Tuesday, August 6, 2013

Linear Shade Guide

If you’ve considered switching to Vita’s 3D shades, now is a good time. Vita’s new Linear Shade Guide includes the same shade tabs as the innovative 3D Master, yet the layout is more intuitive for the guide’s intended use…choosing value first. The Linear Guide includes a Valueguide for making the initial value choice. Once the value family is chosen, the chroma and hue are determined. The 3D Master has helped our clients with shade-taking for many years, and we highly recommend its successor.

Complimentary Shade Service

Calibration Tab
1 of 3 Printouts
Many shade-taking systems have come and gone through the years. The challenges with this technology have been cost, provider-support, and effectiveness. ClearMatch, a system we recently launched, is showing promise. It is a software that determines shade, value, and translucency from a chairside photograph. A special black-n-white calibration tab and a Vita A2 shade tab are held edge-to-edge to a target tooth, and a photograph is taken. The image is emailed to ROE and analyzed with the ClearMatch system. Shade, value and translucency maps are printed and provided to the ceramist (figure 1), and returned with the completed case.

The quality of the photograph is critical to the success of the shade analysis. Proper flash and focus are the two key components. We recommend in-office training, which is available to offices throughout Ohio at no charge. If you are interested, please contact Alan Banks at ROE. Complete instructions can also be found on our website at the Shade & Smile Service page along with a link to a thorough YouTube video.

ClearMatch software, developed a dozen years ago, is proving to be very effective. We use it, along with ShadeVision and other tools, when patients visit us for shade analysis.

Shade legend

In.a.Box Implant Pricing

With a single phone call, a dentist can now virtually plan an implant case, order a surgical guide with drills, order the implant(s), healing caps, and/or a provisional. We call this service In.a.Box. Pricing. It was developed through a partnership between ROE and BlueSkyBio, for implants that are compatible with Zimmer, Astra, Straumann, or Nobel. This service is designed for ease-of-use to help reduce office inventory, and save time and expense, when ordering components for surgery. When cases are planned virtually, the implant size is determined. At this point, everything you need to place, protect, or provisionalize can be ordered.

An economical option in this service is the Direct Cut Kit from BlueSkyBio. This kit was developed for a one-drill protocol for an osteotomy. This computer-guided package includes a surgical guide, the implant and healing abutment, one drill, and the final screw-retained restoration. The total cost is $909.

3 Solutions to Cement Clean-Up on Implant Restorations

In the last couple of years there has been a lot of chatter concerning the effect of residual cement on implant cases: bacteria build-up, peri-implantitis, bone loss, etc. Although there are many methods of managing cement, we would like to offer three.

The number one method of eradicating these issues is, of course, to eliminate cement altogether, and choose screw-retention. We have witnessed a surge in one-piece, screw-retained crowns and bridges. Our most popular is a zirconia/titanium hybrid (TLZ-SR) that is very durable and esthetic and only costs $299.

Another method is to request a two-piece restoration, which includes a custom abutment and a crown designed with a hole in the occlusal or lingual surface. This allows simple clean-up through the following method: seat the abutment using a thumb driver; place a cotton pellet in the access hole of the abutment; insert the crown to check margins, contacts and occlusion; cement the crown in place; remove the cotton pellet before the cement hardens; unscrew the abutment through the hole; remove the crown and abutment together; clean the excess cement; torque down the cleaned restoration, and fill the screw hole with composite. Be sure to have an abutment removal tool, or a driver that can be reversed, when using a friction-fit system, i.e. Zimmer Dental.

A third method is to order a duplicate resin die. This die can be used for “cement pumping”. Here are the steps: torque in the abutment; check margins, contacts and occlusion; place cement in the crown; seat the crown on the duplicate die; clean the excess cement expressed at the margin, and transfer the crown from the die to the mouth.

Spear Education – Class III Treatment

We were recently educated by Dr. Frank Spear on treatment options for Class III patients. These patients are usually offered 3 alternatives: maxillary or mandibular orthognathic surgery, orthodontics, or restorative treatment.

If the patient will not accept the first two options, the doctor must develop a functional, restorative occlusal scheme. Dr. Spear offers advice based on his extensive experience. Class III relationship allows the patient to slide into an exaggerated protrusive position without anterior interference. This slide can become habitual. When the patient is restored to normal occlusion, with standard overjet and overbite, this habitual slide will meet a major interference, leading to wear, parafunction, or worse. Dr. Spear suggests that the best occlusal scheme is end-to-end with little-to-no overjet, and minimal anatomy in the posterior. At this point, the patient has maneuverability and stable occlusion.

New Denture Teeth

Last year we began suggesting Pala Mondial® teeth by Heraeus Kulzer for hybrids and overdentures and have noticed improved results. Our decision was prompted by the claim of the manufacturer, as well as prominent institutions, that the teeth are stronger than those of other tooth company’s and that they offer an increased ‘bond’ to acrylic. Thus far we agree. Mondials are also more esthetic than other brands, are compatible with Vita shades, and are preferred by our technicians for set-ups. For these reasons, we are using the Mondial line as our standard, premium tooth. If you would like a mould guide, please visit the denture page of our web site. Shade guides are available by calling our laboratory. Ivoclar BlueLine and Dentsply BioForm are still available.

Master Cast Size Request

Due to our digital fabrication process, all master casts are scanned to allow the digital design. Often, the dental office provides mounted master-casts that are too large for our scanning equipment. When we receive these casts, we are forced to separate the model from the mounting plates, reduce the size, scan, and then remount. By limiting the size of the casts to a maximum of 60mm high by 90mm wide, this extra procedure can be avoided, and we can ensure the most accurate digital reproduction.