Sep 162014
 

Joint Palpation to detect palpable soundsOne of the pieces of diagnostic information I look at during a joint & muscle exam is whether the patient can open widely, smoothly, and straight up and down. A deviation on opening is a significant finding and makes me ask the question why? When a patient’s opening and closing movements meander right and left there is an underlying cause. It could be as simple as muscle tightness, contraction and a sign of an occluso-muscle disorder.  Alternatively, the cause could be the position of the disc in relationship to the head of the condyle. A disc displacement often causes the patients muscles to learn a programmed series of contractions so they can move around it instead of being “locked” behind it. The following video demonstrates looking at deviation on opening and two patient examples of a deviation, one that is muscle based and the other that is a displaced disc.

The Ultimate Occlusion Series from Clinical Mastery.

 

 

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Sep 082014
 

Custom Impression Coping WebCustom anterior implant provisionals allow us to alter the emergence profile of the abutment from the top of the fixture to the free gingival margin so we can optimize the pink esthetics during tissue maturation. Once this process is accomplished it is imperative to capture this shape so that the lab has a soft tissue model that is identical on which to copy the emergence profile of the final abutment/crown. The instant you unscrew the temporary restoration/abutment the tissue shape begins to slump. No matter how quickly you think you can move to put an impression coping in place and take the impression the changes are significant enough to mean the lab has to sculpt their soft tissue model. This sculpting is a guess and after the hard work that goes into a custom provisional guessing is counterproductive. The implant provisional has a second job and that is to allow you to create an exact replica of that emergence profile on a custom impression coping.

  1. The steps in fabrication of a custom impression coping are quick and simple and insure optimal esthetic results.
  2. Remove implant provisional and inject Mach II die silicone to create a silicone plug to help hold tissue shape.
  3. Screw Implant provisional onto an analog.
  4. Mix snap set stone and fill a medicine cup to about 1/4 inch and place analog/provisional into stone and allow to set for 4 minutes.
  5. Inject Mach II die silicone onto the snap set stone and around the remainder of the exposed analog and several millimeters up onto the provisional to capture emergence profile. Allow to set for 45 seconds.
  6. Mark the facial with a sharpie marker on stone and outside of cup.
  7. Unscrew provisional and replace with an impression coping.
  8. Inject flowable composite around the impression coping into the Mach II soft tissue impression, and cure fully.
  9. Unscrew the custom impression coping, wipe with alcohol to remove any air inhibited layer and place in Chlorhexidine.
  10. Remove Mach II plug from fixture with explorer and seat custom impression coping.

Medicine Cup Impression WebThe final impression, customized impression coping, and the medicine cup impression are all sent to the lab for use to fabricate the final abutment and crown. This is a variation on a technique I learned years ago from Frank Spear. Thanks go to Pete S. at Gold Dust Dental Lab for the idea of filling the medicine cup with a combination of stone and silicone and to Luke M from Gold Dust Dental Lab for the addition of marking the facial with a sharpie!

In our Clinical Mastery course “Implants Live: Mastering Implant Success”, you will get a chance to make a custom provisional and custom impression coping.Impression Coping Contour Web

 

 

Sep 042014
 

photo 2By Drs. John Nosti, Jason Olitsky, and Lee Ann Brady

One of the many benefits to taking a dental continuing education course with Clinical Mastery is the option to be learning hands-on or over-the-shoulder. Over-the-shoulder education offers the participant the chance to learn new information and then immediately see it applied, giving them the confidence to use their new skills instantly.
Top 7 Reasons Over-the-Shoulder Education is Better:

1) Low stress learning-
Participants can observe, question, and engage without the stress of treating their own patient in a foreign clinic. This way, the focus is entirely on absorbing and understanding the new information. Continue reading »

Aug 292014
 

Healing Cap WebIf your goal is to create optimal tooth and gingival esthetics, than the answer in my book is YES. Probably one of the most common questions i get is why the lab can’t simply go from a fixture level impression to the final restoration and create optimal gingival position and contours. The answer is simple, you are asking them to guess as to how the patients tissue will respond to the facial contour of the abutment and crown over time. Guessing inherently includes risk, the patients gingival health, tissue thickness, healing since fixture placement, and more. So asking your technician to sculpt a model and create the final contour from the fixture to the gingival margin is about your personal tolerance for risk assumption, and how you will deal with things when the result doesn’t meet your expectations or the patient’s expectations.Implant Temp 1 Web Continue reading »

Aug 272014
 

questionsBy Mary Osborne

Everyone has an opinion about what a fair fee is in dentistry today. Patients think they know what it should be (usually less than what it is.) Insurance companies have their opinions about what our care, skill, and judgment is worth. Consultants and other experts have statistics, comparisons, and formulas that promise to provide the right answer. In my conversations with dentists and their teams I hear their concern about a changing health care model and changing economic model. They see that systems and structures of the past may be less relevant in the future. As I look at an emerging and evolving health care model I have been working with what I think of as a formula for health: the health and well being of our patients, and the financial health and viability of our practices.
CSJ + PO + FF + MOP = Health Continue reading »

Jul 152014
 

adhese-universalThe recent launch of Ivoclar’s Adhese Universal adds to the growing category of materials known as “Universal Adhesives”.  In general when I hear the word universal I assume it is a product that can be used for all possible applications and with a single set of instructions. I have learned over the years not to assume in dentistry what the word universal applies and make sure I understand the specifics. This new group of materials is no different. There are multiple manufacturers with “Universal Adhesives” on the market, and each one has a different set of procedures it includes with different recommended directions. So with that what are the advantages of using a “Universal Adhesive”? Continue reading »

Jul 092014
 

Cartridge CouplerWasted material is wasted money. Over the years I have tried to analyze the remaining impression material or bite registration in cartridges and make the decision whether there is enough remaining material to accomplish our goals. If not time to use a whole new cartridge. We have also loaded two separate guns and used the remaining material, switched guns to finish loading the impression tray or taking the bite. This approach uses two tips, another way to increase costs.

Recently we became acquainted with a product called Lock-n-Reload. The blue plastic connectors fit on to the end of the cartridge of material, and allow you to attach a second cartridge of material. Using the gun you move the remaining material from cartridge one into the second combining the contents. The now empty cartridge and connector are thrown away and you can get full use out of the material. The connectors are manufactured by a company called IndiGreen Innovations at www.IndiGreen.com and is available from most of the major dental distributors.

Jul 012014
 

Teflon Tape Block Out WebVinyl Polysiloxane and Polyether impression materials are stiff enough that material that locks under a bridge pontic or through a large gingival embrasure can make removal of the impression from the mouth difficult to near impossible. On the other hand Alginate used int he same situations can tear easily or be dislodged from the tray causing distortion that renders the resulting model inaccurate. Continue reading »

May 272014
 

Woman's Eye and World GlobesBy Mary Osborne

For more years than I care to admit I told patients they should brush their teeth; they should floss their teeth; they should come in for regular exams and cleanings. I did that kindly, gently, with compassion and with the best of intentions. Still, I had patients who were not effective at removing deposits and who did not keep their scheduled appointments. I wondered why they didn’t listen to me.
I have come to understand that personal hygiene is, well, personal. Most adults believe they have good enough hygiene. They feel judged and insulted when they are told their hygiene is not good enough. When people feel insulted their defenses go up.  When they feel a need to defend their actions they are likely to get attached to those actions; to justify them; to resist any change. Continue reading »

May 122014
 

Imacon Color ScannerLast week we had a team meeting on Wednesday. This is something we do about every 4-6 weeks. We block out the entire afternoon, order in lunch for everyone and plan some valuable time together. It is amazing to me how often these meetings turn into logistics discussion about the radio station, uniforms or how we are handling sterilization. I am even willing to admit sometimes they degrade into “gripe” sessions. When this happens I wonder why we continue to schedule these as they seem more stressful than helpful.

One of our goals is to have these meetings be positive and  beneficial. There are many levels of benefit we can get, from clinical or technical development, resolving systems based issues, resolving conflict and becoming a more cohesive team. Last week at our meeting one of our team members requested that everyone bring in photos of themselves over a span of years. The suggestion was met with mixed reviews. The day before the meeting at the morning huddle she reminded everyone to bring their photos and some groans were heard. Continue reading »