Monday, May 6, 2013

An Interesting Cloud Back-Up System

If you have experienced data loss, computer failure, or major server issues, then you know the importance of an effective back-up system. Smartronix is a technology provider that offers a cloud-based back-up system for medical offices. A “box” is installed in the office that communicates with cloud servers, and performs a back-up every 15 minutes throughout the day. If a crash should occur, the box becomes your server while your equipment is being repaired. In other words, there is minimal data loss and you are up and running in a matter of minutes. To learn more, visit, or call George Kovach 216-299-6530. Although based in Cleveland he  has the ability to set up and service offices anywhere.

Spear Education Smile Analysis

We are always working to further our knowledge in the area of comprehensive care treatment-planning. We are a member of several Seattle and Spear Study Clubs and watch videos on comprehensive care concepts each Wednesday at lunch-n-learns. We recently participated in a Spear Course on “Facially Generated Treatment Planning” in Scottsdale and thought we would share some highlights on smile analysis.

Step 1
Step 1: Central incisor edge to face. The starting point for determining tooth position is always the maxillary central incisors.  Until we establish the correct position for the central incisors we cannot determine the position of the maxillary teeth. Evaluation should include incisal edge position at rest and in a full smile as it relates to the lower lip, as well as the relationship to the posterior occlusal plane. One question to ask is: “Do the centrals exhibit acceptable, excessive, or inadequate tooth display?”
step 2

Step 2: Maxillary incisor inclination The next point of reference is facial inclination. Do the centrals exhibit acceptable, correct, labial-lingual inclination? Or are they proclined or reclined?

Step 3
Step 3: Midline Location Is the midline correct or does it need adjusted right or left?

Step 4
Step 4: Midline Alignment Even more significant than the position of the midline is its inclination. It should be perpendicular to the floor.

Step 5
Step 5: Maxillary Occlusal Plane Following the determination of the central incisor position, it is possible to evaluate the position of the remaining maxillary teeth based upon the incisal edge of the centrals. In this image you can see the centrals are apical to the occlusal plane of the posteriors. If the centrals are lengthened 1 to 1.5mm, the existing posterior position looks quite good.

Step 6
Step 6: Determine Gingival Levels Display Following the determination of the desired incisal and cusp position, the correct gingival-levels should be evaluated. Is the amount of gingival display acceptable or excessive? Remember that often teeth erupt as they wear. By evaluating overall tooth length from our desired incisal edge position, we can determine if some gingiva needs to be moved based upon pleasing width-to-length ratios.

Step 7
Step 7: Determine Free Gingival Margin Levels and Pupilla Levels Are the gingival zenith positions symmetrical among partner teeth? Are they allowing proper esthetic tooth proportions?

CBCT Scatter - A Thing of the Past?

A couple of years ago we introduced the No-Scan Appliance technique for CBCT implant planning. It allows doctors to simply capture a CT scan, models, and a bite, to plan a surgical guide, and to skip the radiographic scan-appliance step. A contraindication to this technique has been the presence of metal-based restorations, which cause scatter and usually necessitate a scan appliance. We recently discovered a bite material called Memosil (Heraeus Kulzer) that suppresses scatter. The material is viscous, and will require a few layers to adequately cover the entire restoration. Once applied, it allows a CT scan to be captured. As with all implant CT scans the arches must be separated with cotton rolls. This technique makes unnecessary the extra appointment and the cost of a scan appliance. 2 / 50 Milliliter Tubes $101.70 (Benco, Patterson etc)

A New, Advanced Digital Impression Scanner

The leading CAD-design-software for dental laboratories is 3Shape. Their innovation, creativity and vast capabilities are one of the reasons our laboratory can offer so many restorative solutions. Last year they unveiled their exceptional Trios scanner. It is powder-free and very fast. At the Chicago Midwinter Meeting, we saw individuals scanning their own damp mouths, with amazing speed. The occlusals of a quadrant were scanned as fast as 15 seconds. Just as exciting, the files can be quickly uploaded for laboratory-consultation while the patient is in the chair. The files are easily imported into our iRis system, where many of our restorations are created. Implant restorations can also be easily scanned with scan-bodies, for nearly any system, making implant impressions a breeze.

The cost is a little steep, but if you are in the market for digital impressions, this is a system to consider.

Ideal Abutments Often Require “Surgical Placement”

No Blanching                 Blanching                  Ideal  

The vast majority of implant abutments we fabricate are patient-specific, and created with CAD/CAM technology. When designing the emergence profile of the abutments, the doctor has three choices. The first is “no blanching” of the tissue. This abutment will seat without disturbing the sulcus.  A second option, “blanching”, our standard (1mm at the margin), will allow for more natural emergence. The third choice is “ideal,” sometimes called “surgical abutments,” which provide the best esthetic and hygienic result, expanding the emergence profile to that of a natural tooth.  This choice allows us to create crowns that look like teeth, and minimize black-triangles and food-traps. One caveat to this procedure is the amount of tissue displacement. At the seating appointment, the blanching will often necessitate mesial and distal incisions to relieve pressure.

Custom Impression Posts
 Incisions during final seating can be avoided with some preplanning. Impressions can be captured at the time of implant placement, or sometime after, to design custom healing abutments to reshape the sulcus. After the sulcus exhibits the ideal shape  this contour can then be transferred to the lab. A stock implant transfer post will not adequately fill the sulcus, so a customized impression post will be required to communicate the soft tissue contours. A custom impression transfer can be created by injecting flowable composite around the impression post capturing the expanded sulcus dimensions. Once light-cured, the composite is affixed to the impression post; it should be removed and trimmed to eliminate flash prior to taking the fixture-level impression. A work authorization should note the use of this procedure.