Building the Bridge from Dentist to Ceramist: Why Communication Matters Part I

Part 3 - Luxatemp and the completion of the temporaries.

Instructors:

Tom Trinkner, DDS

Tom Trinkner, DDS

Thomas F. Trinkner, DDS, teaches as an associate at the L.D. Pankey Institute and is a clinical instructor for the General Residency Program at Palmetto Richland Memorial Hospital in Columbia. He lectures both nationally and internationally in the field of Aesthetics and Complex Restorative Dentistry.

Matt Roberts, CDT

Matt Roberts, CDT

Matt Roberts is one of the most recognized Dental Ceramists in the United States. His goals are to elevate the quality of restorative treatment received by patients by creating an interactive working relationship between dentists, ceramists, and specialists.

In this section of the dental continuing education, Dr. Trinkner demonstrates the process for creating the temporaries.

Dr Trinkner will prep 8 and 9 to reduce some of the bulk and then the matrix is ready to be refilled. Ideally we need to pick a nice slow pace of loadness, often times we will load on thin veneer cases, load the incisal edge first and go back through and back fill the rest of the preparation design. In this case where it is such a large arch, we want to not have the risk of set here. She's going to continue to load this completely at one time. If we have any voids or air bubbles we can always deal that in the final with a flowable Luxaflow material that matches and correlates to this shade. Again we'll go 60 seconds in the mouth. What may be possible for you to see in this particular, this is a second set of provisionals,you can see there is minimal flash here, we have a much better seat of this particular stint this time. We made a couple modifications that may have been contributing to the previous one not seating down correctly. We're going to go ahead and take our final impression. This is the Permadyne Garant, light bodied and what we have modified the tip with; it's a metal tip that fits onto the mixing syringe. This is by Centrix and what I really like about this is the way it allows the impression material to flow out around the periphery of the margins, it's just a more consistent flow. Jennifer is mixing our tray material which will be the Impregum, soft Pentamix material. We're going ahead and inject our Garant around the entire arch,bear with me; I'm going to stretch you out. Jennifer is going to hold that right in place. You O.K So we want to make sure the ceramist has a clear idea of the impact of the under lying color as the veneers are fabricated. So we're using a natural dye material shade guide which is by Ivoclar Vivadent this kind of has become a standard within the industry to be able to use to communicate that to the ceramist, regardless of what final material he may use or she may use. Next an occlusal record followed by a stick-bite. So we have points of contact with the lingual of her upper anteriors and a stop at tooth #2 over here and we can also utilize our previously taken bite records from before. And this is just to give a verification to the ceramist of the plane of the incisal edges to the inner pupilary line. Lastly Dr Trinkner will take a face bow transfer. With us re-doing our provisional the stint has seated a lot better we have just really very thin minimal flash to remove, we always chair side trim our provisionals so we have a really nice cervical interproximal marginal fit. I think it's very important to do as little damage in the mouth to soft tissue as possible. Next Dr. Trinkner will place the provisional inthe mouth, fill any voids and check for contacts. Tap. Tap. Tap. Again this will tell me a little verification that I got my provisionals in the right place and they weren't way out of whack with the stint and all that. I've got a separation at the inter-proximal area on removal, I'm not too terribly concern about this. We're going to cement the provisionals without etching with the Optibond 2 FL material which is a Kerr product and we'll do this as typically as a provisional cement. It does do a lot of good for preventing for micro leakage, it's been a really a durable provisional cement for me for about 10 years. It's about a 40% fill, 48% fill of composite and there are some concerns, one of which if you have a large amount of core material underneath that you may want to glycerin the core so the Optibond doesn't stick to that. Again we are doing this without micro etching. # 2, when you have to remove the provisionals, we'll have to go through a sectioning of the provisional material, we'll follow that as we go to cementation. But this little crack or void is still is going to be held into its proper position with the Optibond. Let's go ahead and cement these. Bite together again. Good. O.K. Bite together. All right. We'll go back with a yellow diamond, just lightly go over all these areas. Lots of water. Feather touch, very, very light. I would have to say if you're doing cosmetic or aesthetic dentistry and you're not up and out of your chair and doing different angles, you aren't seeing a lot of things you truly need to see for contour and shape and morphology. Very,very important to look at facial planes. And after a few more minutes the patient is ready to see their temporary new smile. Great. It looks perfect. It really looks really great. Big smile, look at it. See the difference Oh yeah. All those holes are gone, all that black is gone. Oh it looks good. It's good, I've wanted nice white teeth. And the best part, it only gets better from here. It's time now to visit with Matt Roberts who tells us how he helps Dr. Trinkner meet or exceed his patient's expectations. Lab communication is really what we most continuously want our friends or our people that we teach or that we deal with in relationships in this world of dentistry and education to understand that we work very hard at this facet of working these things out for our patients prior to treatment. We're looking at the stick bite, we're looking at the provisional restoration, we're looking at the photographs, we're looking at the bite registrations,the mounting, we're making a matrix of where the incisal edge went. All the communicable communication errors and problems we made in the past we try to work through and make it easier on all of us. So part of the importance of this particular section of education that we're doing is to highlight communication between the doctor and the ceramist, and all that goes into making it work. Whether it be Lava material or another ceramic system or porcelain fused to metal or whatever. We want to make the system the basic core of our communication simplistic.