Wednesday, January 22, 2014

Root Tip – A Natural Abutment

When a partially edentulous case presents, and the coronial aspect of a tooth has been or will be lost, before removing the tooth root you may want to consider a tooth-borne attachment.  Using the root to retain an attachment, similar to how an implant is placed, is a conservative alternative, and can be accomplished using a Micro Era from Sterngold, or Locator or Zaag from Zest Anchors.

The technique is somewhat sensitive. To achieve optimal results we suggest discussing the design with us in advance of the preparation appointment. How you prepare the tooth and canal differs depending upon the attachment selection and which technique is chosen to create the impression and indirect, telescopic attachment. It is usually best to minimize the height of the attachment, allowing space for the prosthesis. In fact, when vertical dimension is limited it may be advantageous to use a direct-technique, eliminating the cast coping and bonding the attachment directly to the tooth structure and canal. With proper planning, this type of case design can be a great service to your patients. 

Partial Denture Digital Presentation

For the past four years ROE has employed CAD/CAM technology to create cast-partial dentures. Master casts are digitized and sophisticated software is used to create the final design. A stereo lithography framework pattern is then printed for casting. Our CAD-produced partial dentures are far superior to their hand-fabricated predecessors.

ROE has always provided a complimentary conventional survey and design service. The design is penciled on the study cast and returned for rest-seat preparation and final impression. Now, because of our high-tech approach, clients can send study casts and request a digital survey and design, which includes virtual teeth. This virtual work-up is emailed as a viewable 3D model that can be rotated to any view. The web-based preview can be shared with patients who may be particular about the design. The service even allows you to email a full-smile photograph of your patient to be used in the work-up. The patient photograph allows us to provide a 2D image of the final result, allowing the patient to be aware of clasping in the esthetic zone. This service is available for $25.

Zirconia or Emax, Monolithic or Layered – Decisions, Decisions

Based upon our experience, and reinforced by gurus in our industry, we’d like to make a recommendation of restorative materials and how they relate to location in the arch. The basic selection process for dental materials has not changed over the years - the stronger the restoration the less esthetic, and vice-versa. In the mouth, this directly correlates to stronger in the posterior, esthetic in the anterior. Fortunately, due to material improvements over recent years, the range between the two ends of the spectrum is narrowing. But a combination of treatment around an arch often presents a conundrum.

ROE’s standard recommendation for material-selection is as follows: in the molar area we suggest full-cast gold restorations or full-contour zirconia (TLZ, BruxZir) as the most predictable and reliable. With centrals and laterals, when occlusion is stable, we suggest our very esthetic, layered eMax. Our choice for bicuspids and cuspids varies depending upon a number of factors, such as occlusion, guidance, opposing surfaces, translucency, final shade, and stump shade. For example, if strength is the primary concern, full-contour zirconia might be the best choice; conversely, if a younger patient presents with translucency requirements and a stable occlusion, layered eMax or even monolithic eMax might be well-suited. If the patient has a dark preparation-shade, PFZ, full-contour zirconia, or monolithic eMax is the best choice to mask the discoloration.

In more extensive restorations, it may seem prudent to use the same material to maintain continuity within the smile. However, the patient’s particular needs, and the spectrum of materials available, may complicate the choice of material. In these situations, feel free to gather information and discuss treatment-options with your ROE Technical Consultant. They are experienced and trained to help dentists decide the best material for the situation.

SureTemps – A Better Provisional

Provisional Restoration, Dental TemporaryToday’s technology allows dentists to use laboratory-fabricated provisionals for long-term treatment and diagnostic use. SureTemp provisionals, presently fabricated at ROE, are a significant improvement over pro-visionals made just a few years ago. These provisionals are either CAD-engineered, or designed from a template such as a wax-up or approved study model (by way of laser-scanning) and are milled using an industrially processed and cured acrylic called PEEK (Polymethylmethacrylate). PEEK is tooth-shaded to classic Vita shades, and can be stained or layered with pink acrylic to simulate gingiva. SureTemps are superior in every way to conventional acrylic temporaries. They are dense and durable, have improved morphology, and can be adjusted or added to with acrylic or composite. Because they are made with CAD/CAM, a replacement can be fabricated within 24 hours, should the need arise!