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Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach

This book is a must have if you enjoy doing bonded porcelain restorations and you want to see how a master does it. The lab work is unbelievable and the photography is excellent. Its like having an Ansel Adams book: you have to see how the best do it so that you have something to aspire to.

Unlike traditional veneers, the approach described in this book draws upon the ideal hues, the subtle shades, and especially the intracoronal anatomy of the intact tooth to serve as a guide to reconstruction and as a measurement of success. From this perspective, a checklist of fundamental esthetic criteria is presented, and treatment planning, diagnostics, tooth preparation, laboratory procedures, adhesive luting procedures, and maintenance protocols are carefully detailed. The reader will find all the information and step-by-step instruction needed to obtain the authors’ superior results, which are showcased throughout the book.

No one will contest the need for less expensive, satisfactory, and rational substitutes for current treatments. The answer might come from an emerging interdisciplinary biomaterial science called biomimetics. This concept of medical research involves the investigation of the structure and physical function of biologic “composites” and the design of new and improved substitutes. Biomimetics in dental medicine has increasing relevance. The primary meaning for dentistry refers to processing material in a manner similar to that by the oral cavity, such as the calcification of a soft tissue precursor. The secondary meaning refers to the mimicking or recovery of the biomechanics of the original tooth by the restoration. This, of course, is the goal of restorative dentistry.

Several research disciplines in dental medicine have evolved with the purpose to mimic oral structures. However, this nascent principle is applied mostly at a molecular level, with the aim to enhance wound healing, repair, and regeneration of soft and hard tissues. When extended to a macrostructural level, biomimetics can trigger innovative applications in restorative dentistry. Restoring or mimicking the biomechanical, structural, and esthetic integrity of teeth is the driving force of this process. Therefore, the objective of this book is to propose new criteria for esthetic restorative dentistry based on biomimetics.

Biomimetics in restorative dentistry starts with an understanding of hard tissue structure and related stress distribution within the intact tooth, which is the focus of the opening chapter of this book. It is immediately followed by a systematic review of parameters related to natural oral esthetics. Because the driving forces of restorative dentistry are maintenance of tooth vitality and maximum conservation of intact hard tissues, a brief chapter describes the ultraconservative treatment options that can precede a more sophisticated treatment. The core of the book centers on the application of the biomimetic principle in the form of bonded porcelain restorations (BPRs). The broad spectrum of indications for BPRs is described, followed by detailed instruction on the treatment planning and diagnostic approach, which is the first step in learning this technique. The treatment is then described step-by-step, including tooth preparation and impression, laboratory procedures related to the fabrication of the ceramic workpiece, and its final insertion through adhesive luting procedures. The book ends with discussion of the follow-up, maintenance, and repair of BPRs.

Breeze Self-Adhesive Resin Cement

Any thoughts on Breeze, a new Self-Adhesive Resin Cement from Pentron?

According to Pentron: “Breeze is specifically designed to make the cementation of crowns, bridges, inlays, onlays and posts faster and easier by eliminating individual etching, priming, bonding, and mixing steps.

By eliminating the etching, priming, and bonding steps, both postoperative sensitivity and procedure time are drastically reduced, improving peace-of-mind and freeing up precious chair time.

Formulated with advanced resin technology, Breeze Self-Adhesive Resin Cement provides the strongest retention available in a self-adhesive cement with the quick and easy to use auto-mix delivery system. Upon application, Breeze Cement quickly goes to work to condition dentin, enamel, and the restoration all in one quick and simple step. ”

Has anybody used this Cement? Was procedure time reduced?

Mineral Trioxide Aggregate: An alternative to the traditional calcium hydroxide apexification technique?

Amy Dukoff, D.M.D. from EndoMessageBoard.com
comments:

“Mineral Trioxide Aggregate (MTA) has been enormously successful as a vital necessity in the treatment for adult dentition. It has famously been noted for its ability to seal internally in the pulp chamber and along the root canal wall. As a barrier seal, it has proven its outstanding ability to prevent microleakage and is also valuable for its antimicrobial properties. The use of MTA as a root-end closure in immature apices should be considered as an alternative to the traditional calcium hydroxide apexification technique.

Creating an artificial barrier that is biocompatible is a necessity when treating the immature apex. Establishing a hard apical barrier is necessary in order to obturate the pulpal chamber. MTA is biocompatible, and it has the ability to stimulate hard tissue formation. Furthermore, normal periodontal ligament space has been found after mineral trioxide aggregate placement. Just as important, MTA placement can be done in one visit; both the practitioner and the patient benefit from fewer clinical treatment visits incomparison to the number of visits required by long-term apexification treatment application. Calcium hydroxide apexification treatment technique typically included multiple appointments over months and also required continual appointments to monitor its progress. After calcium hydroxide treatments, mineral trioxide aggregate can be introduced to create an artificial barrier. The two materials can work synergistically to create the desired result for both the practitioner and clinician.

Mineral trioxide aggregate is an important material that should be considered when planning treatment for teeth that have immature apices. Both gray and white MTA provide a seal against microleakage. Both materials create an artificial barrier that can become an apical barrier useful in the treatment of teeth that have an immature apex.”

What do you think about Mineral Trioxide Aggregate: An alternative to the traditional calcium hydroxide apexification technique? Leave your comments below.

You can learn more about this at: EndoMail.com and Discuss it at EndoMessageBoard.com
.

Diode Laser: Potential Damage to Pulp?

Dr.W. asks:
I recently attended a hands-on course using the diode laser. I was frankly amazed at all of its uses. I was also impressed at how easy it was to use. We learned how to use the laser to create a trough around a finish line of a prepared tooth to make a final impression. I watched the instructor hold the laser tip pointing at the vital tooth. I am concerned about pulpal damage. If you aim the laser tip at the tooth, is there any potential for damage to the pulp? Is there any chance of damaging the tooth surface?

Stratos Articulator: A Better Choice?

Dr. E. asks:
I have a prosthodontics oriented general practice in which I do about a dozen full mouth reconstructions each year. I am in an area where the patients tend to stay in the practice for a long time. When I do anything, I want it to last. I charge a reasonable fee for full mouth reconstructions. I have taken some courses in using new kinds of articulators like the Stratos favored by the Las Vegas Institute. One of its features is that you do not need to take a facebow because you use the hamular notches and the incisive papilla for orientation of the maxillary cast. It eliminates the need for a facebow. Before I do a case using this approach, I would like to get some feedback from users. Any experience with the Stratos Articulator? Advice?

Contemporary Fixed Prosthodontics

This text provides a strong foundation in basic science, followed by practical step-by-step clinical applications. Procedures are presented in an organized, systematic format, and are illustrated by over 3,000 clear, high-quality drawings and photographs, now in full-color. The material is logically divided into sections that cover planning and preparation, clinical procedures, and laboratory procedures. The text also includes two invaluable appendices that provide an updated list of dental materials and equipment, as well as a guide to manufacturers.

* Follows ADEA curriculum guidelines for fixed prosthodontics
* Features hundreds of step-by-step procedures
* Integrates basic science with clinical applications
* End-of-chapter glossaries consistent! with the most recent edition of The Glossary of Prosthodontic Terms (see above)
* Text boxes scattered throughout present quick facts and tips about selected artwork
* Selected key terms presented at the beginning of each chapter and set in bold type within the text facilitates rapid information retrieval
* Essay format study questions offer the reader an opportunity to test his or her knowledge and comprehension after reading each chapter
* Updated references support concepts presented in each chapter.
* Valuable appendices on dental materials/equipment and manufacturers.
* 15 contributors collaborate with the editors to present up-to-date information and state-of-the-art techniques in prosthodontics.

Functional Occlusion: From TMJ to Smile Design

Debunks many popular misconceptions through practical discussion of their origins and the deficiencies of the arguments behind them. Different sides of many philosophies are presented while guiding the reader to the most functional and esthetic solution to various occlusal situations. Hundreds of full-color photographs, illustrations, and diagrams show aspects of the masticatory system, the epidemiology of occlusal problems, and procedures for finding the ideal occlusion. Whether the reader is a general dentist or a specialist, they will find this book applicable to their treatment methods and philosophies.
* Special atlas sections break down complex information accompanied by descriptive diagrams and photographs to further explain sources of occlusal disorders and related pain.
* Hundreds of full-color photographs and illustrations show problems and procedures.
* Procedure boxes offer step-by-step explanations of specific procedures.
* Important Considerations boxes in the Treatment chapters outline treatment plans and describe what is to be accomplished.

Endodontics: Principles and Practice

You’ll easily understand and learn procedures through step-by-step explanations accompanied by full-color illustrations, as well as video clips included on CD.

* Comprehensive coverage of normal structures, disease, diagnosis and treatment planning, periodontic endodontic interrelationship, trauma, local anesthesia, root canal instruments, access preparations, cleaning and shaping, obturation, temporization, retreatment, endodontic surgery, endodontic outcomes, internal bealching, vital pulp therapy, geriatric endodontics, vertical fractures, and more gives you a complete understanding of modern endodontics!
* Distinguished experts in the field of endodontics share their experience regarding each topic discussed.
* Current references incorporate evidence-based information that is relevant to your practice.
* Advice for the prevention and treatment of accidental procedural errors ensures you are prepared to safely care for your patients.
* Outlines and Learning Objectives at the beginning of each chapter provide quick reference for specific topics.
* High-quality, full-color illustrations allow you to see the procedures described.
* Newly reorganized content now simulates the order in which procedures are performed in clinical settings.
* NEW CD included with the text brings procedures to life with video clips, and reinforces your knowledge with interactive chapter review questions.

Using Chlorhexidine as an Endodontic Irrigant?

Dr. Allan Deutsch from EndoMessageBoard.com
comments:

“For most of my endodontic career there was only one irrigant, and that was sodium hypochlorite. It was and still is the workhorse of endodontic treatment the world over. It dissolves tissue and kills most of the bacteria present in the root canal—but not all of it. The one bug that it does not kill too well is E. faecalis. This bacteria is becoming increasingly associated with failed root canal treatment. So, if your instrumentation doesn’t remove E. faecalis, you may have a doomed root canal treatment from the very beginning.

Luckily for us, over the last ten years a lot of research has been done on chlorhexidine and its antibacterial properties. Most of you are probably familiar with chlorhexidine as the active ingredient in the mouthwash “Peridex.” Peridex is a 0.12 percent solution of chlorhexidine. Unfortunately the 0.12 percent solution is not strong enough for use as an endodontic irrigant. At this low concentration, the chlorhexidine would take several hours to kill the bacteria in the canal. This length of time is not a practical option when treating patients. The research has shown, however, that a 2 percent solution of aqueous chlorhexidine will kill the bacteria in one to two minutes. This length of time is certainly acceptable for practical endodontic treatment.”

What do you think about Using Chlorhexidine as an Endodontic Irrigant? Leave your comments below.

You can learn more about this at: EndoMail.com and Discuss it at EndoMessageBoard.com
.

Use Glass Ionomer to Cement Posts and Seal up Endo Access?

Dr. F. asks:
My endodontist has told me that composite leaks badly and that many of the endo cases that he does are due to composites that leak. He advised me to use glass ionomer to cement posts and to seal up endo access, like over orifices. I have had terrible experiences using glass ionomer with cores for crowns. They break or fall out. So, what about using glass ionomer to seal up the access and cover it with a composite core? Will the glass ionomer eliminate the microleakage? The composite core should give me retention and strength. Thoughts?

Improve Efficiency of Endodontic Procedures with Endo File Boxes?

Dr. T. asks:
I have been trying to improve the efficiency of my endodontic procedures and I want to start using stainless steel boxes made by Medidenta to hold my endo files. We have been placing one set of files in gauze and then autoclaving that. But I find that I sometimes need more than one file of a particular size so then we have to open another pack of files. So boxes from Medidenta may prove very helpful.

But the stainless steel boxes I have looked at all have lids that fit over the bottom half and seem to create like a water-tight seal. So how does the steam get inside to sterilize the files? These steel seamless boxes do not have any holes in them so how do you know you are getting enough steam inside the box to sterilize the files?

CAD/CAM Scanners: Are You Having Success with These?

Dr. F. asks:
There have been advertisements for the new Lava Chairside Oral Scanner [3M ESPE] in the major dental journals and dental magazines. This is another version of the CEREC and iTerra CAD/CAM machines. You use these to optically scan the prepared tooth instead of having to make an impression. These CAD/CAM optical scanning devices are extremely accurate, according to the manufacturers. CEREC is the only one of the three units that can produce the ceramic restoration chairside. The one major disadvantage that I see is that in order for the scanning to be accurate, the tissues have to be retracted, and free of blood and saliva. That generally requires lasers. I am curious as to what kinds of success users are having with these machines.

LightSpeed: Larger vs. Smaller Diameter Endodontic Files?

Dr. L. asks:
When I first took the hands-on course with LightSpeed files [Tulsa Dental], I learned that instrumenting the apical 1/3 to a #20 or 25 in general was very wrong because most canals are oval shaped in the apical one third and unless you use a larger diameter file, you leave mound of tissue. In the LightSpeed course we instrumented and obturated teeth and then sectioned them 1mm from the apex. It was truly amazing. If you used a smaller diameter file, you really failed to remove most of the tissue at the apex. I have been using nickel titanium rotary. You cannot get to the apex with larger diameter files unless it is a straight canal. How come there is no interest in using larger files at the apex?

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