To Bond or not to Bond? The answer to this question is always a puzzle. When the lesion to be restored is subgingival, the answer is blurred furthermore. The two step matrix technique for the restoration of gingivally extensive lesions with glass ionomer first and then with composite is the missing piece to this puzzle. Although technique sensitive, this restoration protocol is effective and predictable. First, clear the tooth of caries and remove all infected dentin from the DEJ and CEJ. After the bonding protocol, the first matrix (modified toffelmire) is placed subgingivally close to the root surface to allow placement of a glass ionomer restoration upto the CEJ. The second matrix (V-ring with sectional matrix) is then used to restore the remainder like a standard class II composite restoration. Occlusion is adjusted and the restoration is then finished and polished. Composite restorations are simple in concept but challenging in reality in most scenarios. It becomes especially technique sensitive when the lesion is deep and subgingival. Using the two-step matrix placement protocol for restoration of a gingivally extensive lesion makes it manageable and predictable towards success and longetivity of the restoration.
- Understand the importance of establishing a clean periphery when performing direct restorations.
- Know a method for isolating the extensive gingival wall in a class II preparation for composite.
- How to build a class II back to ideal controls and contact utilizing a two-step matrix technique.
Gayathri Iyer, BDS
ACT Restorative Dentistry
UCLA School of Dentistry
Los Angeles, California
This projected clinic will cover some of the design concepts that can guide a dentist to use an unconventional preparation design by combining sound reduction principles and maximizing remaining tooth structure. This restoration type is made possible by using CAD/CAM in office to fabricate an indirect all-ceramic single tooth restoration in a single office visit, which maximizes patients time, and increases the number of services that can be offered to patients. Multiple full cases will be presented to demonstrate these techniques in full detail, which will allow the viewing dentist to return to their practice and confidently offer new, more conservative, services for patients.
- Why the practitioner should consider managing unconventional scenarios with unconventional CAD/CAM restorations.
- When to consider this selection.
- How to avoid sacrificing additional tooth structure while still maximizing esthetics.
- About the time advantages of a single visit esthetic CAD/CAM restoration.
- Pearls for using digital technology including: preparation design, methods to better digitally capture interproximal margins, and custom staining tips.
Jaren May, DDS
Bulk Fill Posterior Composites: Clinal Excellence or Clinal Shortcut?
Bulk fill posterior composite systems have taken a significant portion of the dental market. There are multiple different types of bulk fill systems available with different techniques. This presentation will review and demonstrate the currently available options, techniques, advantages & disadvantages of each and review existing literature on these materials.
- Identify the different types of bulk fill posterior composite systems on the market based on placement technique.
- Understand the different strategies employed in order bulk fill posterior composites clinically viable.
- Recognize clinical applications where bulk fill posterior composite could be used successfully and predictably.
- Briefly discuss overview of current literature base as related to bulk fill posterior composite.
Joshua Austin, DDS, MAGD
San Antonio, Texas
Additions to the Endodontic Toolbag
The purpose of this table clinic is to give the General Practitioner some additional tools to use during the course of endodontic treatment. While the majority of cases would not require removal of full coronal restorations or treatment of swelling, the techniques presented can be catalogued for use during these challenging scenarios.
- Understand methods for removing crown and bridge restorations prior to endodontic therapy.
- Develop a strategy for performing incision and drainage of odontogenic infections.
Mark A. Camp, DDS, MS
Clinic 9 – The Ralph Phillips Award Recipient
Efficacy of Direct Restorative Materials in Proximal Box Elevation (PBE) on the Marginal Quality and Fracture Resistance of Molars Restored with CAD/CAM Onlays
Proximal box elevation (PBE) is a conservative technique use to restore severely damaged teeth. However, only a handful of studies have been published regarding the technique’s efficacy. Published studies have evaluated resin-based composites (RBC) and other direct materials to elevate tooth margins. No study to date has compared restorative glass ionomers (GI) and resin-modified glass ionomers (RMGI) to RBCs in elevating tooth margins prior to delivering CAD-CAM (Computer Aided Design-Computer Aided Manufacturing) onlays. The purpose of this study was to investigate the effect of four direct restorative materials (Fuji IX Plus, Fuji II LC, Filtek Supreme Plus, Filtek Bulk Fill uno) that may be used with the PBE technique. Following margin elevation, samples were submerged in water at constant 37 C and subjected to cyclic fatigue (100,000 cycles at 65 N). Margin quality was evaluated with scanning electron microscopy (SEM) at 200x using epoxy resin replicas before and after cyclic fatigue. In addition to margin quality, the fracture resistance of each group was measured using a Zwick 10k testing instrument.
- How PBE material affects maximum fracture resistance of molar teeth restored with CAD-CAM onlays.
- How PBE material affects marginal quality of molar teeth restored with CAD-CAM onlays.
- Ideal material choices for PBE dependent on environment and situation.
Thomas D. Grubbs
North Liberty, Iowa
Recent Methods of Detection and Management of Deep carious lesions. What do we know?
Dentistry has been full of advancements in all different disciplines within the field. These fantastic advancements have affected the process of detecting and treating carious lesions, especially the deep carious lesion approaching the dental pulp. This presentation will look into the numerous new modalities in deep carious lesion detection, how to differentiate between true carious dentin and affected dentin, when to stop caries removal, what to remove and what to leave, if leaving any caries, and the different techniques of deep carious lesion management and treatment.
- Explain the deep carious lesion process, types and extent
- Identify recent diagnostic modalities used in identifying deep carious lesions
- Discuss different strategies/techniques in the management of deep carious lesions
Mohamed El Naga, BDS, MS
Dental Photography 101
Figuring out the optimal settings for taking quality clinical images is a conundrum in itself, one which often leads to frustration and eventual loss of precious chairside time. Following the basics of photographic science, this clinic shall take the audience through a simple algorithm which shall allow them to determine How to achieve the ideal settings for any shot. A comparison of the current available photographic systems will aid in the clinician making a better decision when investing in a photographic set up. In addition, a new clinical photography prototype shall be showcased which echoes the overall theme of Excellence through Simplicity. Using this prototype, studio quality images can be achieved right on the dental chair, saving both space and time for the clinician.
- Learn to arrive at the precise camera settings for any shot in any situation.
- Make an informed decision when investing in a photographic setup for your clinic.
- See the application of these principles in a new clinical photography prototype.
Mudit Krishna Yadav, BDS
ACT Restorative Dentistry
UCLA School of Dentistry
Los Angeles, California
Practical Application of 3D Printing in Dental Offices
Over the last decade there has been many advancements in 3D printing technology which included a decrease in costs and increase in accuracy. It is foreseeable that 3D printing will play a huge role in the dental profession. The purpose of this study is to explore new ways in which 3D printing can be applied in the dental field. They included the formation of custom RPD guide plane jigs, jigs which can allow a practitioner to place orthodontic brackets at a precise location, jigs for restorative purposes (ie: diastema closure, cuspal fracture) which will allow the clinician to apply composite against the jig and restore tooth esthetics and function, and the 3D printing of basic dental components such as rubber dam clamps. The completion of the backbone design for a successful rubber dam clamp will help accomplish a few goals. One, it allows for the creation of dental supplies which can be printed in a dental office with ease. Second, the design can be modified and customized for specific clinical purposes Third, it probes into the thought of possibly 3D printing other day to day dental supplies as a convenience and cost saving measure. Overall, as 3D printing becomes mainstream in the dental environment it is important to figure out ways in which it can benefit the delivery of patient care and effectiveness of clinical time.
- Successfully capture a 3D image of a rubber dam clamp.
- Develop CAD knowledge and modify rubber dam clamp so that it is compatible with 3D resin.
- 3D print rubber dam clamp and use intraorally.
- Customize rubber dam clamp as needed for tooth specific purpose.
Pavel Vasilyuk, DDS
Clinic 8 – The Dr. Ray Bowen Award Recipient
Bioactive Materials: Ion Release, Flexural Strength and Secondary Caries Depth
Caries remains a significant clinical problem especially in salivary deficient individuals. Caries development is a dynamic process between demineralization and remineralization of dental hard tissues that eventually results in cavitation. Fluoride releasing materials like resin modified glass ionomers (RMGI) may protect the restored tooth from demineralization, but salivary deficient individuals have limited remineralization since little calcium, phosphate, fluoride or bicarbonate are available. Bioactive materials have begun to appear in the literature and hence the need to understand them better. A bioactive material is one that forms a surface layer of an apatite-like material in the presence of an inorganic phosphate solution. Bioactive materials release calcium, phosphate, and fluoride which may increase tooth remineralization. Limited remineralization data is available demonstrating the superiority of bioactive or ion releasing materials compared to fluoride or no ion releasing materials. Activa, Cention N ,Fuji LC II and Filtek Supreme Ultra were studied. Firstly, the fluoride, calcium and phosphate release of these materials was measured using ion specific electrode at 24 hours, 1 week, 1 and 3, month intervals in deionized water and acidic solution Secondly, the flexural strength of the materials was measured using at 24 hours, 1 week, 1 and 3-month intervals. Thirdly, the efficacy of these materials to prevent demineralization in an artificial caries solution was. measured and compared. In many cases, fluoride releasing materials have inferior mechanical and lower wear resistance compared to non-ion releasing materials. The obtained measurements from all specimen groups should reflect the bioactive nature of calcium and fluoride releasing materials. This study aims to enhance the understanding of the mechanism behind the bioactivity of these materials and emphasise their clinical application.
- Clinicians will learn a better definition and uses of bioactive restorative materials.
- The ability of bioactive materials to clinically perform with or without adhesive will be demonstrated.
- Ion release of bioactive materials will be demonstrated as well as success of these materials in artificial caries solution.
- Clinical success of one of the bioactive material will be demonstrated.
Prajakta Shreeram Kulkarni, BDS, MS
Extended Seated Table Clinics
A Live, Internet Based, Surgical Guide Design and Treatment Planning Workshop
This workshop will be a continuation of and more detailed look into utilizing intraoral scanning in the fabrication of surgical guides for precision implant placement. We will do a live treatment planning seminar with an internet-based surgical planning, design and fabrication service that will demonstrate the simplification of a process that is perceived as very complicated and difficult. After this workshop attendees will realize that surgical guide fabrication is actually very straightforward and predictable enabling more accurate implant placement and improved restorative outcomes.
- How to utilize intra-oral scanning to capture relevant anatomic structures for surgical guide design.
- How to fabricate a predictable implant surgical guide.
Brian K. Schroder, DDS
San Antonio, Texas
A Simple Approach to Predictable Implant Prosthetics
This “interactive table clincic” will be a Digital platform that will be ran on video, in which I will serve as moderator, and in which the computer presentation will have a series of small video lectures made by myself and some of my residents. It will discuss important topics of implant dentistry, specifically esthetic planning in implant cases. The computer will do the talking, my presence will be more as an additional source to the presentation.
- Important treatment planning steps for predictable implant esthetics.
- A systematic approach to managing adequate implant soft tissues.
- Material selection for implants in the esthetic sector.
Jonathan Esquivel, DDS
New Orleans, Louisiana