The Art of Predictable Endodontics

Here You Go...

1) LUBRICATION

  • Lubricate handpiece regularly
  • Lubricate with regular airspray provided by the manufacturer
  • Lubricate after work
  • Clean it before you start in the Patient Mouth
  •  After lubrication keep it upside down on the chair or stand

2) LET THE HANDPIECE DRY

  • After lubrication keep it upside down on the chair or stand

3) COMPRESSOR AIR PRESSURE

  • Adjust the air filter regulator of the chair at 40
  • It should within 30- 40, more than 40 will spoil the bearings of the handpiece

4) USE THE CHUCK LIGHTLY

  • Use the Chuck Lightly or
  • If it is pressable secure it firmly
  • Don’t over tighten the Bur
  • use only quarter turn to secure the Bur
  • Use clean burs only
  • Discard the bur if it is not going smoothly into the handpiece

5) CORRECT POSITIONING OF THE BUR

  • Colored marking indicates position of the bur it should be placed exactly near to the marking

6) CLEAN YOUR BURS

  • Clean your burs using Aluminium oxide stone chips
  • After cleaning of the bur run it on the stone with plenty of water spray

7) BUR MANAGEMENT

  • Use only sharp Burs
  • Discard the Burs after 5 or 6 Teeth of crown preparation
  • Use Burs cautiously during access cavity preparation of the posteriors there are chances of maximum torque and Dualplane forces.

8) HIGH POINTS

  • Don’t Remove the metal highpoints with airotor handpiece

9) CONTROL OF AIR SPRAY

  • Clear the water channel regularly with Wire provided by the manufacturer or Orthodontic Ligature Wire.
  • Don’t use handpiece without Water it will block water channel

10) WATER SPRAY DIRECTIONS

  • Water spray should fall on the tip of the Bur

10 Tips to maintain Dental Handpiece

Here You Go...

1) LUBRICATION

  • Lubricate handpiece regularly
  • Lubricate with regular airspray provided by the manufacturer
  • Lubricate after work
  • Clean it before you start in the Patient Mouth
  •  After lubrication keep it upside down on the chair or stand

2) LET THE HANDPIECE DRY

  • After lubrication keep it upside down on the chair or stand

3) COMPRESSOR AIR PRESSURE

  • Adjust the air filter regulator of the chair at 40
  • It should within 30- 40, more than 40 will spoil the bearings of the handpiece

4) USE THE CHUCK LIGHTLY

  • Use the Chuck Lightly or
  • If it is pressable secure it firmly
  • Don’t over tighten the Bur
  • use only quarter turn to secure the Bur
  • Use clean burs only
  • Discard the bur if it is not going smoothly into the handpiece

5) CORRECT POSITIONING OF THE BUR

  • Colored marking indicates position of the bur it should be placed exactly near to the marking

6) CLEAN YOUR BURS

  • Clean your burs using Aluminium oxide stone chips
  • After cleaning of the bur run it on the stone with plenty of water spray

7) BUR MANAGEMENT

  • Use only sharp Burs
  • Discard the Burs after 5 or 6 Teeth of crown preparation
  • Use Burs cautiously during access cavity preparation of the posteriors there are chances of maximum torque and Dualplane forces.

8) HIGH POINTS

  • Don’t Remove the metal highpoints with airotor handpiece

9) CONTROL OF AIR SPRAY

  • Clear the water channel regularly with Wire provided by the manufacturer or Orthodontic Ligature Wire.
  • Don’t use handpiece without Water it will block water channel

10) WATER SPRAY DIRECTIONS

  • Water spray should fall on the tip of the Bur

WHAT IS GRAPHENE AND ITS USES IN DENTISTRY

GRAPHENE

Hey guys, today I am going to share with you a super material. which is going to change the future of Dentistry.

  • It is a supernatural wonder material,  which is stronger than any material known in the universe.
  • It is lighter than paper but stronger than a diamond.
  • It is 200 times stronger than steel. Its tensile strength is 130 Gigapascals yet it is very thin like an atom. 1 gm material is enough to cover an entire stadium.
  • If somehow we can make an elephant stand on a pencil and try to break this sheet with it, It will not tear or break.You may be wondering!!!! What is this materiel? This is Graphene.   It is a unique single thin layer of graphite which is of 2 Dimensional hexagonal structure . It was invented in 2004 by Prof Abdre Geim and Prof Koysta Novoselov. Who got nobel prize for the same in 2010. Graphene is an allotrope of carbon, In 2 Dimensional Honeycomb like structure.

    How it is useful for the dental industry. 

  • Graphenano dental has come up with a biopolymer of graphene in CAD CAM millable disc form called as G-CAM Disc. Graphene is a nanotrophic form of carbon, which allows to cover the monomer particle with its precursor thus resulting in a very dense biocompatible high flexural strength bio-material with mechanical, biological and chemical supermaterial properties. The polymerisation of PMMA trigers the exothermic chemical reaction. This chemical reaction is improved by graphene due to its excellent heat conductive property and resulting complete polymerisation with a very stable compact material with the elimination of all the negative properties of acrylic like coefficient of absorption of liquid and strength. This graphene polymer has very high flexural strength, high esthetics, high superficial abrasion resistance. This is what every dentist was looking for any prosthesis.
  • This is one of the game changer in Implant Dentistry, as it has high flexural strength so the impact forces on the underlying implant is very less.
  • Graphene superstructure will act as a shock absorber thus leading to prevention of high impact force on the implant body.
  • As it is highly aesthetic we can fabricate entire prosthesis in a single framework.
  • There are also other materials which has got flexibility and strength in the prosthesesis but they can’t stand by themselves so you can make only a framework out of that and you need high precision, high end equipment and materials to make an implant prosthesis. where as GCAM can be milled in any dry or wet milling machine. And you can just add glaze or composite layering on it to get the right shade of the teeth and gingival color.

Advantage for Dentists:

  • As it is a polymer we can repair anything intraorally it can be shade or shape or occlusal contacts. Even we can reshape the gingival contour in the oral cavity itself. We can also make Full crowns, veneers, Fpds also. G CAM discs are available in monochromatic and polychromatic forms so we can make direct monolithic crowns also. It has high esthetic than that of our Zirconia. The biggest advantage with general practitioners is these crowns are not that costly and clinical workflow is very simple. You can get the Aesthetics of Lithium Di-silicate with just monolithic poly-chromatic crowns.
    Repair is very easy; you can use your normal composites for any repair work no need to send it to the lab.

Advantage For Labs

  • The biggest advantage for Dental lab in comparison with zirconia; this  doesn’t need sintering so you will save lot of time and money Also it doesn’t require high end milling machines, any existing dry or wet machine can serve the purpose also we don’t require any cermist. If you have little knowledge of composite layering or its shading is enough to make g cam crowns. Yes it is new material with all together new fundas so we have train ourselves to get the best out of that. I am very thankful to the almighty that we are the part this change. There are so many advancements coming in this,  please stay with us. Thanks  to Neodental Technologies Pvt Ltd which has brought this product to India. Thank you for your attention. For more details or further clarification contact Kosmo Dental Academy.

Author: Dr M Anil Goud

  • Professor:  Dept of Prosthodontics and Implantology NRDC
  • Director:  Asian Dental academy Hyderabad.
  • Mentor: GPS Digital  Smile  Designing LAS Vegas USA
  • Mentor: German Oral Implontology and Surgery Germany
  • Coordinator: UCAM univrsity Spain.

SOCKET SHIELD TECHNIQUE FOLLOWED BY IMMEDIATE PROSTHESIS

Introduction

Maxillary anterior teeth are very important in achieving successful aesthetics. Several factors contribute to this success which includes patient’s healing capabilities, level and condition of existing soft and hard tissues and provisional and final restorations.
  • Tooth extraction is followed by severe bone alterations both in height and width. Such re-modelling can make implant placement a challenging task mainly due to deficient  facial bone. However, it is possible to overcome this challenge by carrying out Socket Shield technique by partial extraction.
  • The following case outlines the technical basis of SST and demonstrates its importance in anterior implant planning.
  • Case Details

    A 46 year old female patient with no medical history, presented with appalling aesthetics.The patient had high smile line and had a history of wearing fixed prosthesis wrt 11, 13 & 21, 23 with midline diastema since 8 years. Clinical examination showed bulky prosthesis with irregular and short margins and severe gingival inflammation.

    On radiographic examination, the central incisors and prosthesis deemed hopeless, so removal of prosthesis along with 11, 21 was suggested . Also, thin buccal cortical bone was evident, so a socket shield technique by partial extraction of 13, 23 was planned.

    Case Planning

    • Patient’s CT was obtained and the planning was done on Blue Sky Bio software. The anticipated site wrt 13 & 23 were viewed in Cross – sectional and Tangential windows . It was observed that there was a very thin buccal plate available wrt 13 &23.
    • A measuring scale was used to define the measurements of the available bone. The length was measured from the crest of the bone to the nasal floor which was around 12mm and the crestal width was around 6 -7mm  in the right canine region.
    • On the left canine region, the length was around 14mm and the crestal width was around 7mm.
    • The final dimensions of the Implants decided were:  wrt 13 (4.2×11.5mm) & wrt 23 (4.2x13mm).
    • The anticipated placement of the Implants in the desired sites were viewed in panoramic window.

    Case Presentation

    • Following administration of LA, the tooth wrt 13 was sectioned using TF-13 bur at gingival level.  After complete sectioning of the anatomic crown of 13, 11 was extracted using maxillary anterior forceps the FPD along with 11 was extracted in toto.
    • Vertical and crevicular incisions were given to raise a full thickness flap and all the granulation tissue was removed. The tooth was sectioned bucco-palatally using PET (partial extraction theraphy) bur kit . This was intended to preserve the buccal 1/3rd of the root intact and undamaged. After thorough sectioning of the root, x-ray was taken to ensure the right path of the cutting.
    •  The palatal section of root was then carefully removed without traumatizing the buccal root section using Periotome and root forceps. The remaining buccal half of the root section was then shaped properly and reduced to the level of the alveolar crest. Curettage was done of the extraction socket to remove any granulation tissue.
    • Implant placement phase was initiated using a lance drill to engage the palatal aspect of the socket so that the buccal half of root would remain intact. A desired length of 11.5mm was achieved using the lance and pilot drill. Subsequent diameter drills were used to place the desired implant of diameter 4.2mm.
    • For proper flap approximation, the connective tissue was debrided and any remnant granulation tissue was curettaged. 
    • Same procedure was performed for the contralateral side wrt 23. Multi-unit abutments were screwed in for angle verification. 
    • Post-op OPG was taken to verify the implant placement according to the implant planning phase.
    • After the implant placement, a screw-retained temporary prosthesis was fabricated, chairside as per routine protocol for immediate implant placement in the esthetic zone. For this, temporary cylinders were tightened on the MUAs and holes were drilled in the prefabricated RPD at the temporary cylinders site.
    • Rubber dam was placed and a pick-up of the cylinders was done using cold-cure acrylic resin. After polymerisation, the prosthesis was removed and high-points adjustments were done. After finishing and polishing, the screw holes were blocked with Teflon tape and composite was placed and cured.
    • Following fabrication of the interim restoration, a meticulous occlusal check was performed to ensure non-functional loading. Postsurgical instructions included antibiotics and analgesic medication and chlorhexidine 0.12% oral rinse. At 2 weeks, the patient was asked to return for a postoperative evaluation. 

    BEST AND MOST ECONOMICAL STEPS FOR CROWN AND BRIDGE PROSTHESIS.

    For any FPD, diagnostic impression with putty is most useful and economical   

    •  It serves as diagnostic impression,
    • Diagnostic Casts made from it,
    • Mock preparations can be done from these casts
    • It can be used for making immediate temporaries
    • Same can be used to make final impression with Light Body

    STEP THREE: GROSS TOOTH PREPARATION STEP BY STEP PREPARATION:

    Do the occlusal/Incisal preparation first

    • This will reduce the tooth bulk a lot, gives more clarity of long axis of the tooth
    • Always do preparation by cutting motion
    • Do not follow wiping or swiping motion for preparation
    • Use new burs for preparation. I can’t explain the details of preparation but if you follow my unique technique of crown preparation, your preparation will be highly predictable , conservative and fast. It needs little Hands on Extracted teeth with 2 ,3 preparations only you will get to know how exactly this cutting motion works. Better join our Fixed Prosthetic Session or Clinical Dentistry Fellowship.

    STEP FIVE: GINGIVAL RETRACTION:

    • Start gingival retraction with temporaries this will facilitate easy insertion of cord
    • Remove temporaries
    • Do final preparation and finishing

    STEP SEVEN:   BITE REGISTRATION

    • Take bite if necessary I will explain in detail About in my next Blog

    STEP EIGHT: CEMENTATION OF TEMPORARIES:

    • Lute temporaries with temporary cement
    • Use noneuzenol cement for all ceramic or zirconia crowns
    • Use Euzenol cement for metal ceramic crowns

    STEP TWO: SHADE MATCHING

    • Shade matching should be done before tooth preparation
    • You can’t get accurate shade from comparing adjacent tooth

    STEP FOUR:  TEMPORIZATION

    Before going for final impression or gingival retraction

    • Prepare temporaries first
    • Lubricate the prepared teeth with petroleum jelly
    • Cut out excess material from the impression to have smooth re-seating  
    • Prepare vent hole channels along with the cervical margins of the prepared teeth to the outer surface of the impression with a scraper /BP Blade
    • This will let out the excess material out of the impression without creating any undue pressure
    • Add temporary resin or acrylic mix into the diagnostic putty impression into the prepared teeth sockets and place it over the teeth
    • After initial setting when material starts polymerization(increase in the temperature of mix), take out the impression and temporaries
    • Remove excess material
    • Finish And polish it
    • Try these temporaries in patient’s mouth
    • Check seating and high points

    STEP SIX: FINAL IMPRESSION

    • Now take final impression after few min of cord insertion
    • Take wash impression with light body, with or without cord, no need to add complete arch, just fill prepared teeth impression sockets and insert in patients mouth
    • Wait for 3 min and take out the impression Inspect for any voids, bubbles, irregularities

    SUMMARY: 

    • Here we used same putty for diagnostics, temporaries and for final impressions also
    • My sincere request is try using rubber base impressions for FPD’s and give immediate temporaries, may be metal ceramic or all ceramic
    • Alginates are used for diagnostics not for final impression
    • Cost may be higher by 200 Rs. But we are getting temporary along with that
    • We are giving immediate temporaries that’s a great relief for patients.
    • All together patients perception and your work standards will be improved with this.
    • Better join with us in the Fixed prosthetic session at Asian Dental Academy Hyderabad or NRDC Dental College Nanded, your complete perception towards Fixed prosthetics will be changed. We started Clinical Dentistry Fellowship where you will be given 10 cases of Endo, 10 cases of FPD’s and 10 cases of  Restorative and Extractions. We also cover Laminates and Veneers in this.

    BEST CLINICAL METHODS TO AVOID POST OP SENSITIVITY IN COMPOSITE FILLINGS

    The major reasons for op sensitivity is because of Micro- Leakage: Especially due to  improper bonding and condensation. Most of the clinicians in fact avoid composite fillings due to post op sensitivity phobia. There are lot many advancements evolved  in adhesion mechanism to counteract bonding failure, we need to understand many aspect of composite restorations to avoid these complications. This article will help you construct clarity on the right methods of composite filling:

    PROPER MARGINAL SEAL:

    • Proper Marginal Seal can be achieved by clear understanding of the complex interplay between polymerization shrinkage and adhesion.
    • The cross-linking of resin monomers into polymers is responsible for an unconstrained shrinkage of 2% to 5%.
    • The uncompensated forces may exceed the bond strength of the tooth-restoration interface, resulting in a gap formation from a loss of adhesion.
    • The shrinkage forces generated by a high modulus material or a high volumetric shrinkage can result in stresses, being transferred in a pulpal direction, resulting in dentinal tubular fluid movement that stimulates the odontoblastic process.
    • This pressure change may be responsible for postoperative sensitivity upon mastication.
    • There are lot factors which can decrease this gap formation and thus Post op sensitivity.

    HOW TO GET PROPER ADHESION:

    • Understanding Basics of adhesion principles or Dentin bonding is must to get proper adhesion
    • There are Two concepts of Bonding
    • Total etch (etchant + prime and bond) and self etch (single Bottle, all in one)
    • Total etch should be prefered for cavities or preparations involving only enamel surfaces and Self etch should be used for Dentin preparations, and for deeper restorations Resin modified glass inomers liners should be used.

      Note: The most  important thing is to prepare the tooth surface for Bonding,  creating the moist tooth surface will facilitate good bonding and remember  at any circumstances Dentin should not be dried thoroughly but moderately moist.  

    NOW STEPS FOR BONDING:

    1. The cavosurface enamel margins of the preparation should be etched for 30 seconds with 37.5% phosphoric.
    2. A self-etch primer should be applied to the dentin for 20 seconds and air-dried for 2 seconds.
    3. A bonding agent was applied to the enamel and dentin surfaces for 20 seconds, lightly air-dried and light-cured.
    4. If it is self etch one, apply the bonding agent for 40 seconds, air dry it by chip blower for 2 seconds
    5. Curing should be done for each surface in the perpendicular direction.

    NOW HOW TO REDUCE SHRINKAGE??

    Before we get on to the procedure, lets know the  major factors that influence polymerization shrinkage:

    • Type of resin,
    • filler content of the composite,
    • Elastic modulus of the material,
    • Curing characteristics,
    • Water sorption,
    • Cavity configuration, and the intensity of the light used to polymerize the composite

    TO ELABORATE:

    • First three factors are related to the Material which can not be controlled by dentist
    • Rest all are operator dependent.  

    HOW DOES LIGHT AFFECTS POLYMERIZATION??

    • Intensity of light, the illumination must be in the range of 460-480 nms. I recommned all to please check the curing unit light intensity at least once a year.
    • Time: strictly follow manufacturers instructions,
    • Distance from the curing material,  It should be as near as possible.   For each mm light intensity is reducing drastically. This diagram explains the intensity of light at 0-1mm, 1-2mm, 2-3mm. For the first 1 mm it is 65% and for 3mm it is negligible.

    ANGULATION:

    • The light coming out of the tip is like a stream of water from a hose. The flow is highly acclimated. There fore, light only goes where you point the tip.
    • Unusual features of the cavity preparation design require that you angulate the light from a variety of directions (usually requiring more curing cycles).

    PROPER CONDENSATION:

    • Avoid bulk filling and bulk curing, follow layering technique to avoid Marginal leakage
    • Use clean instruments
    • Don’t keep any voids in between the layers
    • Give sufficient time after each layer of condensation and each cycle of curing to compensate material to shrink
    • Understand the basic principles of C- Factor

      C-Factor configuration factor is the ratio of the bonded surface to the unbonded or free- surfaces in a tooth preparation. The higher the c factor greater is the potential for bond disruption from polymerization effects.

    • Don’t keep premature occlusal contacts
    • Fully excavate residual tooth decay
    • Polishing should be done after complete adjustments of occlusal contacts
    • Liquid polishers will be more useful to fill the Voids on the surfaces
    • Don’t use bonding agent as polisher
    • These are the few basic things which needs to be understood.
    • Composite restoration is purely artistic job we need to invest lot of time to master this art
    • For any query please write us in comment box
    • If you liked please do forward to your fellow colleague.

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