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

Part 1 - Why conservative dentistry should always be the first option.

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 dental CE course, Dr. Tom Trinkner reviews a conservative approach to restorations. He will also discuss what information is necessary to communicate to the lab.

Hi, I'm Marlene Hilton and welcome to this HDIQ Dental extended video presentation. This program from Dr Tom Trinkner and ceramist Matt Roberts will present a case from A to Z. If you ever wondered what happens after you send your case to the lab, we have the answers. We'll also show you how to prep and seat a full upper arch. Our dentist and lab technician need little introduction. Dr Trinkner maintains a private practice emphasizing comprehensive restorative and cosmetic dentistry in Columbia, South Carolina. Currently an instructor at NewYork University for the Aesthetic Advantage and the Panky Institute, Dr Trinkner is a highly respected lecturer in his field. Matt Roberts is founder of CMR Dental Laboratory in Idaho Falls and is one of thirteen accredited ceramists in the American Academy of Cosmetic Dentistry. He lectures nationally and internationally and worked with many leading clinicians in the country. In the first part of our programs, Dr Tom Trinkner discusses what is necessary for lab communication and what he'll do to make sure the case meets his patient's expectations. The kind of one of the nice things about this particular case is that we do not warrant any real changes in the vertical dimension. She has a comfortable joint, muscles are comfortable, the vertical dimension will be maintained by minimal preparation to the upper second molars, tooth # 2 we're going to do an occlusal composite, tooth # 15 we'll do some sort of ceramic inlay/onlay, the bases being there's still a palatal cusp that will have a holding contact for her vertical dimensions stability. In addition to that she will also have contacts on the lingual aspect of her upper anterior teeth since as will be conservatively veneered. The change in technology certainly with zirconium frameworks our ability to do more aesthetic bridges with posterior teeth in mind has drastically changed and we've had good results that so in this particular case it was a great opportunity to combine stronger functions and use it in zirconium bridges in posterior areas i.e. specifically Lava in this case and then to be able to tie all of these bridges together in aesthetic parameters by doing conservative veneers in the anterior segment of the mouth so all of the things kind of worked in the favor for this particular patient to be able to have a beautiful aesthetic result and really I think appreciate this down the road. The part of the replacement of this bridge certainly is aesthetic in nature. There's been some over contouring changes in the tissue; it hasten a functional bridge for her, occlusally sound, now we would like to have the functional and esthetic success for her. So we're going to change this out to a Lava re-enforced bridge for this area and try to blend certainly much better aesthetic. Its just a preparation matrix we're going to use to give us some ideas on the depth of our preparations on our anterior teeth which will be a ceramic or veneer restorations, and we want to utilize this to ensure we do minimal evasive dentistry on these teeth as minimal tooth structure as possible, in our preparation phase, should be removed. I'm trying to preserve an occlusal stop on this tooth. You O.K. there? Just after evaluation we're going to change this to a full coverage crown or onlay, there's just a lot of underlying tooth structure that's undermined and we want to have a more solid final restoration and we may even do a core in this area. And we're in the process of placing a retraction cord at tooth #15; to make sure we that we really have nice clean margins. This has gone to a full coverage restoration and I think this will do nicely and the zirconium type crown, we certainly work through this with Matt Roberts to make sure this is going to be the most practical restoration for this area, we do need a cementable crown. So our initial attempt were to go ahead and restore tooth #2 with an occlusal composite and this tooth will be certainly important for maintaining our vertical dimension along with the lingual aspect of the upper anteriors, they will preserve another point of contact for vertical dimension and tooth #16 was originally going to be an MO type restoration possibly ceramic or zirconium base and when we got into the removal of the old restoration, everything was just too undermined. We in turn transferred this into a full coverage crown and we just packed a cord to help with margination on this tooth. Now we'll continue to move forward to tooth #15, #12 and #13 to re-marginate all these areas, following the removal of the old porcelain to metal restoration. O.K let's check your occlusion here. Let's close all the way. Again, we're looking for minimum of probably 2 millimeters of clearance. Before we continue preparation on the top right side, I want to capture an occlusal record to maintain vertical location on this top left and I most likely take a couple records just in case there was damage to any of the first record. Close together, all the way down till you touch your teeth. And this is MegaBite, it's a Discus product, just has a lot of rigidity to it and I will most of the time try to back this up with multiple bites just in the full mouth case. Definitely has some marginal decay around tooth #4 and #6. She could have gone through the technical challenge and the clinical challenge of implant dentistry and that is always relatively possible in this day and age. We look at CAT scans we look at the amount of available bone, do we have to modify the bone, what are the parameters in the aesthetics. In her particular case though,although her daughter does works for a Periodontist, it washer decision was not to do that and go through implant dentistry, financially certain issues were also present. This was a logical means for us to replace these older type of bridges with something more that is more current more aesthetic and yet very functional and strong. So that was a clinical decision based upon her being educated about all the opportunities and choices she could make to restore this case. And frankly if the teeth had been virgin teeth on either side of the spaces then that would have been certainly something I would have pushed to more clinically correct decision.