One Critical Mistake I Almost Committed

I am so glad I caught this. I almost made a critical mistake with the provisional restorations for a case I completed earlier this year.

The upper provisional was completed, I thought it looked excellent and went to take a few pictures of it before seating and right there through the camera viewfinder I saw it.

Can you see what is wrong with this provisional?

I left the gingival embrasure between the central incisors closed!

This could have blunted the papilla and left a black triangle at insert (along with an unhappy patient).

Now, as we know from Dr. Dennis Tarnow if the contact point of the restorations is 5.0 mm or less from the interdental peak of bone the papilla will reform.

That is great long term but the patient would not be happy short term. Therefore, I recommend in my trainings to design and contour the gingival embrasures of the provisional to provide space for the papilla. 

Here is ideal papilla contour after the removal of long-term provisional restorations. The cement you see on the preparations is Durelon. I use this for long-term provisional restorations but it adheres to tooth structure a little and I remove it with an ultrasonic scaler. 

Several different instruments can be used to create ideal gingival embrasure form with your provisional restorations. I like the Vision Flex discs from Brasseler and/or a 7901 carbide to carve the ideal embrasure form.

These ultrathin discs are excellent to define precise embrasure form.

I recommend you instruct your dental assistants to be careful how they handle them for cleaning and sterilization because they are expensive and if they get even a small bend on one corner they do not cut with the same precision and are basically useless. 

So, with this new case, I saw the poor embrasure form while I was taking pictures and corrected it.

Here is the final provisional contour the day I seated them.

Here is an composite image showing the initial provisional with the poor embrasure form first. The middle image represents the adjusted provisional embrasure form after shaping with the 7901 carbide and the final seated image shows the provisional with a knife edge type of embrasure form created from the Vision Flex disc.

Here they are a few weeks later when the tissue was healed.

Here are the final restorations immediately after bonding.

Here are the final restorations after 4 months of healing. Note the excellent tissue health and contour. I am glad I caught that mistake I almost committed with the provisional restoration.

The ceramics were created by Master Ceramist Harald Heindl. 

If you would like to see this new case in detail with examples of the preparations for Occlusal Veneers, Veneer Crowns, and Onlay Veneers please register for my new webinar while it is still available.

Click Here to register for this New Webinar.

During this new webinar, you will learn:

  1. Where to start your analysis when a severe wear patient presents into your dental practice. I have a system for this that will help to clarify the confusion surrounding helping these patients.
  2. How to identify the risks involved with wear patients. Both risk of treatment and the risk of doing nothing. 
  3. How to design and test a new occlusion for these patients. What happens if they cannot tolerate this new Occlusion Design?
  4. How to manage muscle forces with a wear patient so you can achieve longevity with their restorations.
  5. How to choose the best restoration design for individual teeth in an erosion or attrition patient. Should you choose crowns, onlays, veneers, occlusal veneers or veneer crowns?

I hope you enjoyed this new email training and look forward to connecting with you during the webinar.

 

 

Strong Restoration VS Strong Tooth

 

As clinicians we are often faced with the dilemma of trying to balance material and lab needs with the desire to be conservative.

Would you prefer to be safe and provide the lab with plenty of reduction so the material is strong and the resulting thickness makes it easier to create a desired esthetic result?

Here is a picture for the ceramics from a recent case I completed. 

Notice the thickness of the central incisor crowns compared to the lateral incisors!

The central incisors were originally prepared by a different clinician with a more traditional preparation design and a butt joint margin.

Unfortunately, this leads to what I would refer to as Strong Restoration VS Strong Tooth.

Notice the lateral incisor crowns. These are prepared with a different philosophy that I would refer to as Strong Tooth VS Strong Restoration.

Here is the preparation photo.

The important question to ask is, “can we have both?”

I believe the answer is yes. I feel with the predictable ability to either bond directly to enamel or use IDS to predictably bond to exposed dentin you can achieve Strong Tooth AND Strong Restoration!

I do not believe we need excessive reduction of healthy tooth structure to achieve our long-term goals. We can bond a thinner thickness of ceramic leading to less reduction of healthy tooth and stronger remaining teeth while still achieving excellent esthetics and predictable results.

This leads to some exciting preparation designs even with erosion patients like you see in the picture below.

We can use Occlusal Veneers, Veneer Crowns, and Onlay Veneers to help restore a patient like this with severe erosion in a more conservative manner.

If you would like to see this new case in detail and examples of Occlusal Veneers, Veneer Crowns, and Onlay Veneers please register for my new webinar while it is still available.

Click Here to register for this new webinar.

This new webinar will feature a detailed new case study for a patient with severe erosion I treated this year with a partial rehabilitation.

If you have wear patients you are unsure about or you have avoided treating you should watch this encore webinar.

Here are a few slides from the webinar presentation. As you can see below I use a variety of preparation designs for this case to produce a Strong Tooth AND Strong Restoration! 

 

During this new webinar, you will learn:

  1. Where to start your analysis when a severe wear patient presents into your dental practice. I have a system for this that will help to clarify the confusion surrounding helping these patients.
  2. How to identify the risks involved with wear patients. Both risk of treatment and the risk of doing nothing. 
  3. How to design and test a new occlusion for these patients. What happens if they cannot tolerate this new Occlusion Design?
  4. How to manage muscle forces with a wear patient so you can achieve longevity with their restorations.
  5. How to choose the best restoration design for individual teeth in an erosion or attrition patient. Should you choose crowns, onlays, veneers, occlusal veneers or veneer crowns? 

Click Here to register for this new webinar.

I hope to connect with you during the webinar.

 

Dental Excellence Video 21: Occlusal Veneers to open the vertical dimension with wear patients

This is the 21st video in my Dental Excellence Video Series.

In this new video, I talk about occlusal veneers to open the vertical dimension for wear patients that may not require full coverage restorations for the molars.

During the video, I share with you images from two cases I completed in my practice. The first case was finished 13 years ago but I saw him this week during his hygiene appointment and I included new 13-year post op photos taken Wednesday.

The second case was completed this year in my practice.

 

Thank you again for being a member of my online community and remember…

You can do this kind of dentistry!

I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,

Stephen

P.S. If you are interested in this kind of dentistry, I believe you would enjoy my Online Seminar. Altering the Vertical Dimension Case Studies.

This seminar will feature 3 detailed case studies teaching a different vertical dimension concept for each case. These case studies are from patients that I have successfully treated in my own practice over the past 21 years.

The first case study is the 13-year-old case from my new Dental Excellence video so you can be confident these techniques work in a regular clinical practice. 

Click Here to register for this seminar.

During this online seminar, you will learn:

  • The one thing you NEVER want to do when you alter the vertical dimension!
  • The starting point to assess if the vertical even needs to be altered.
  • Three different options to alter the vertical and when to use each.
  • Should I test out the new vertical with a splint first?
  • Will my patient be able to speak properly after I alter the vertical?
  • What should I do if my patient has speaking issues after I alter the vertical?
  • Can I predict if my patient can tolerate an alteration to the vertical dimension?
  • Will my patient have pain after if I alter the vertical dimension?
  • How stable is the new vertical dimension?
  • How should I design the anterior guidance to work with my new vertical dimension?

Click Here to register for this seminar.

 

Season’s Greetings, Merry Christmas and Happy Holidays!

 

Season’s Greetings, Merry Christmas and Happy Holidays!

I would like to wish you and your family a happy, healthy and safe holiday season and thank you again for being a valued member of our online dental community!

Thank you for your support and I wish you much success in 2018.

 

Dental Excellence Video 19: Dental Implant Adventures

This is the 19th video from my Dental Excellence video series.

A couple of weeks ago I was prepping a rehabilitation case and we had a bit of an unexpected implant adventure. This new video will tell you all about it and offer a very nice solution.

 

Thank you again for being a member of my online community and remember.

You can do this kind of dentistry!

I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

Dental Excellence 17: Root Extraction System

This is the seventeenth video from my Dental Excellence video series.

In this New Dental Excellence Video I will share with you a very cool root extraction system.

This new training will use extensive video footage filmed with my Zeiss dental microscope to teach you this simple but highly effective extraction technique.

Thank you again for being a member of my online community and remember.

You can do this kind of dentistry!

I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

P.S. All of us have patients that suffer from tooth wear in our practices. During this new Dental Excellence video I also tell you about my Altering the Vertical Dimension Case Studies Online Seminar.

If you are interested in this kind of dentistry CLICK HERE to register and find out more about this new seminar presentation.

P.P.S. We all know the importance of the diagnostic wax-up. When you attend my new online seminar I have a special bonus for you. At the 5-minute mark I have created a link to download my New Diagnostic Wax-up Instructions PDF to use with your cases!

You have to log in and attend the seminar to receive this download.

Click Here to register for this new seminar this weekend, Altering the Vertical Dimension Case Studies and receive this Free Download when you log in.

Dental Excellence 16: Case Acceptance Systems

This is the sixteenth video from my Dental Excellence video series.

In this New Dental Excellence Video I will teach you the overall system I follow to help patients with more complex dentistry select appropriate treatment plans.

I will tell you about a new patient that I recently completed the diagnostic records for that is going ahead with a full mouth rehabilitation.

I have edited my recent Facebook Live presentation to use a multi-video camera presentation that I think you will enjoy!

Near the end of this new video I take you on a tour of my large operatory and show you my microscope, loupes, piezo, cameras and laser. This is the operatory I prepare my full mouth rehab cases in. ☺

Thank you again for being a member of my online community and remember, you can do this kind of dentistry! I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

P.S. To learn more details about presenting fees for these cases and to see the actual case presentation slides for a full mouth rehabilitation consultation join me for my Master Your Case Acceptance Webinar by clicking this link to register https://www.phelandentalseminars.com/myca-reg

Dental Excellence Video 13: Predictable Long Term Restorative Techniques

This is the thirteenth video from my Dental Excellence video series.

In this New Dental Excellence Video I would like to share with you a very predictable restorative dentistry technique that I use in my dental practice.

Click Here to register for my free online seminar that I talked about at the end of this new video.

This online seminar will only be available until August 24th so if you want to learn about my systems for treating wear patients you should register and join us right away.

Thank you again for being a member of my online community and remember, you can do this kind of dentistry! I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

Dental Excellence Video 12: Full Mouth Rehabilitation Cases

This is the twelfth video from my Dental Excellence video series.

In this new video I would like to share with you a Full Mouth Rehabilitation case that I have been working on for the past 8 months and the one tip that has made a big difference in the finishing of this type of case in my dental practice.

Thank you again for being a member of my online community and remember, you can do this kind of dentistry! I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

As I mentioned in the video above, Occlusion Design is currently closed for new members. If you have enjoyed this or other training videos from me I believe you would really benefit from my Occlusion Design membership.

If you would like to join the waiting list, use the form below and I will send you priority access when Occlusion Design is open again for new members.

Click Here to join the waiting list to receive priority notification for the next class of Occlusion Design.

Dental Excellence Video 8: Porcelain Veneer Provisional Ideas.

This is the eighth video from my Dental Excellence Video Series. This new video contains one excellent recommendation that will help you with your provisional veneers.

My next class for Occlusion Design is opening for registration in a few weeks. If you would like to join the early bird list, use the link below and I will send you priority access with a Special Bonus Package when you register early for Occlusion Design.

Click Here to join the early bird list for the next class of Occlusion Design.