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Letters to the Editor<br />
Dear Dr. DiTolla,<br />
First of all, I want to thank you for helping<br />
me with anterior crown preps! I, too, find<br />
that as soon as I begin preparing, I lose<br />
my frame of reference. I have tried various<br />
depth measurement methods, but your<br />
Reverse Preparation Technique is priceless.<br />
Also, your in-depth video demonstration of<br />
its use is outstanding. Thank you so much<br />
for transforming my technique and for my<br />
newly gained confidence in accurately doing<br />
anterior crown preps in a timely manner.<br />
I have a question for you: From the brief<br />
view I got of your dental unit on your video,<br />
it looks like you have an A-dec unit (Continental<br />
style). Also, the electric handpiece,<br />
if I viewed it correctly, is an A-dec/W&H<br />
electric motor. However, I noticed that you<br />
use the KaVo ELECTROtorque high-speed<br />
attachment. I did not know that KaVo electric<br />
handpieces were capable of connecting<br />
to A-dec/W&H electric motors. Do you<br />
need a special coupling/adaptor, or are you<br />
able to simply snap it on the same way you<br />
would if you used an A-dec/W&H electric<br />
handpiece? Also, I have the same A-dec<br />
unit plus A-dec/W&H electric motor, but<br />
I use the A-dec/W&H electric handpieces. I<br />
find them to be very good, but I must admit<br />
I have never tried the KaVo ELECTROtorque<br />
electric handpiece. Have you used or tried<br />
the A-dec/W&H electric handpiece? If so,<br />
4<br />
www.chairsidemagazine.com<br />
how does it differ from the KaVo electric<br />
handpiece that you use?<br />
Thank you very much for your time. Again, I<br />
enjoy watching and reviewing your instructional<br />
videos!<br />
– Larry Kolar, DDS<br />
Chicago, Ill.<br />
Dear Larry,<br />
Thanks for the kind words!<br />
The KaVo electric handpieces do snap<br />
directly onto the A-dec motor; no<br />
adapter is needed. I have never used<br />
anything but KaVo handpieces, even<br />
going back to my air turbine days, so<br />
I guess that means I’ve been pretty<br />
satisfied with KaVo.<br />
I know KaVo is doing a special promotion<br />
where, if you go to www.trykavo.<br />
com, they will send you an electric<br />
handpiece at no charge that you can<br />
snap on for a few days, prep some<br />
teeth and see which one you like better.<br />
Let me know what you think!<br />
Best,<br />
– Mike<br />
Dear Dr. DiTolla,<br />
I was wondering which is the strongest<br />
anterior bridge material besides monolithic<br />
zirconia? I have had failures with IPS<br />
Empress ® II and IPS e.max ® (Ivoclar<br />
Vivadent). Fractures usually occur when<br />
patients unknowingly bite into a hard bone<br />
(meat that is supposed to be boneless), or<br />
forget they need to be cautious with the<br />
restorations and chomp on something like<br />
a hard baguette. The bridges in these cases<br />
have had solid, broad connectors. Could<br />
you comment on IPS e.max versus zirconia<br />
with layered porcelains (e.g., 3M ESPE <br />
Lava )? Is it possible to make the lingual<br />
occlusion of an anterior maxillary bridge<br />
in zirconia and layer just the facial with<br />
porcelain, using the same concept of metal<br />
occlusion in a PFM? I am sitting on a case,<br />
so a quick response would be appreciated.<br />
Mahalo for your input.<br />
– Todd Okazaki, DDS<br />
Haleiwa, Hawaii<br />
Dear Todd,<br />
Good question! First of all, you are<br />
correct in thinking that monolithic<br />
zirconia, such as BruxZir ® Solid<br />
Zirconia (<strong>Glidewell</strong> Laboratories), is the<br />
strongest all-ceramic bridge material<br />
that we have. This time last year, I would<br />
have hesitated to recommend that a<br />
dentist prescribe BruxZir Solid Zirconia<br />
for an anterior bridge. The esthetic<br />
nature of BruxZir restorations has really<br />
improved over the last year, although<br />
it hasn’t quite caught up with its<br />
monolithic brethren, such as IPS e.max.<br />
An anterior PFM bridge is probably<br />
the strongest solution, although the<br />
ceramic material can certainly chip<br />
off the metal understructure, and the<br />
esthetics can be compromised by the<br />
lack of translucency and possibly<br />
exposed metal margins.<br />
I am not sure I would want to go with<br />
the zirconia-layered-with-ceramic option<br />
you mention, as we have noticed<br />
more chipping with that combination<br />
of materials than we have with porcelain<br />
fused to metal. In fact, porcelain<br />
fused to zirconia would probably be<br />
my last choice after BruxZir Solid Zirconia,<br />
IPS e.max and PFM.<br />
You also asked about making the lingual<br />
of the bridge in solid zirconia,<br />
similar to a metal lingual on a PFM<br />
restoration. While we do fabricate<br />
bridges like that on request from dentists,<br />
we don’t get many requests for it.<br />
Perhaps the reason is that the strength<br />
of BruxZir Solid Zirconia comes from<br />
its monolithic nature — the fact that<br />
it doesn’t have any ceramic material<br />
fused to it. As a result, it fractures and<br />
chips less than any other restoration<br />
in the lab (except cast gold, of course).<br />
When we do make a BruxZir restoration<br />
like that, we typically place the