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Letters to the Editor Dear Dr. DiTolla, First of all, I want to thank you for helping me with anterior crown preps! I, too, find that as soon as I begin preparing, I lose my frame of reference. I have tried various depth measurement methods, but your Reverse Preparation Technique is priceless. Also, your in-depth video demonstration of its use is outstanding. Thank you so much for transforming my technique and for my newly gained confidence in accurately doing anterior crown preps in a timely manner. I have a question for you: From the brief view I got of your dental unit on your video, it looks like you have an A-dec unit (Continental style). Also, the electric handpiece, if I viewed it correctly, is an A-dec/W&H electric motor. However, I noticed that you use the KaVo ELECTROtorque high-speed attachment. I did not know that KaVo electric handpieces were capable of connecting to A-dec/W&H electric motors. Do you need a special coupling/adaptor, or are you able to simply snap it on the same way you would if you used an A-dec/W&H electric handpiece? Also, I have the same A-dec unit plus A-dec/W&H electric motor, but I use the A-dec/W&H electric handpieces. I find them to be very good, but I must admit I have never tried the KaVo ELECTROtorque electric handpiece. Have you used or tried the A-dec/W&H electric handpiece? If so, 4 www.chairsidemagazine.com how does it differ from the KaVo electric handpiece that you use? Thank you very much for your time. Again, I enjoy watching and reviewing your instructional videos! – Larry Kolar, DDS Chicago, Ill. Dear Larry, Thanks for the kind words! The KaVo electric handpieces do snap directly onto the A-dec motor; no adapter is needed. I have never used anything but KaVo handpieces, even going back to my air turbine days, so I guess that means I’ve been pretty satisfied with KaVo. I know KaVo is doing a special promotion where, if you go to www.trykavo. com, they will send you an electric handpiece at no charge that you can snap on for a few days, prep some teeth and see which one you like better. Let me know what you think! Best, – Mike Dear Dr. DiTolla, I was wondering which is the strongest anterior bridge material besides monolithic zirconia? I have had failures with IPS Empress ® II and IPS e.max ® (Ivoclar Vivadent). Fractures usually occur when patients unknowingly bite into a hard bone (meat that is supposed to be boneless), or forget they need to be cautious with the restorations and chomp on something like a hard baguette. The bridges in these cases have had solid, broad connectors. Could you comment on IPS e.max versus zirconia with layered porcelains (e.g., 3M ESPE Lava )? Is it possible to make the lingual occlusion of an anterior maxillary bridge in zirconia and layer just the facial with porcelain, using the same concept of metal occlusion in a PFM? I am sitting on a case, so a quick response would be appreciated. Mahalo for your input. – Todd Okazaki, DDS Haleiwa, Hawaii Dear Todd, Good question! First of all, you are correct in thinking that monolithic zirconia, such as BruxZir ® Solid Zirconia (Glidewell Laboratories), is the strongest all-ceramic bridge material that we have. This time last year, I would have hesitated to recommend that a dentist prescribe BruxZir Solid Zirconia for an anterior bridge. The esthetic nature of BruxZir restorations has really improved over the last year, although it hasn’t quite caught up with its monolithic brethren, such as IPS e.max. An anterior PFM bridge is probably the strongest solution, although the ceramic material can certainly chip off the metal understructure, and the esthetics can be compromised by the lack of translucency and possibly exposed metal margins. I am not sure I would want to go with the zirconia-layered-with-ceramic option you mention, as we have noticed more chipping with that combination of materials than we have with porcelain fused to metal. In fact, porcelain fused to zirconia would probably be my last choice after BruxZir Solid Zirconia, IPS e.max and PFM. You also asked about making the lingual of the bridge in solid zirconia, similar to a metal lingual on a PFM restoration. While we do fabricate bridges like that on request from dentists, we don’t get many requests for it. Perhaps the reason is that the strength of BruxZir Solid Zirconia comes from its monolithic nature — the fact that it doesn’t have any ceramic material fused to it. As a result, it fractures and chips less than any other restoration in the lab (except cast gold, of course). When we do make a BruxZir restoration like that, we typically place the
ceramic material on the facial and carry it from the gingival down to the incisal edge, without wrapping the incisal edge. We want to allow the patient to function in protrusion on the zirconia, rather than the porcelain. But doing this takes it from being a monolithic BruxZir restoration to a bilayered restoration, which is more prone to chipping. While there are no absolutes, my first choice today is IPS e.max for a 3-unit bridge in the anterior on a patient who does not show a lot of wear. For that same bridge in a patient who does show signs of wear, my choice is BruxZir Solid Zirconia, especially if the patient has previously chipped a PFM restoration. As the size of the bridge increases beyond 3 units, I begin to consider PFM as my choice because of the superior strength of the metal connectors when compared to any allceramic system, especially when there is a lack of room for the connectors. As always, your mileage may vary. Hope that helps! – Mike CONNECT WITH CHAIRSIDE FOLLOW US ON TWITTER Find us @GlidewellDental FIND US ON FACEBOOK Search “Glidewell” to see what’s new. ITUNES WATCH AND LEARN Go the iTunes Store and search “Glidewell.” Plus, download the free Glidewell Publications app for iPad. SHARE YOUR THOUGHTS Visit www.chairsidemagazine.com and select “Contact Us.” Or write to: Glidewell Laboratories ATTN: Chairside magazine 4141 MacArthur Blvd. Newport Beach, CA 92660 ACCESS OUR RESOURCES Clinical videos, product information and patient resources are a click away at www.glidewelldental.com. ADVERTISE/SUBMIT AN ARTICLE Call 888-303-4221 Letters should include writer’s full name, address and daytime phone number. All correspondence may be published and edited for clarity and length. Dear Dr. DiTolla, I haven’t talked with my wife for days. She can’t stop! – Tom Novak, DDS Weatherford, Texas Letters to the Editor 5
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Contents 42 Is It Time to Do Routin
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 10 and 11: Numbers by the 143 CEREC Number of
Page 12 and 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 14: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 17 and 18: Tooth Preparation The amount of too
Page 19 and 20: Case Report Placement of the Initia
Page 21 and 22: It was decided to grant her request
Page 23: Conclusion Figure 21: A retracted f
Page 26 and 27: Figure 1: First Appointment — We
Page 28 and 29: Figure 13: I use my NV MicroLaser
Page 30 and 31: Figure 24: Now that I can finally s
Page 32: Before After Figure 34: A retracted
Page 35 and 36: Interview with Glenn Lombardi - INT
Page 37 and 38: technology because it made my iPad
Page 39 and 40: appointments instead of texting her
Page 41 and 42: control of this, but they’re prob
Page 44 and 45: Is It Time to Do Routine Adult Pulp
Page 46 and 47: Figure 3: Earliest pulpotomy discov
Page 48 and 49: Figure 7: Two Sargenti (N2) pulpoto
Page 50 and 51: There are theoretical concerns over
Page 52: expensive endodontics. If the pulpo
Page 55 and 56: Figure 1: Electric handpiece units
Page 58 and 59:
THE REMAKE DEBATE - ARTICLE by Mari
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lenging, difficult patients, and th
Page 62 and 63:
Digital Impressions for an Immediat
Page 64 and 65:
Once the digital files were receive
Page 66:
The Chairside® PHOT Hunt Once agai
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