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 11: Seating Porcelain Veneers

Welcome to my Dental Excellence video series. In this new video I would like to share with you an excellent technique to ensure the perfect seating of your porcelain veneers. To enhance your learning experience, I am using video filmed with my Zeiss ProErgo microscope to teach you these detailed clinical techniques.

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 register for my new clinical training webinar that I was speaking about in the video above  click here.

This is a brand new webinar and it is going to be excellent!

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!

If you are not a member of my email list join today and receive a free video about implant esthetics.

Dental Excellence: Longevity of Porcelain Veneers

I have created a new series of Dental Excellence videos that teach clinical techniques and case studies from my practice.

In this first video I explain the most important factor for the longevity of porcelain veneers. A 10-year old porcelain veneer case is used to illustrate the concept.

You can ask a question or comment using the link above and don’t forget to Like, Share or Tweet this video.

Thank you again for being a member of my online community and remember, beautiful dentistry with precise fit and occlusion is not just for the gurus.

 

Envelope of Function, Part 1

Using a custom anterior guide table with complex cases.

If you are planning to treat patients with more complex dental problems you should consider using an anterior guide table. Many patients with tooth wear, especially pathway wear and restricted envelopes will have milled out the envelope of function that they feel comfortable with.

It would be wise to recreate this pattern in the restorations you make for them when you restore their case. One of the best techniques to recreate this pattern is to make a custom anterior guide table for your case using the accurate, mounted study models on an articulator.

It is essential to have an accurate mounting for this technique to work and I have created my occlusion DVD series to instruct you in the step-by-step process to take the bite records and then mount the case on an articulator. I will also cover this topic in detail during my new occlusion seminar.

Once you have an accurate mounting you or your technician can use the original models to create a custom anterior guide table and recreate the patients pattern of wear and envelope of function in the diagnostic wax-up.

This technique allows you to make esthetic changes to the case but still maintain a familiar occlusal scheme that the patient will feel comfortable with.

I have included some pictures from an anterior guide table my technician, Mr. Harald Heindl has created for the diagnostic wax up for a patient with severe anterior attrition and erosion as well as pathway wear in the envelope of function. I have also included the before and after images of the lower incisors from this case so you can see the dramatic change that occurred during the full mouth reconstruction for this patient

In the next post in this series I will talk about how to transfer the diagnostic wax-up to the patient’s mouth and test the results.

Feel free to add any comments or questions using the link above.

Plumber’s tape for dentistry

Plumber’s tape can have many uses in your dental practice.

One product that is really inexpensive and useful to have around your dental practice is plumber’s tape. You can buy it for a few dollars at the local Canadian Tire or hardware store and it can be very handy for isolation.

If you look at the pictures attached to this post I have isolated the adjacent teeth with plumber’s tape so I can etch and bond the veneer preparations without damaging the adjacent teeth. This isolation technique prevents etchant and adhesive from contaminating the adjacent tooth structure, which can lead to bonding these teeth together when you insert the veneers.

Another use for plumber’s tape is to isolate the screw holes for screw retained provisional implant crowns like the ones in my exclusive video, How To Create A Custom Implant Transfer For Esthetic Implant Cases. In a case like the one in the video the plumber’s tape is used to prevent the cement or composite resin from clogging up the abutment screws and make it difficult to remove or tighten them at a later date. This can be very useful when you have provisional implant crowns that need to be removed one or two times to refine the esthetics before the completion of the case.

With the plumber’s tape you can screw the provisional into place and insert the rolled up plumber’s tape over the abutment screw and then seal the access with composite resin. When you need to remove the provisional all you need to do is drill out the composite resin to the level of the plumbers tape and then remove the plumber’s tape with a probe or explorer.

I used cotton pellets for this technique for years but I now find that the plumber’s tape is a cleaner and easier way to handle these cases.

Do you have any other ways you use Plumber’s tape in your practice?
Feel free to add any comments or questions using the link above.

Full Mouth Rehabilitation with Porcelain Restorations

In this video Dr. Stephen Phelan explains some of his concepts for treating full mouth rehabilitation cases and presents the ceramic work for a case that will be bonded into place the next day.