Incisal Wrap Veneer Prep

 Esthetic Dentistry, Restorative Dentistry  No Responses »
May 172012
 
Butt Joint Incisal Edge Reduction

Incisal Edge Reduction-Butt Joint Margin

Veneer preparations that include incisal reduction require a decision about lingual margin design. The two most common designs are a butt joint  or a lingual wrap design. There are pros and cons to each of these designs and one or the other may be appropriate depending on the parameters of the case. Creating a butt joint margin is what I prepare more commonly these days. This design allows us to have adequate thickness of porcelain at the incisal edge to allow the technician artistic freedom to create incisal translucency and dentinal effects. Wrapping over the incisal edge also creates the ability for the technician to have artistic freedom, so what are the differences. Continue reading »

 Posted by Lee Ann Brady on May 17, 2012  Tagged with:

Bur Systems: The Key To Efficiency

 Restorative Dentistry  No Responses »
May 162012
 
Indirect Restorative Block

Indirect Restorative Block

One of my goals in practice is to increase my efficiency and effectiveness during restorative procedures. A key ingredient in accomplishing this has been creating my own bur systems that are customized by procedure. So many dental offices I visit have a draw of burs behind the dentists, blocks full of randomly organized burs from front to back. How many times during a procedure are you looking for a different bur, or sending your assistant to find one? If the answer is even once you have lost productive time.  My goals are clear-cut. I want to have every bur I need for a given procedure out in a block on my side of the patient. Second, a bur goes into the handpiece one time only. It goes in, is used to completion, and when it goes back into the block it means I am done with it for the remainder of the procedure. It is also grossly inefficient to keep putting the same bur in and out of the handpiece. Continue reading »

 Posted by Lee Ann Brady on May 16, 2012  Tagged with:

Supragingival Margins: When Do They Work?

 Restorative Dentistry  No Responses »
May 152012
 
Minimal Prep Veneers

Supragingival Margins on Veneer Preps

I believe it would be a nearly perfect world if the only type of margin I ever cut was supragingival. No retraction issues, no worries about tissue management and margins that any patient can clean with a toothbrush in addition to always bonding to enamel at the margin. Unfortunately I don’t get to always do supragingival margins, but more and more these days I can. In the early years of my practice when my esthetic restoration was a porcelain fused to metal crown with metal margins we placed the margins as far subgingival as possible without violating the biology. Why, to hide the ugly metal ring of the restoration. Today, all ceramic restorations have become esthetic enough that we no longer have to hide our work. Continue reading »

 Posted by Lee Ann Brady on May 15, 2012  Tagged with:

Carbamide Peroxide Vs. Hydrogen Peroxide

 Dental Materials  No Responses »
May 142012
 
Venus White Whitening Products

Venus White

There are so many formulations of whitening and bleaching products on the market today it can be confusing. Not only do we have to understand which  active ingredient to use, Carbamide Peroxide or Hydrogen Peroxide, but also the strength. Both of these chemicals are oxidizing agents, meaning they liberate oxygen and actually lighten the color of the dentin structure of teeth.  This is by ADA definition what distinguishes a “bleaching”agent from a “whitening” agent, as whitening is the removal of extrinsic surface stain only. Continue reading »

 Posted by Lee Ann Brady on May 14, 2012  Tagged with:

Anterior Photography for Shade Communication: Translucency & Surface Morphology

 Esthetic Dentistry  1 Response »
May 102012
 

Shade communication is one of the most challenging things we do, and is a critical step in success. On the technicians side they are asked to produce an artistic reduction of a tooth with very limited knowledge of the person, what they or their teeth look like. To assist them we can send photography, and lots of it. In addition to our routine photos there are several specific images I take for shade communication on anterior teeth. The first is an image for translucency. I want the technician to capture the character of the incisal edge enamel so they can reproduce it. The first step is to clean and dry the teeth. Using retractors that are positioned higher to pull the upper lip out of the way shoot a close -up from canine to canine. Continue reading »

 Posted by Lee Ann Brady on May 10, 2012  Tagged with:

Contacts Opening Between First and Second Molars

 Occlusion/TMD, Restorative Dentistry  1 Response »
May 092012
 
Distalizing Occlusal Interference

Distalizing Excursive Interference

It is not uncommon to place a restoration on an upper second molar and have the contact open over time. The new crown is checked diligently at the seat appointment, and the contact flossed to ensure that it has the proper tension. The patient presents on an emergency because they are packing food, or at a routine hygiene exam and the open contact is detected.  This can be frustrating and disconcerting for both the patient and the dentist. So why does this happen? As with many things in dentistry it is most likely multi-factorial, but one of the first things I check is the occlusion. Continue reading »

 Posted by Lee Ann Brady on May 9, 2012  Tagged with:

Using a Mock-Up For Conservative Anterior Preps

 Esthetic Dentistry, Restorative Dentistry, Restorative Techniques  1 Response »
May 082012
 
Venus Temp 2 Mock-Up

Venus Temp 2 Mock-Up

A large majority of the anterior restorations I complete incorporate changes to tooth position, alignment or contour. I aim to balance the required tooth reduction to accomplish the clinical goals with being conservative. Often the changes we are making between the existing tooth position and the proposed tooth position are additive and act to reduce the amount of reduction required.  Tooth reduction is challenging enough to get accurate without the added guessing of what will be needed to accomplish the tooth form from a wax-up. Transferring the information from the diagnostic wax-up to the teeth in the form of a mock-up allows me to use my usual technique, cut depth cuts and create the required reduction from the final tooth position, conserving tooth structure. Continue reading »

 Posted by Lee Ann Brady on May 8, 2012  Tagged with:

Is Tooth Wear Normal?

 Occlusion/TMD, Restorative Dentistry  3 Responses »
May 072012
 
Incisal Edge Tooth Wear

Wear in a 16 Year Old Patient

I ask the question “Is Wear Normal?” at almost every lecture I do on occlusion. Usually the response is a small number of mumbled replies. A good follow up question is ” How many eighty-five year old patients have you seen with mammelons?” I hope your thinking not many, if any at all. So yes tooth wear of some amount is normal. A combination of attrition, erosion, and abrasion we all lose enamel over a lifetime. The more important question is when is the wear age appropriate and when is it advancing at a pathologic rate? We don’t have the data to know how many millimeters of enamel lose is appropriate at every decade of life. In order to help with this answer in my office I play a mental game. With the picture of the patients current wear in mind and a knowledge of their age I imagine if the wear continues at the same rate at what age will their teeth be in jeopardy or need restorative dentistry to be saved? Continue reading »

 Posted by Lee Ann Brady on May 7, 2012  Tagged with:

Placing Cord For Impression Success

 Restorative Dentistry  1 Response »
May 032012
 

Retraction CordThis week in the office the theme has been around placing cord. Yes, I admit it, I am still a two cord dentist most of the time. I have yet to find an alternative technique that predictably creates appropriate impression flash. Getting fabulous impressions is not a given with any technique; the magic is in how you use it. Over the years I have learned a few tips that make using cord highly predictable. My initial prep margin is placed equigingival, which creates a reference to tissue position for placing the primary cord. With a perio probe, measure sulcus depth and decide where in relation to the base of the sulcus you plan to place the prep margin. With this information I begin with a size zero cord. I gently place it into the sulcus. Continue reading »

 Posted by Lee Ann Brady on May 3, 2012  Tagged with:

Month End Reports, What Do You Track?

 Practice of Dentistry  1 Response »
May 022012
 

With the month of April coming to an end, dentists everywhere are wading through stacks of reports. Many of these reports are printed out of habit and never read, stacked in a cabinet for someone else to throw away. A question to ask your self is what reports do you want, or better yet need? Answering this question starts with understanding what the key barometers are of your practices success. Commonly we track numbers like total production or total collections.These are great numbers, but in and of themselves only help us see a correlation to our bank account. One number I want to track is collection percentage. We work so hard to drive production, it’s important that it actually translate into collections. Continue reading »

 Posted by Lee Ann Brady on May 2, 2012  Tagged with:

Soft Appliances, Do They Work?

 Occlusion/TMD, Restorative Dentistry  5 Responses »
May 012012
 

You may have hear both positive and negative things about all soft occlusal appliances. A common conversation is that they will aggravate muscle signs and symptoms. It is true that some patients will increase the amount of clenching they do in response to the squish of a soft appliance. For patients with muscle signs and symptoms and a healthy condyle disc assembly a soft appliance would not be my first choice. Another factor to consider is the amount of grinding and tooth wear a patient has. Soft appliances will protect the teeth from wear, where hard appliances do still have the ability to cause tooth wear, albeit at a much reduced rate than tooth against tooth. Continue reading »

 Posted by Lee Ann Brady on May 1, 2012  Tagged with:

Custom Staining Provisionals

 Esthetic Dentistry, Restorative Dentistry  No Responses »
Apr 302012
 

Anterior provisionals are an important way to differentiate your practice. Patients, their friends and family and specialists are amazed by exquisite provisionals and it clearly demonstrates your offices commitment to excellence. One of the key ingredients is the shade, matching value, chroma and hue whether we are doing a single tooth or a full arch. All of our provisional materials are monochromatic and can appear lifeless even when polished. With the simple step of custom staining we can add life, vibrancy and depth to the provisional. Continue reading »

 Posted by Lee Ann Brady on April 30, 2012  Tagged with:
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