Delivery Visit #4

dental angles

<–Step 4  Step 5 for full mouth dental rehabilitation  Step 6-->

Appointment time

  1. 1 carp palatal apex of 2nd PM
  2. Removal temps. Hemostat IP and the temps
    “pop” off.   Sometimes it is a somewhat loud crack or
    crunch sound so warn the patient of it before you do it, if aggressive preps may need to be cut
  3. Clean with Pumice then consepsis scrub post try-in pre-etch
  4. Try-in and photos
  5. Patient and doctor ok (use line angles as below)
  6. Check E and S sound and F and V sound
  7. Natural airflow between incisal edges when S sound
  8. Ensure incisal edge proper position and contacting inner vermillion border for F and V
  9. Return ones don’t like
  10. Cement ones do
  11. Fine tune major bite issues if present

 

 

Use Microsoft Digital image Software to draw some lines.
It highlights the line angles
Notice the blue line on 8…not going towards the belly button

Cementation process V if a veneer step

  1. (V – Optragate and) try each restoration in
    individually to verify fit. then try them all in together to verify that the contacts are correct
    and that the margins are all still closed.
  2. V- Depending on your ingot selection you can now try in the restorations
    with Rely x veneer try in paste.  You can place a
    light try in paste in one side B0.5 and A3 on the other
    side and see what this does to the restorations.
  3. (V- Take optragate out) BTWs to check seat
  4. Photos check on computer
  5. Let patient approve.
  6. Cement with Relyx luting wherever can with Bruxzir and emax >1.5mm
  7. V- Rubber dam placed
  8. V – Maxilla – Clamps on molars.  In huge opening in the center put dry angle and then blue mousse or some
    other VPS bite registration
    material to block this out.  Have assistant retract the dam under the buccal of both molar clamps
    and inject blue mousse here as well.
  9. V – Mand – clamps on the
    molars.  Take 3 bend brushes and place under the clamps and
    cross them up front.  Have your assistant push the brushes down into the
    muccobuccal fold area–  inject bite registration material under the
    brushes and she holds them there until the material is set.   Then
    lock the brushes together and you are set.  Dry angel over tongue and syringe some material over it.
  10. Consepsis scrub
  11. V- Etch the preps 15 seconds.  Utilize 4 handed dentistry and work on one side, while my
    assistant does the other.   If you cannot do this, do the etch in
    segments.
  12. V- Rinse and place gluma 30 seconds blot dry
  13. V- Place bonding agent and air thin Air Dec
  14. V – If lot of dentin cure bond now
  15. V- Seat all the treated restorations (see below) at once starting with the centrals, then
    laterals, then canines..etc..   Rely X veneer
    cement.
  16. V – TAC
    cure – place finger on the incisal
    edge, assistant is holding the base of the light and with other
    hand use the light to push at the gingival margin.
  17. V – I say “GO” and my assistant hits the light (not
    “yes” not “okay”.. because you will have a tendency to say
    okay or yes too often and get mistaken.. there is no mistaken
    “go”).  This is a quick 1 second tac.
  18. V – After they are all Tac’d you take off the tac
    light and put on the regular tip.   Hold the light approximately 1
    inch or so away and quickly wave over all the restorations for 3-5 seconds
  19. V – You should be left with the cement in the gel
    type state that “fujicem” gets to.  If you waved too long– it
    is harder.  This should clean off easily with an explorer, or
    scaler.   Get it ALL
    off.  Floss to lingual in direction of seating veneer.
  20. V – Glycerine oxygen inhibition layer De-Ox or seal-n-shine and cure
  21. Ensure all cement removed
Two holes in the molar area… connected by a
U-shaped cut done with scissors – John Nosti DT

 

John Nosti DT

Treatment of ceramics after try-in

  1. Clean with alcohol
  2. Etch 30 seconds phosphoric
  3. Silane air dry
  4. Place Rely x veneer cement

Patient

  1. Wear 1-2 weeks