Dental Excellence 15: Ultrasonic Preparation Clinical Microscope Video

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

In this New Dental Excellence training I would like to share with you a new clinical video I filmed with my Zeiss microscope teaching you how I use ultrasonic diamond tips for the precision preparation of class 2 box forms.

Near the end of this video I tell you about my new clinical tutorial: Creating Stunning Provisionals. Click here to learn more.

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 14: Precision Preparation Guides

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

In this New Dental Excellence Video I would like to share with you the stents and putty matrices that I use for the precision preparation design for everything from a 6-unit veneer case to full mouth rehabilitation cases.

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

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 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.

One critical step to transform your smile design cases for your patients.

I wanted to write a blog post to teach you about a critical step that I feel will really transform your smile design cases for your patients.

When I look back at all of the beautiful smiles that I am fortunate to create for my patients I concluded that one of the steps in my system that has been critical to success is the provisional evaluation appointment.

We all know that the provisional restorations are critical for the ceramist to use as the guide when creating the final porcelain restorations. The potential for a problem happens because the provisional is the last step for the preparation appointment and if you are running out of time can be rushed or not properly evaluated. This is compounded by the patient having a lack of natural lip mobility due to any remaining local anesthetic and fatigue from the entire preparation, impression and provisional process. At this stage of the appointment, many patients just want to get out of the chair.

With all of this in mind I added a provisional evaluation appointment as a critical step in my system for smile design and rehabilitation cases.

I have been using this appointment for the last 18 years and it has allowed both myself and the patient a more relaxed and ideal time together to evaluate not only the occlusion but the esthetics of the provisional results.

This appointment is the time to make any changes in the occlusion design and incisal edge position BEFORE the ceramist starts to build the final restorations.

My system is to have the patient return anywhere from 1 to 2 weeks after the preparation date and evaluate the provisional results and make any desired changes to the case. If the provisional looks great or the changes are minor I will take a final provisional impression, bite records and digital photo series of the provisional results.

If the changes are significant I will have the patient go a few more weeks to evaluate the changes and then have a second provisional evaluation appointment.

I would like to share a recent case with you that illustrates a good lesson.

This patient was treatment planned for 7 Emax restorations for the maxillary anterior.

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The first step after the functional analysis and treatment planning was to alter the gingival tissue levels.

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After healing a new maxillary model was taken and mounted on the Sam 3 articulator to complete the diagnostic wax-up.

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The patient came into the office for the preparation appointment and the old restorations were removed, new core build-ups placed and the final preparation impression and provisional restorations were created.

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The patient returned to my office 2 weeks later for the provisional evaluation appointment. Due to traffic issues the patient was very late for this appointment but he told me that he was very happy with the results of the provisional restorations.

With this in mind I took a quick look at the results and decided it looked good to me as well. I checked the occlusion, discussed the shade and took the digital photo series. I then left the case with my assistant to take the final impression of the provisional.

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The next day I was looking over the models and photos of the case preparing everything to send to my master ceramist, Harald Heindl. At this point I realized that I missed the fact that the incisal edge position was slightly canted and down on the right side. Even with the patient being late I should have taken more time on the provisional evaluation appointment.

The patient told me the day before that he was happy with these results but when I reviewed them I realized that this could be dramatically improved.

The decision was made to bring the patient back for a second provisional evaluation appointment so I could shorten the right side and level out the incisal edge position.

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In a case like this one where the change is not that extensive I will shorten the incisal edge on the right side with Soflex XT discs, reevaluate the results and retake the provisional records.

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The case was then sent to Master Ceramist Harald Heindl and completed with layered Emax crowns.

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The moral of this story is that a critical evaluation of the provisional restorations is important for our cases even if the patient is late or you are behind and have a patient waiting in another chair.

Let me know if you have any questions or comments using the link above this post and if you like the written blog post format.

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

All the best, Stephen

Dental Excellence Video 7: Tooth Preparation Guides and Stents

This is the seventh video from my Dental Excellence Video Series. In this video I share with you the different tooth preparation guides and stents that I use in my dental practice.

Remember. You can do this kind of dentistry and that beautiful dentistry with precise fit and occlusion is not just for the gurus!

My next class for Occlusion Design is opening for registration in April. If you would like to join the early bird list, use the link below and I will send you early access with a special bonus offer for those who register early for Occlusion Design.

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

Dental Excellence Video 5: Equilibration For The Porcelain Veneer Patient.

This is the fifth video from my new Dental Excellence video series. In this video I share with you my thoughts about Equilibration For The Porcelain Veneer Patient.

Watch the video below to find out when I would equilibrate a patient before placing porcelain veneers.

Remember. You can do this kind of dentistry and that beautiful dentistry with precise fit and occlusion is not just for the gurus!

Transcription and Slides: Dental Excellence Video 2

Hi there. I’m Dr. Stephan Phelan. Welcome to Dental Excellence.

For this video I want to point out one of the themes that I follow when I’m teaching about more complex dental cases or aesthetic dental cases and that theme is the wax up is the blueprint. I really believe that you need to “begin with the end in mind”, to quote Steven Covey, if you’re going to be thinking about doing more complex dental or aesthetic cases.

I designed my diagnostic wax up communication form to enable my ceramist to really have the vision that the patient and I have for the case. I did share this with a lot of people when I was promoting my occlusion design online course a couple of years ago and I think it was really well received. People really liked the concept and I wanted to add this to my Dental Excellence video series.

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The concept of creating an additive diagnostic wax up, as well, is something that I first heard from Pascal Magne and Michel Magne when I went to the first course that they hosted at IDEA about ten years ago. It was a fantastic course; it really made me think about aesthetics at a really higher level just because of the level of beautiful dentistry that the Magne brothers produce.

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And so, when I spoke to Harald, my ceramist, Harald Heindl, about the cases, we talked about additively contouring the porcelain restorations based on the wax up and the wax up additively contouring to the teeth so that we could, again, preserve more tooth structure and more of the patient’s own enamel. Even with crown cases, I like to preserve as much tooth structure as possible and as much enamel as possible so that if something were to break, I’d rather the porcelain, veneering porcelain, break than the tooth break at the gum line. So we try to preserve as much tooth structure as possible. So if you can, within the confines of the patient’s overall smile design, if you can create an additive contour wax up, that allows you to preserve more tooth structure.

So additive contour wax up is a really great concept. I would Google Dr. Pascal Magne and read some of his articles about this that he’s written with his brother, Michel Magne and this is a case that we did next to the case report from the Magne brothers.

And I’ll just share with you this case briefly. It’s a patient that came into my practice with a lot of erosion, attrition and tooth wear. The result is the teeth are already somewhat prepared because of the amount of erosion and attrition on the teeth. There is no need for me to excessively prepare these teeth, there’s no reason to. We need to additively build up the tooth structure.

And you can see the before model next to the diagnostic wax up and appreciate the amount of volume of tooth structure we’re adding with this wax up. We then use that as the blueprint to make the provisional restorations, which are then the blueprint to create the porcelain restorations. So the wax up is the key, it’s the foundation for creating these restorations.

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So here’s the patient again, occlusal view, you can see all the wax being added to the before model. It’s an additive wax up concept. And the wax up is the blueprint.

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Here’s this particular patient and if you look at his before pictures, you know, we didn’t have to prepare the teeth a lot; the erosion and the attrition have prepared the teeth already. I had to prepare the teeth interproximally, so the jacket crowns would go over the teeth because I felt there was too much facial erosion to really prepare these teeth for porcelain veneers. But jacket crowns, conservatively prepared, are a good option for a patient like this with this much facial and incisal erosion.

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So you look at the different views– here he is before. Again, end–to-end occlusion from the wear and the movement of the teeth as the teeth wore. He developed a more end-to-end occlusion as opposed to any kind of over jet and over bite. So we are going to open the vertical to create over jet and over bite so he has a more normal functioning occlusion and it helps with the survival of our restorations as opposed to having our restorations contact in an end-to-end occlusion.

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There are a lot of good teaching points on this case and I will talk about this case in a few future Dental Excellence videos, but the bottom line for this video is the wax-up is the blueprint.

So you look at the before pictures. Looks like Bruxism, if you were to look at how the wear facets line up. The wax-up, again, was the blueprint to create the diagnostic provisional restorations.

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So if you look at the provisional restorations, we’ve changed the length of the teeth, the tooth volume and we’ve changed the occlusion design. We’ve opened the vertical, created some over jet and over bite and maintained a pretty flat occlusal guidance scheme. And so, look at the before and after change just by adding plastic– additively in the mouth, with the provisional restorations.

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So here he is with his provisional restorations. What I said earlier is that we create the final restorations based on the provisional restorations. The provisional restorations were created based on the diagnostic wax-up. So we are, again, using the wax-up as the blueprint.

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So here are the final restorations, these are Lava Zirconia crowns, layered Lava Zirconia crowns. You know, this case was completed about four years ago. My ceramist Harald Heindl from the Seattle area creates the restorations; he’s a German Master Dental Ceramist. Beautiful anatomy, beautiful layering of the porcelain but for me the keys are beautiful fit and beautiful occlusion– beautiful fit and occlusion. Those are the keys to make my life easier as well as the beauty and the aesthetics.

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So there are the before and after photographs of the close-up view and, you know, it’s a huge change for this patient, it’s a transformational change, really. When you look at what this does to the overall appearance of the person it makes almost everybody who has a before and after change like this look tremendously younger. You can’t help it because you’ve changed the whole part of the face that people look at the second-most; they say that people look at the eyes the most and then secondly the teeth and smile. So, you know, this is transformational.

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These photos were taken a while ago with the three-year post ops, you can see the case has held up exceptionally well but he did have very nice occlusal design, very precise and well thought-out occlusion design for this particular case. I talk about the occlusion design and the different things that we look at with over jet, over bite, angle of guidance, pathway of guidance as well as degree and width of guidance.

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Here are some more views. Natural-looking aesthetics, these are Lava Zirconia restorations but layered in such a way that they can look very natural.

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And I’ll just end by saying that you can do this kind of dentistry. I have an everyday practice, I just really document well and I work with a great ceramist so I’m fortunate that way, obviously.

You can do this kind of dentistry. Beautiful dentistry with precise fit and occlusion

Dental Excellence: The Wax-up is the Blueprint

In this second video of my new Dental Excellence video series , I discuss a theme that I follow when I am treating complex dental cases or aesthetic dental cases and that is The Wax Up Is The Blueprint.

Watch the video below to find out more and see another great case from my practice and always remember that beautiful dentistry with precise fit and occlusion is not just for the gurus!

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