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Restorative Photo Essay The IOS FastScan and an Anterior BruxZir® Bridge For the photo essay that follows, I wanted to highlight a case that demonstrates some of the techniques I use on a daily basis, while showing a few new techniques derived from our most recent clinical R&D efforts. The case begins with the Rapid Anesthesia Technique and then utilizes the depth-cut based Reverse Preparation Technique. Next, we use a BioTemps ® provisional to create an ovate pontic receptor site. After utilizing the Two-Cord Impression Technique, we take a digital impression with the IOS FastScan from IOS Technologies. The anterior bridge is then milled without a model using BruxZir ® , a solid zirconia material primarily used for posterior teeth. We have received many requests from dentists who have wanted to use BruxZir as an anterior bridge material, so I was looking forward to seeing what type of esthetic result we could achieve on this first attempt. Restorative Photo Essay: The IOS FastScan and an Anterior BruxZir Bridge15
Figure 1: The Rapid Anesthesia Technique was originally created for posterior teeth, specifically lower molars. It came from a desire to be able to anesthetize individual mandibular molars without having to give a lower block. Lower blocks are the injections most likely to be missed by dentists; they also have the longest onset. The ability to quickly and painlessly anesthetize individual lower molars is a huge benefit to the general dentist. The first step is to place the PFG Light topical anesthetic (Steven’s Pharmacy; Costa Mesa, Calif.) in the sulcus using an Ultradent syringe with a metal Dento-Infusor tip. The PFG Light is left in the sulcus for 30 to 40 seconds, then rinsed off. Figure 2: The 30-gauge extra short tip is connected to the STA System (Milestone Scientific; Livingston, N.J.), and a carpule of Septocaine ® (Septodont; Lancaster, Pa.) with 1:200:000 epi is placed in the sulcus using the tip of the needle without penetrating the attachment. I step on the foot pedal and give two to three drops of anesthetic in the sulcus, allowing it to soak for 5 to 10 seconds. At this point, I step on the foot pedal again to start the flow of anesthetic, and I advance the needle tip through the attachment until I contact bone. Next, I give one-half to twothirds of the carpule while the machine confirms that I am in the PDL with visual and audio prompts. Figure 3: To remove the Maryland bridge, I cut through the connectors with a Razor Carbide bur from Axis <strong>Dental</strong> (Coppell, Texas). Cutting through this all-composite bridge is easy for the Razor, and I routinely use it to cut through PFMs. In the past, I would cut through porcelain with a diamond and then switch to a carbide to cut through the metal coping. However, the cutting flutes of the Razor allow it to smoothly cut through porcelain and metal, simplifying the procedure. Figure 4: To prevent aspiration of the pontic, I cut through one interproximal contact and then grab the pontic with forceps and snap it off. A dentist once told me the story of a patient aspirating a Maryland bridge pontic, and he cut through the second contact and the pontic flew free. 16 chairsidemagazine.com
Page 3 and 4: Contents 9 Dr. DiTolla’s Clinical
Page 5 and 6: Publisher Jim Glidewell, CDT Editor
Page 7 and 8: Dear Robert, Thanks for the kind wo
Page 9: Daniel J. Melker, DDS Dr. Daniel Me
Page 12 and 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 15: 14 chairsidemagazine.com - ARTICLE
Page 19 and 20: Figure 9: You can clearly see the 2
Page 21 and 22: Figure 15: I can see that the BioTe
Page 23 and 24: The BruxZir bridge is solid zirconi
Page 25 and 26: Figure 29: Now that I am finished s
Page 27: Figure 37: A look at the bite regis
Page 30 and 31: Interview of Dr. James Dower - INTE
Page 32 and 33: from the solutions going to that cr
Page 34 and 35: get sort of comfortable doing one t
Page 36 and 37: penetration of the mandibular block
Page 38 and 39: of their lip back. So if you’re g
Page 40 and 41: dentist would reuse prophy cups and
Page 42 and 43: dental school about 10 years ago, s
Page 45 and 46: Rubber DaM Haz rds - Article and Cl
Page 47 and 48: The rubber dam is difficult to ster
Page 49: References 1. Francis CE. The rubbe
Page 52 and 53: When the furcation is removed and t
Page 54 and 55: Contours of shaped teeth are shown.
Page 58 and 59: Alginate Substitutes: Rationale for
Page 60 and 61: Figure 5: Alginate substitute (COUN
Page 63 and 64: Patient Product Review Dr. DiTolla
Page 65 and 66: “That damn lab — I wrote freest

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