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Making Smile Design Profitable, Efficient and Predictable

Part 7 - Final seating of the restorations

Instructors:
Trent Smallwood, DDS
Dr. Smallwood demonstrates the final seat of the restorations and how to make clean up easy in the last section of this dental continuing education video.

Now I come back and it's very important, that when we use the bond, we are going to be using a bonding agent as I showed you when we were preparing the veneers. I use Excite, these two brushes are what are available and the bend-a-brush is a better brush for this application verses the spikey kind of micro brushes. Micro brushes tend to elicit some hemorrhaging around the tissue so I prefer to use a bend-a-brush cause it does not do that I definitely put a nice copious amount around each one of the teeth and you will rarely see anyone elicit any hemorrhaging what so ever. I prefer to use the A-dec warm air dryer because of the fact you don't induce any humidity or water into the line at all and then Amanda will give me alight, and she will cure one side and I will cure the other and we will kinda rotate around the tooth make sure we are getting all aspects for ten seconds using LED lights. O.K we are in great position, so as you can see from basically the shininess of the teeth, we've got all our bonding agent on. We've got everything positioned nicely, as you can again recognize the beauty of the gums, Michael has done just a tremendous jobs,one of the best cases I have ever seen with regard to maintenance of his gums if you ask Michael he would probably say, "oh well I didn't do anything differently," but it sure looks tremendous. Now we are going to place all of the veneers at at one time. As you can see we start from the center and move outward we don't and Amanda has basically labeled these as such so we don't get them mixed up. That's important, it's just like people who cut off the wrong leg I would hate to do that. We want to make sure we position everything correctly and we are going to begin with tooth number 8 and 9 and I just grab them right out. Remember that tooth number 9 has an XL cement and tooth number; rather I should say tooth number 8 has an XL cement where as tooth number 9 has the B cement. Michael justin case you were wondering all the teeth are the same length now. The other thing you will notice too is we do not get a lot of excess material around or oozing out so to speak. Amanda has given me the explorer because she knows I want to check the margins and I do. Now we can move to our, we are going to continue to keep moving outward and I will then go tooth number 6 and 11. And Amanda is covering the tray each time I take one of the veneers and place it. Michael you are also going to feel me pushing on you firmly and this is make sure I've got the veneers completely set I do not have to place them hard but I do want to use firm position to be able to get the veneer downall the way. As you can see everything is positioning nicelypassively and without issue, "knock on wood." Michael open justa little wider, sorry about that stretch. Now we've got all theveneers placed and they are all beautifully positioned,everything is seated fully now what we want to do is we aregoing to tack cure each tooth. I do. So what is critical here is that we position well the tacking tip and Amanda will cure for about two seconds, good and she will immediately do tooth number 9 and if I can get a good apical incisal position she is going to move to number 10 I will steady her hand as she moves to 7 she is staying 90 degree angle. This tacking of the veneer will ensure that the veneer is placed firmly in its correct position but not fully cured. O.K, Amanda you're doing a great job everything is looking good. Now I want to concentrate on this area because what we want to do is we will do wave technique where we will take the light and basically go over all the teeth fora total of two seconds. One, one thousand, two one thousand, same with the lingual and that will and that will not fully cure but what it does is it tends to cure enough where I can come in with an explorer, and Michael you are going to feel me right around the gums just a little bit. Now in case we do elicit any kind of hemorrhaging Amanda is going to be able to jump right on it with the explorer or rather with the curing light I will be very gently removing the cement on tooth numbers it is almost completely removed. Very lightly we will just come in and remove the excess and again noticing I am just using an explorer. If I can do this for most of the procedure,it creates a far easier clean up than using burrs scalpels and what not. O.K. we've got a little hemo on the facial, if we get just a little bit then what will happen is Amanda will just jump in there and hit that area, yea go ahead and hit that again. O.K that's good Amanda, that will keep any hemo from getting up underneath the veneer. We are just going to take off the last remaining amount on the facial, we are pretty much good to go there, now once I have all that I will just go in with a 2x2 and basically wipe all this out and again I am not wiping any kind of cement, residual cement I am just really taking off any pieces that we can see and this also as you notice, really critical here is that we kept all the cement off of the facial of the veneer, we want to be able to do that as well. Now just finishing excess removal and then we are going to floss this area and then we move onto final clean up and then we get this whole apparatus off Michael here and move onto bigger and better things. The ease of clean up is made possible because of the conservative amount of cement placed in the veneers initially. The next thing we will do is we will begin to floss. Now sometimes when we floss we floss very light and easy but going up and down all of the margins and hopefully we will connect through most of the time. Sometimes we get caught up, sometimes we elicit a little hemorrhaging, going up and down very passively and in this case everything is in good shape. This makes a lot of people nervous because they feel like they dislodge veneers. I can't tell you I probably dislodged a veneer, 4000 veneers ago when I did this, it is just so rare and if it happens just put it right back on, no big deal. Continue going up and down, pulling lingually not facially because again that like you were saying that can tend to dislodge the veneer if you are not careful so we want to pull everything to the lingual position. We are all set, there is only one area that I need to use a separator between 6 and 7 and then we will be ready for final curing. This is basically a cera-saw that we are going to now separate through just a bit and sometimes they can be a little sensitive for Michael and weare ready for our glycerin gel just to really solidify good smooth margins all the way through and no leakage and we are going to place this around each one of the margins and we will then start to cure each tooth, we will cure each tooth approximately 1 minute moving 10 seconds around. O.K the last aspect is just cleaning off any excess cement, which is very minimal using just a blunted tip, 16 fluted or a 32-fluted carbide burr. Michael, you may feel a little bit of sensitivity right around the gums just barely going right over the margins smoothing down removing any cement. Showing the angle of just removing excess cement we are able to really clean and smooth the margins nicely barely if at all touching the veneer. Go ahead and bite one more time, and I want you to bite one more time and I want you to slide very slowly.. keep coming very good. He's got good guidance right there and that will show you immediately that the rest of the teeth disocclude. We will go ahead into your normal bite again and then slide one more time to that left side. He's got good guidance and as a result weare able to get everything positioned the way we wanted to. And we are just going to dry off the teeth, we are going to look just a little more closely at the occlusion and what I would like to have you do is tap those teeth up and down firmly good and open and the same thing again, tap, tap, tap,open. Now this time I want you to bite down one time and grind back and fourth, not real hard just medium strength, good. And bite one time, medium strength and open. Here you can actually see many of the occlusal areas where we are hitting. We are hitting slightly pre-mature within the pre-molar area and we will adjust those. We don't have any areas in the centrals that we are hitting abnormally just nice pin point position. As you can see minimal adjusting needed, he is hitting very well on all the teeth. With just a few more minutes of clean up and just under an hour and a half our patient walks out with a brand new smile. We hope you enjoyed this program. To order Dr. Smallwood's book, Platinum Paradigm visual smile. At HDiQ Dental we are committed tobecoming the standard by which the dental training industry isjudged, thanks for watching and we'll see you next time.