Thats about me ladies and gentlemen.
If you already know
me i am blessed, if you dont then i need to work harder 🙂
Let us divide our learning today into 3 parts diagnosing a
case deciding on what material you are going to use and
finally delivering the best possible result for your patient
First things first, diagnosis is a very important tool in what
we do
To diagnose we have a set of tools available at our
disposal let as look at these in a very brief manner
I am sure all of you can related to the image of the chair
light coming in and that giving you vision to see in the
mouth but what is more important than the chair light is
the use of a high quality mouth mirror this helps you in
directing the light and focusing it at the exact place
Please start using a front surface mouth mirror because
that's the first tool that goes into the mouth and frankly
that has to be the best
I have given a few names on the slide relax FS and zirc
both these mirrors are good and get the job done very very
nicely. Today you have others available in the market also
which are also equally good so you have a wide range of
choices now
far as the next most important tool is concerned it is our
probe. Please buy a good probe which can help you in
detecting caries and also help you in checking for
periodontal pockets.
The next most important tool that you will be using
everyday in your practice is your x-ray or RVG.
Unfortunately not many people in India use the bitewing
holder.
Frankly without a biting you cannot do bonded dentistry
In the posterior to detect class II and in the anteriors to
understand the position of your bone in relation to the
crest of the papilla
As you can see in the slide there it is very important for
you to understand where the crest of bone lies and where
should your contact point be made
Because if you want to close a diastema and not land up
with a dark triangle then you need to communicate well
with your technician to give you the apt mock up and also
understand this if you are going to do a direct restoration
The distance from the crest of the ridge to the contact
should be at Max 5 mm only then 100% of the times the
papilla will close and you will not have a dark triangle
So please buy a bite wing holder because this will help you
in a long long way
Sometimes the patient might have cracks in the teeth and
you will not be able to see this on an x-ray or even
clinically also the patient will never complaint of any
symptom so it is mandatory in our practice today to check
for crack or craze lines and for this I just love the microlux
2.
believe this is a tool that you should all have in your
practice because it just makes my life very easy.
It also help me in detecting early caries lesions, as you
can see in the slide there it helps me in checking for white
spots, checking for residual caries and also cracks it's it's
a one tool that I would recommend everyone to purchase
You could contact mm dental for further information on the
microlux
from these handheld tools what is most important is your
vision and a magnified vision at that
Trust me my life changed 10 years back when I bought my
first microscope it is a different world under those two
lens.
I cannot stress the importance of magnification in
everyday dentistry we will have an entire lecture on the
details of magnification and how you can encorporated in
your practice by Dr Sahil and I am sure we all admins and
moderators will always be there to help you out in
choosing the right magnification for you
Frankly there is no dentistry without magnification today at
tattoo artist uses loupes at least to do his work shouldnt
we be doing this atleast then.
If there is one thing that you can take back from my lecture
today please order a pair of loupes at least
of the above mention tools help you in diagnosing a case
correctly and then you move on to decide what will be the
best for your patient
When you are deciding on a treatment plan the most
important part of it is understanding what is left behind in
a tooth. What is the substrate you are working with?
Whether it is enamel whether it is dentin or whether it is
cementum.
Once you have that in mind you then choose the correct
material that perfectly suits the patient at that given time.
It's very important for you to also take into consideration
the age of the patient and the habits that he has. Because
you will be eventually looking at longetivity and strength.
After you decided on your material you will then decide on
the bonding strategy now this is in coordination with the
substrate and the material.
For example if you are in enamel completely then resin or
composite is the material of choice
If you get into dentin and deeper layers then you will have
to do immediate dentin sealing and then use and apt
material for enamel replacement
After you have decided on the material and your bonding
strategy you will then decide the prep design whether in a
particular case you will be doing up prep based Restoration
or a non prep
When you will be doing any amount of preparation it is
mandatory for you to create bevels and polish those bevels.
Injection moulding versus over molding these two terms
are used very commonly and interchangeable but there is a
slight difference between the two
As you can see about injection over molding is building
around the tooth over moulding the tooth and then cutting
it back to give it the proper shape for this you will be using
oversized matrices and filling them up with heated
composite
Injection moulding however or flowable injection utilises a
precise matrix made from clear silicone which will allow
you to restore a tooth to its precise point.
[1
0:52 AM, 3/6/2024] +91 98661 02747: The above are
indications of where you would think of doing the injection
technique.
[10:53 AM, 3/6/2024] +91 98661 02747: This list is of
patients which are ideal or what you should be looking at
when you are looking to do the injectible technique
[10:53 AM, 3/6/2024] +91 98661 02747: However there are a
lot of non ideal patients present and you should be very
careful when you are dealing with such patients for them
probably orthodontics or restorative dentistry in a different
way is the correct option
Now what are the different steps that you will follow when
you are doing the flowable injection
You will select the appropriate case after the case is
selected after you have explained all the details to the
patient taken the consent you will go ahead and take a
impression
If you have taken a analogue impression that means a
regular alginate or PVS then you can send it to the lab to
give you a wax up.
However if you take in a digital impression then you can
design the smile if you have the design software all the lab
can help
Next you will make a clear silicon index and onto that
index you will give injection access openings so that it
allows the tip of the flowable composite syringe to go
inside
We will discuss in detail all the steps now
Like I said above you can choose any of the digital or the
analogue way. Studies today suggest that it doesn't make a
huge difference if you are doing it the digital way or The
analogue way in terms of the fit and in terms of the result
Just that when you are doing the digital way you have a
huge library that you can play with also you are shapes can
be modified better because if you deal with the particular
technician he will only have a particular number of shapes
that he can give that's human memory beyond that you will
either have to change the technician or move digital
Once you have the mockup back from the lab you will then
make a clear index from the mock up.
clear silicon index will allow you to inject over the tooth
Onto these index you will make guide holes to allow the
placement of the flowable syringe tip
We will do this guide hole creation during the hands-on.
So ideally you are doing this technique to be minimally
invasive and thus you will generally not do any prep
But in certain cases where you have some teeth chipped
off or partial fractures you will have to bevel the enamel
and polish the bevel well
What is mandatory however is the removal of the attached
pellicle or the biofilm
This can be removed by using a micro etcher or blaster
with Al trihydrate.
I personally use Esthetrix microetcher
And the most important fact is the last line stay in enamel.
As far as the bonding protocols are concerned you will
generally be doing a total etch technique using universal
bond
As far as possible use a bond which is colorless and does
not have a very yellow colour to it
Some examples of this bond are the bond from fgm which
is absolutely colourless and the bond from dentsply which
has a very little yellow color.
Also please protect the adjacent to when you are bonding
to one teeth especially when you etch.
Use either retraction cord or Teflon in the sulcus this will
prevent any excess going into the sulcus
The slide clearly explain the use of filled flowables or
injectibles for this technique
have also mentioned the names of the composite that you
can use
Always injection mould 1 tooth after the other and after
you have done your injection please finish the tooth before
you move to the next
Finishing and polishing as you can see above can be
divided into three parts finishing pre polish and final polish
For finishing you can use the safe ended carbide burs from
SS white and also so flex XT disc from 3M
The Safe ended carbides are called NE 10 OR NE 20
10 indicates 10 flutes and 20 means 20 flutes. So 10 would
be for finishing and 20 would start to polish
You can also use at 12 number blade to remove the excess
from the gingival area and the adjacent tooth but be very
careful when you do that
After finishing you move to the pre polish in this I love to
use the if twist spirals from EVE.
Use them in the proper sequence and and the correct RPM
Final polish can be with either diamond or Aluminium oxide
based paste
I will explain all these in the hands-on in detail.
my time ladies and gentleman thank you all for being here
and being the patient listener I know you did not have an
option because I had the admin only mode on 😁😁
This was in a gist of what we are going to cover and
explaining the technique all the other details and the way
of doing will be explained in person life on 30th of March
where I would begin the hands on like I have begun the
lectures
