty nicely. Yeah. Yeah. Absolutely. What about the single crown Yes. Okay. Ceramist are even shaking their head yes, they're the toughest, they're always the toughest. Ceramists are the toughest. I mean on any ceramic work that hits the screen, they're the roughest. I mean you know getting Nelson calibrated, it's taken us years to get Nelson calibrated. Yes, right. So anyway what if this diastema is closed like this and what if this crown was off by four value shades and was the wrong shape Okay because if you treat it, it gets judge. You can't, you can do a beautiful job here. Now the feedback, we were talking about feedback, the feedback will come back saying as saying you did a beautiful job with case type 4 closing the diastema, please remake no. 10 and resubmit it. Okay. But not in this case obviously cause its handled so nicely. Yes, sir. What if no. 10 was not treated here is the question and just closed the diastema. Then Jack saying bad case selection because now we're back to that incident where I told you, I can't give you an answer. I really can't. You're not getting the plus 1 and not only that we go back, remember I told you the case where examiners struggled because the one single unit was handled so beautifully and then two teeth down the bicuspid was just so far off. Now they certainly could have chosen resin. Okay. They could have closed this and used resin here as opposed to porcelain, that would have be fine. The issue is they have to address this yellow tooth. They couldn't just close the diastema. They have to address the yellow tooth. Excellence in cosmetic dentistry. They didn't simply stop. They didn't get so tunnel visioned and they didn't just stop only on the case type and lock in that this is case type 4, don't touch anything else in the mouth. I just do case type 4. No, they did case type 4 and case type 2 and really the dentist could have chosen either way as far as I'm concerned. It's a beautiful end result. Okay. How many of you can do this with resin Not as many hands went up at this time but that's okay and I agree because this is really really well done. Maybe a little long in the contact, I think that's squeezed out. That papilla just to me is just begging to be released, just a little bit there. Okay but otherwise this is beautiful. Look at the translucent effects built into here and look at the line angle, look at the flashpoints that were here and then the flashpoints that come back again here showing line angle development. I mean this is look at from the side, look at how these embrasures, the facial embrasure was developed in there. That's good stuff. Yes, height of gingival contour 7, 10, you're right they don't match, minor, major, catastrophic Minor, it didn't even hit my radar screen, yeah, because technically this is not a smile design case, technically your treating closing the space and your single unit so I'm not going to bring in the rest of these parameters. Gingival health I might bring in a little bit, you know if it looks a little red and puffy but in terms of contours, now if that had been way down here or way up here, obviously I would have a different opinion if it's reaching extreme points, that's a minor discrepancy there. It looks like that's ideal, that's slightly too high, it was too high in the preop. Let's look at a class 4 situation. Okay. So what they're doing now is we've got a fractured front tooth and I don't care if they're bleeding, you get that preop shot. You blacked eye and clean up the blood, get the scan going and make sure you get that preop shot before you start fixing them up. Okay. So here we go and we've got, this is, there's no question in here whether this is the 10% rule. We're not worry about 10% here, are we That's pretty good trauma to that central incisor. Okay. So what are you thinking in terms of handling the material and the blending. Again you're trying to make it disappear. The number one sin to this case type is when the examiners can see the finish line. If examiners can see the finish line between the resin and the tooth, this tooth, this case is not going to pass. So that's your number one, its how you're blending in. But otherwise, how is this working. Tell me what you see in pluses, minuses, value is an issue, isn't it. Okay. So we look here and then we look here and that looks definitely brighter grey, grey, more grayish, whatever you want it, whatever term you want to use there. Okay that's one the things. Tell me what else you see. Embrasure. Why is that that shape and why is that that shape. Okay. Flashpoint. Look at the, you're going to hear me say this all afternoon. So I'm just going to start now so you're going to say oh yeah he's going to say it all afternoon, let nature be your guide, let your nature be your guide, let nature be your guide. Every single case you look at, let nature be your guide. Sometimes nature isn't so good and you have to just totally replace it. But lots of time it's your perfect guide. Look at the anatomy in this tooth and this tooth. Everything should be built off what you see right there. Everything should be built off of that. You keep referencing back over and over to make sure that what you do here follows what you saw preoperatively. You just made an extension of that. Okay. Look at the effects in here. Not seeing here. Things are starting to add up here a little bit. Alright but let's go back in the scheme of what's its testing, where are you. You're failing. Failing. Failing. Okay. Case passed. Case passed. But I agree with you that this would be very very marginal. Okay. There's enough examiners in the room that I think if you submitted that with the value issues, the anatomy issues, with the contact issues with the incisal embrasure issues, I think you have enough on the screen there and enough evidence that this would be very very close. It could go either way. Okay. And let's look at a case type 5. Cause now what we're going to do is we're going to take that resin which you saw and we're going to use it, and we're going to go 5 through 12. Okay. 5 through 12. Glasses before and after do not matter. No factor. Okay. Do you like this smile Do you like this smile Or does it matter. Liking it. I see a lot of heads nodding up and down. Does anything bug you about this This case bugs me. I mean it just drives me nuts. What bugs you Centrals. It killed me. This case drives me exactly. The gentleman back here just did one of these. Okay. But not really. Look at her lip, look at her lip position. But preoperatively look at the harmony here and then look at the centrals here. Now this is why, I'll put this case up here, and why this is so important. This is bugging this gentleman and it's bugging me. But just because it's bugging me, is that a criteria. Look on your criteria list and see this bugs me and see if you find it on there. Cause as examiners what we need to do is we have to take ourselves out of what bugs us and look at the case for what's its worth and does it meet the criteria and does it do the things its supposed to do. So proportionality wise, what do you think of the two central incisors, proportionally. Probably not bad. I mean probably if we got out and measure, maybe a little square, maybe a little bit. But probably not bad. Okay. So let's look at the rest of the case. Look at the way the resin is handled in general. Part of what probably bugs me is we have this lateral that came and rounded down with this nice big open embrasure and now it looks like it got this saw off lateral that comes in here a little bit. Okay. Where does that bugs me come on the criteria sheet. It doesn't. Okay. So is it enough of a criteria here that I'm deducting for it. Maybe. Maybe but it would be minor. Okay. How is the resin handle overall in terms of blending, in terms of building it over the top. We have lots of hypocalcification. We've got some discolorations. We've got some issues going on. How is this resin being handled in terms of anatomy, contour, color. I see heads nodding up and down. Okay that's what this case is testing. So there are some issues in here that aren't necessarily ideal but look at that shot, look at the flashes in here. The way the anatomy is handled and the line angle on here. But now I'm going to give you the money shot. Look at the occlusal shot and look at the way, this is something again, ceramist handled this for us on a regular basis. They do this all the time. It just come second nature to them. As dentist we don't do this on a regular basis but look at the line angle development, look at the lobe formation, look at the facial embrasure formation in this occlusal shot. This is a big shot for examiners. This is a great place for you to critique your work. And if you struggle with this take an impression of it real quick and pour it up while the patient is there, while you're building the resin. Take that impression, pull it, go pour itin fast set stone, go back and touch up a little bit and look at it right on a 3D model. This is a huge shot for examiners.