Oral Health Labs Fall 2016

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contents

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Editorial The Beauty – And Logic – Of Minimal-Prep Veneers

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Pacific Dental Conference Lab Expo 2017

PDC Abstract – Dr. Damon Adams

CASE STUDY

Prep “Less” Veneers: Treating Tooth by Tooth Instead of Case by Case

22 New Products 23 Dental Marketplace

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editorial THE BEAUTY – AND LOGIC – OF MINIMAL-PREP VENEERS Less Pain And More Gain Gives Practitioners And Patients More To Smile About If you’ve ever seen vintage photography, you’ll notice an absence of toothy grins. Somber, tight-lipped portraits ruled the day well into the early 20th century. This was probably for the best, since most smiles were not photogenic.

Before the 1920s, dentists were hard to find. Cosmetic dentistry was nonexistent. Extraction – today’s treatment of last resort – was often the only remedy available. It was not a pretty picture.

Such aggressive treatment methods seem primitive to us today because of our improved preventive care and multitude of new restorative dentistry options. The esthetic dentistry profession has evolved in another important way, too: We are moving toward a more conservative, whole-person treatment approach.

Today, more patients and professionals are seeking minimally invasive treatments and procedures because we now understand that physiological systems are interconnected.

Compromising any part of the body – including gums and tooth structure – can affect the health of the whole person.

Fortunately, innovations in dental lab technology, ceramic materials and bonding techniques mean that dentists and patients can now achieve esthetically superior porcelain veneers with less preparation, tooth loss and pain.

For example, our technicians use operating microscopes at 10-20x power magnification, ensuring a precise marginal fit to within 10-15 microns of accuracy. We also customshade each tooth with the latest all-ceramic materials

Mr. Maragos founded Valley Dental Arts in 1974 to create a new standard of excellence in aesthetic and cosmetic dentistry.

Mr. Maragos” heritage is family-centric. Whatever the need or concern, it has always been “family first,” and he was determined to extend “family status” to every one of his dentist clients. His relationship-focused model of doing business worked as he grew Valley Dental Arts to become a national leader in delivering uncompromising quality, not only in craftsmanship, but

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selected specifically for each patient.

When it comes to bonding, the more enamel left intact, the better. Ceramic restorations cannot bond to dentin. Patients with restorations bonded to a greater surface area of enamel experience higher functionality and esthetic survival rates; again, underscoring the benefits of a minimal- to no-prep approach.

My son, Dean Maragos, is the patient of Dr. Holger P. Meiser whose restorative case study is featured in this issue.

Dr. Meiser successfully used a minimal-prep technique to help Dean achieve the outstanding, natural-looking smile he was hoping for.

In partnership with Dr. Meiser, Jenny Wohlberg, AAACD and senior vice president of Ceramics at Valley Dental Arts, meticulously measured, shaped and handcrafted each of Dean’s 20 feldspathic veneers. Because of Dr. Holger’s minimal-prep approach, the integrity of his teeth was preserved and the fact that all margins were supragingival helped achieve a perfect fit and natural look in one visit.

While Dean’s results are exceptional, the path to achieving them is accessible to any dentist willing to learn. We have successfully guided many dentists in this technique, reducing patient chair time while helping practitioners ensure precise – and minimal – tooth reduction.

In summary, I recommend minimal-prep veneers for the following reasons:

also in customer s ervice.

Known as “The Father of Contemporary Diagnostics”, Mr. Maragos is one of only three dental artisans in the nation to be accredited through membership in the American Society for Dental Aesthetics (ASDA), where he also serves on the board. A member of the internationally renowned Oral Design Group, Mr. Maragos has lectured globally on laboratory communication, aesthetics, computer-aided design and computer-aided manufacturing (CAD/CAM) systems. He

received the best design award and letter of appreciation from the Leading Dentist Association (LDA) in Japan. He is co-author of “Aesthetic and Restorative Dentistry: Material Selection Technique” (1st ed.), and has served as a clinical instructor at Baylor University.

Mr. Maragos has lived his vision for aesthetic excellence every day for more than 40 years. His team of like-minded professionals treats dentists like family and provides unequalled quality to dentists and their patients every day.

editorial 1. Preserves tooth structure and enamel For most restorative and esthetic treatments, proper veneer-to-enamel bonding can be achieved with minimal or no removal of tooth structure or enamel using either feldspathic porcelain or lithium di-silicate (E-Max) porcelain – both premier esthetic materials for custom veneer restorations.

Leaving the surface area of the enamel intact enhances bonding and reduces the already low failure rate for porcelain veneers: less than one percent.

2. Reduces patient pain Grinding down tooth structure involves more patient chair time – and more patient discomfort. With less aggressive preparation, patients experience less pain. Numbing is not required. Patients are often pleasantly surprised at the ease of treatment with minimal-prep veneers.

3. Protects gingival health The recommended margin placement for minimal-prep veneers is a supragingival finished margin. Using supragingival margins for veneer placement protects the integrity of the gingiva, eliminating the potential for tissue damage, bacterial growth and infection. Supragingival margins also allow for easier removal of resin, avoiding the need to scrape underneath the gum line (irritating the gum). It also reduces the risk of resin remaining under the gum, which can inflame the tissue and lead to tissue recession.

4. Saves chair time Minimal-prep veneers require little, if any, tooth grinding and no patient numbing. In addition, this technique seldom requires provisional restorations. The result: fewer and shorter patient appointments, leaving practitioners with more time to treat other patients.

Mrs. Wohlberg’s career started in 1990 with a singular focus on excellence in ceramics. The quality of her work and unwavering commitment to craftsmanship and artistry led her to Valley Dental Arts. Here she is able to share her expertise and craft with clients and continue to develop her understanding of smile design and natural aesthetics.

Mrs. Wohlberg learned her

5. Produces outstanding esthetic results Today’s porcelain materials are natural looking and beautifully translucent. With lab guidance on the right bonding materials and contouring techniques, practitioners can expect to produce “the contact lens effect” – a seamless transition from porcelain to enamel. In my opinion, it is the epitome of dental artistry 6. Accommodates future restorations No restoration lasts indefinitely; most require replacement after 20 years or so. The beauty of minimal-prep veneers is that the process is essentially reversible. Because their original smiles are left unaltered, patients have more options in the future when additional restorations may be needed.

While minimal-prep veneers are an ideal solution for a variety of restoration needs, one treatment plan does not fit all cases.

Patients who may not be candidates for this approach include those with misaligned teeth, large or protruding teeth or badly stained teeth that require more than two shades of whitening.

Esthetic dentistry has come a long way in a short time.

Progressive practitioners can tap a growing armory of highperformance materials, advanced techniques and qualified labs. Today, we have more to smile about than ever before.

Chuck Maragos, CDT Jenny Wohlberg, AAACD

intricate, ceramic-layering techniques from masters in Sweden, Japan, Italy and Switzerland.

She has co-authored several papers on ceramic material selection and veneer preparation design, and has lectured and given numerous hands-on courses to dentist and technicians around the world. She is one of a handful of accredited technicians of the American Academy of Cosmetic Dentist-

ry, and is an accredited member of the American Society of Dental Aesthetics.

Mrs. Wohlberg’s skilled craftsmanship is rivalled only by her dedication to Valley Dental Arts’ clients. For more than 25 years, Mrs. Wohlberg has lived the Valley Dental Arts mantra of building lasting relationships with dentists to position them for success, in their business and with their patients.

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Pacific Dental Conference Lab Expo Saturday, March 11, 2017 Vancouver, BC Vancouver Convention Center – West Building

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THE TIME TO CONNECT IS NOW

Join us at the PDC Lab Expo, March 11, 2017 Th Dental Technicians Association of BC’s The [[DTABC] annual conference at the PDC has a new look and a new direction! Entering the ffourth year of the DTABC conference, being hheld at the PDC, we are pleased to come toggether with the entire dental community.

The breakout sessions feature leading expperts who are able to share their knowledge Chris Opitz President, DTABC and tips that will help you in your profession. The PDC Lab Expo will continue to showcase suppliers with the latest dental technology equipment, materials and methods.

The new ’Showcase Stage” located in the PDC Lab Expo will feature 30 minute demonstrations where exhibitors will display their latest products and technologies.

On behalf of the Board of Directors of the DTABC and our partners at PDC, I would like to invite you to join us for our annual conference on March 11, 2017 in Vancouver, BC.

Welcome to PDC Lab Expo, Western Canada’s largest dental technology tradeshow, taking place on Saturday, March 11, 2017. The Pacific Dental Conference is one of North America’s top dental conferences and we are expanding the brand to include the Lab Bruce Ward Expo. Exhibit and be part of the growDirector, PDC ing tradeshow!

All registered PDC attendees will have access to the PDC Exhibit Hall and the PDC Lab Expo! This year we will invite the dentists, as well as their team, to join our dental technicians and denturists for PDC Lab Expo. On the Saturday of the PDC, we are expecting 3,000 people to attend and this is a great opportunity for dentists and dental technicians to explore new options and technologies together.

Please join us for a great time of learning!

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Featured Speakers

O

n Saturday the DTABC Conference program features nine speakers, who will present topics specially related to these areas of dentistry. There will be three time slots during the day where attendees can choose sessions of their choice.

We also invite our dental technology and denturists attendees to take advantage of other open sessions on Thursday and Friday. The speaker roster includes 140 renowned speakers from around the world, all here in Vancouver for the Pacific Dental Conference! This is your chance to take full advantage of seeing and hearing some fantastic speakers and learning about cutting edge technologies and products.

Keynote Speaker

Immediate Dentistry

Jesse Miller

Christien Kopas George Cowburn

Jesse Miller, a noted international speaker presenting and consulting to schools, nonprofit groups and companies since 2007. Jesse is in high demand as a keynote speaker on the topics of Social Media Awareness, Internet Safety and Online Content Evaluation. During the 2011/2012 school year, his awareness programs for schools in British Columbia reached over 225,000 student participants.

All-Ceramics: Latest Trends, Controversies and Clinical Tips Damon Adams, DDS Damon Adams a graduate of the University of Michigan School of Dentistry, is an assistant clinical professor at the University of Toledo, College of Medicine, Division of Dentistry.

He is the editor-in-chief of Dentistry Today and is listed in Dentistry Today’s Leaders in Continuing Education. Dr. Adams is a member of the ADA, AGD, AACD, SCAD, ASDA, NADL, and a Fellow in the ICD.

Christien Kopas attended Bellingham Technical College obtaining her Dental Assisting Certificate. After graduating, she focused on managing dental offices in Kelowna, BC. With 26 years in dentistry as a CDA, administrator and manager, Chris became an expert in intra-oral scanning and digital workflow and in 2012, she offered 3Shape Trios ready seminars to Universities, Prosthodontists, GPs and RDT’s.

George Cowburn originally was enrolled in engineering but switched over to the denturism program at NAIT after seeing the industry’s potential. In 2003 George gave a presentation to his classmates on how digital dentistry would completely change the industry. He was about a decade ahead of his time. He is the jack of all trades as a denturist, scanning expert, design expert and implant specialist.

Co-Sponsored by Carestream Dental

Creating Dentures with 3 Appointment Approach Using CAD/CAM Technology Stephen Wagner, DDS, FACP Stephen Wagner, a Diplomate of the American Board of Prosthodontics, a Fellow of the Academy of Maxillofacial Prosthetics and an Associate Fellow of the Academy of Prosthodontics, is currently in his 37th year of private practice in Albuquerque, New Mexico. He received his dental degree from the University of Southern California School of Dentistry.

Co-Sponsored by Dentsply Canada Limited

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Jonathan Ng, BMedSc, DDS, MSc, Dip. Pros., FRCD(C)

Jonathan Ng obtained his dental degree from the University of Alberta and his Prosthodontic specialty at UBC. His private practice specializes in complex prosthodontic care, implant surgery and implant prosthetics. He is an Associate Clinical Instructor at the UBC, and a Staff Prosthodontist at the BC Cancer Agency. He works closely with technology having written a thesis and numerous articles on digital dentistry.

Western Canada’s largest dental technology and denturist tradeshow Dentists, as well as their whole team, are invited to join our dental technicians and denturists for the PDC Lab Expo.

Our aim is to create a better understanding and working relationship between dental offices and dental labs.

The best way to do this is to bring everyone together to share ideas and common issues.

Inviting all PDC attendees to have lunch at the Lab Expo For the first time, lunch will be offered on Saturday to all PDC attendees and will be available in the Lab Expo exhibits area. Come network with your colleagues and check out the latest dental technologies.

Showcase Stage NEW for 2017!

30 minute demonstrations where exhibitors will showcase their latest products and technologies.

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PDC Lab Expo • 8:00am - 3:00pm VCC West – Ballroom A and B 37

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Registration Area

Exhibitors 3Shape Bego Canada Brasseler USA Carestream Dental Dentsply Sirona Implants Garfield Refining Co. GC America Inc. Ivoclar Vivadent Inc. Panthera Dental Sinclair Dental Co. Ltd. Zahn Canada Zimmer Biomet &RQ¿UPHG WR GDWH

Conference Hotels Take advantage of the special hotel rates available only to the Pacific Dental Conference participants at the hotels listed below. Reservations can be made directly with these hotels by phoning or by clicking the links found in the Hotel Information section of the Pacific Dental Conference website www.pdconf.com.

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Fairmont Pacific Rim Hotel

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Pan Pacific Vancouver Hotel

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Fairmont Waterfront Hotel

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Four Seasons Hotel Vancouver

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Vancouver Marriott Pinnacle Downtown Hotel

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Pinnacle Hotel Vancouver Harbourfront

Toll-free: 1-877-900-5350 Quote Block Code: 0317PDC_002 Single/Double starting at $265 Toll-free: 1-800-663-1515 (Canada) Toll-free: 1-800-937-1515 (USA) Single/Double starting at $239 Toll-free: 1-800-441-1414 Quote Block Code: 0317PDC_001 Single/Double starting at $239

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Coast Coal Harbour Hotel

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Hyatt Regency Vancouver

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Metropolitan Hotel Vancouver

Toll-free: 1-604-683-1234 Single/Double starting at $219 Toll-free: 1-800-667-2300 Single/Double starting at $179

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Fairmont Hotel Vancouver

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Delta Vancouver Suites

Toll-free: 1-866-223-9333 Single/Double starting at $195 Toll-free: 1-800-207-4150 Single/Double starting at $215

Toll-free: 1-800-663-1144 Quote Group Block: CCC-GFC3544 Single/Double starting at $190

Toll-free: 1-800-257-7544 Quote Block Code: 0317PDC_003 Single/Double starting at $219 Toll-free: 1-888-663-8811 Single/Double starting at $185

Toll-free: 1-844-337-3118 Single/Double starting at $209

You must mention the Pacific Dental Conference 2017 to receive the special rates

Please be advised that the PDC has no relationship with companies offering to book accomodations.

When you book through the PDC — ONLY the hotel you book with will ask for your credit card information. To book your hotel with safety DQG FRQ¿GHQFH SOHDVH use the hotel information above.

Canada Line SkyTrain–2 blocks from the Vancouver Convention Centre (Waterfront to Airport in 25 minutes) The Expo and Millennium SkyTrain Lines

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abstract

PDC Abstract from Dr. Damon Adams

I

t is very rewarding to have a career that has been quite unusual (in a good way), especially when compared to that which the vast majority of dentists experience! Presentations, like the ones that I will have the honor and privilege to share at the Pacific Dental Conference this coming March (with the doctors on March 10th, and then a day later with the laboratory technicians) are filled with the perspectives from a unique career track. The information, along with candid opinions, are born out of years of clinical experience in private practice, nearly 10 years as the editorin-chief of one of North America’s leading clinical and news journals, and from extensive work as a consultant and a doctor-technician liaison for the dental laboratory industry.

One thing that brings great pleasure is to challenge and encourage my audiences to think for themselves based upon evidence-based science, and case examples and technical information shared. Being able to open our minds to new thoughts and concepts can open the door to both personal and professional growth. With this in mind, the latest trends and forward looking projections that will be covered are born out of the eyes and mind of an editor and, as an added bonus, the eyes and hands of a distinguished list of leading authors with whom I work on a daily basis.

On Saturday, March 11, with the dental laboratory team in mind, a short selection of relevant laboratory and clinically

Dr. Damon C. Adams, a graduate of the University of Michigan School of Dentistry, is an assistant clinical professor at the University of Toledo, College of Medicine, Division of Dentistry. He is the editor-in-chief of

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related topics will be covered. These will include an update on the latest trends in all-ceramics with a strong emphasis on lithium disilicate and zirconia. For example, it has been widely observed that monolithic posterior zirconia formulations, if properly used, experience no failures due to fracture, and anterior zirconia products that are being rapidly introduced have started to make positive strides in their effectiveness to satisfy certain anterior aesthetic demands. However, what are some of the future challenges that the doctors and laboratory technicians might have to deal with in relatively near future with these recently introduced materials? How could this impact the laboratories in the long run? Are doctors preparing teeth in a way that reflects the materials strengths and weaknesses, and takes into account indications for use as well as other treatment planning considerations? Are doctors and their office treatment teams caring for the beautiful lab-fabricated restorations in their patients with a protocol that will not adversely affect the aesthetics of the restorative work as the years go by? Do doctors still seem a bit confused at the complexity of material choices and cementation protocols, and are there some principles and materials that could make their work easier and more predictable? These are the kind of learning topics that will be shared and discussed in our brief time together. It is content aimed squarely at initiating further discussion between lab team members, and to ignite and improve honest dialogue and collaboration between doctors and dental technicians. I am looking forward to being with all of you soon at the PDC meeting in beautiful Vancouver!

damon@drdamonadams.com AdamsDentalSeminars.com

Dentistry Today and is listed in Dentistry Today’s Leaders in Continuing Education. Dr. Adams lectures internationally focusing on updates in dental materials, the latest trends and innovations in dentistry, doctor-technician

relationships and techno-clinical perspectives. Dr. Adams is a member of the ADA, AGD, AACD, ASDA, SCAD, and the National Association of Dental Laboratories; and is a Fellow in the International College of Dentists.

oralhealth guidelines manuscript submission

Oral Health wants to hear from you!

We are actively seeking original article submissions from all of our valued readers. Here’s what we need from you: MANUSCRIPTS Manuscripts should run between 1,000 to 5,000 words; any manuscripts submitted on disc or flashdrive should be PC and MAC compatible (i.e., Microsoft Word). Should you have concerns with the compatibility between your word software and that of Oral Health’s, simply save your file as raw text (i.e., Text Only files).

AUTHORS Biographical information regarding the author(s) should be included with the manuscript. The author’s name and degrees, as well as any association the author may have with any institution should be included. The author’s address, including city and province/state should also be included.

These requests for standardized submission of material are necessary for correctness of publication.

The Editorial Board looks forward to your submission. Please mail original manuscripts to: ORAL HEALTH, 80 Valleybrook Drive, Toronto, ON M3B 2S9

ILLUSTRATIONS The quality of photographs supplied contribute directly to the quality of reproduction in Oral Health. Therefore, when making a submission, please consider the following:

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news

Modern Dental Successfully Completes the Acquisition of RTFP Dental (MicroDental) in the U.S.

M

odern Dental Group Limited, the leading global dental prosthetic device provider, is pleased to announce that Modern Dental successfully completed the acquisition of 100% equity of RTFP Dental Inc. (“RTFP Dental” or “MicroDental”) in the United States on October 21st, 2016.

Modern Dental Group currently holds the largest share of the dental prosthetic market in Western Europe, Australia, China and Hong Kong. This new acquisition will lead them into the North American market with the well-built reputation MicroDental Laboratories already holds in the industry.

Executive Director and CEO of Modern Dental Group, Godfrey Ngai said, “We are delighted to smoothly complete the acquisition of MicroDental, a renowned and high-quality brand with over 40 years of history as well as strong presence in the U.S. and Canadian dental laboratory industry. Acquiring MicroDental further expands Modern Dental’s nationwide sales and distribution footprint throughout North America, which is in line with Modern Dental’s fast-growing business development blueprint in globalisation. With our

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experienced and seasoned management team, we are confident that Modern Dental can achieve greater economies of scale, faster turnaround time, and closer proximity with its customers, and as a result, enhancing the Group’s profitability while providing better post-sales services in the North American markets. In the future, we are confident that we will continue to strive for excellence by outperforming our peers in the fast-growing yet fragmented market in dental prosthetics.”

Laing F. Rikkers, Board Member of MicroDental and Managing Director of HealthpointCapital, which owns a majority interest in MicroDental, is looking at the acquisition with positivity as the expertise of international business and strength in dental knowledge from Modern Dental Group will hopefully make this a successful move for both groups.

“We ae pleased that Modern Dental is acquiring our business because they have a unique appreciation for the people, onshore production, technological capabilities and brand at MicroDental.”

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Something S omethh T o Chew To Che e On

With four leading publications and a dynamic website, Oral Health Group delivers complete, comprehensive coverage of the dental profession in Canada.

Our publications serve all members of the dental team: dentists, hygienists, dental lab owners and technicians, dental students and members of the dental industry. Proud to be serving the Canadian dental profession for over 100 years, Oral Health is the voice of Canadian dentistry!

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case report

PREP “LESS” VENEERS: TREATING

TOOTH BY TOOTH INSTEAD OF

CASE BY CASE By: Dr. med.dent. Holger P. Meiser DDS, MAGD Holger Dental Group

Dr. med.dent. Holger P. Meiser graduated from the Ruprecht-Karls University School of Dentistry in Heidelberg/Germany in 2002. He went on to complete residencies and fellowships in Advanced General Dentistry and Implant Dentistry at the University of Minnesota Dental School where he also earned a certificate in Contemporary Restorative and Esthetic Dentistry. He has fulfilled the requirements to achieve Mastership

in the Academy of General Dentistry and Associate Fellowship in the American Academy of Implant Dentistry. Dr. Meiser is a member of the American Society for Dental Asthetics. He maintains a private practice in Minnetonka, MN, USA and serves as adjunct faculty in the Implant Program at the University of Minnesota and as an advisor to the Pankey Institute in Key Biscayne, FL, USA.

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case report

ABSTRACT

T

he patient treated in this report was not pleased with the appearance of his smile and his confidence to smile was affected. He desired ‘bigger’ and ‘whiter’ teeth. As with any elective cosmetic restorative procedure, a minimally-invasive approach providing the patient with a predictable, long-term result was indicated. The author utilized a combination of contemporary yet wellestablished, evidence-based techniques including a diagnostic wax up (Master Diagnostic Model MDM

by Valley Dental Arts), analysis of preparation requirements for each individual tooth based on the desired outcome (as per MDM) and ultrathin bonded feldspathic Veneers to achieve the goals the patient desired.

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Fig. 1: Unretracted smile

Introduction Contemporary cosmetic dentistry requires the dentist’s utmost consideration to maximize the preservation of healthy hard and soft oral tissues by applying minimally-invasive, evidence-based treatment techniques. Only by adhering to this core principle can the cosmetic dentist achieve predictable and long-term functioning restorations with high patient satisfaction and without compromising the immediate or long-term health of the tooth structure and gingival tissues.1,2 Ultra-thin porcelain laminate veneers are in many cases elective restorations and are often placed in the absence of disease for purely esthetic reasons. A high degree of technical and scientific knowledge and skill is required by both the dentist and the laboratory technician and careful consideration of the available treatment options and techniques becomes critical to achieve the desired clinical outcome without compromising the patient’s health.3,4 When it comes to bonded ceramic restorations it is well established that restorations bonded to intra-enamel tooth preparations demonstrate higher functional and esthetic survival rates.5 Even a 0.5 mm chamfer commonly aimed for in traditional veneer preparations6 will expose dentin in the gingival third of maxillary central incisor where the mean thickness of enamel is only 0.410mm.7 Subgingival margin placement can lead to inflammation of the gingival tissues from the restorative procedures and materials.3,8 Supra – or paragingival placement of a traditional margin can lead to a less than ideal esthetic result when dark tooth structure or a traditional margin are exposed even by naturally occurring recession in individuals with good oral hygiene.9 Exposed margins can also be areas of increased plaque accumulation putting the patient at risk of developing gingival inflammation or secondary caries.3,10 In this case report we describe the application of ultra-thin Veneers (0.1 mm-0.3 mm) that can be predictably placed and either completely or partially cover the facial surface of the involved teeth to create a beautiful smile.11,12,13

case report Clinical Evaluation, Diagnosis and Treatment plan Minimally invasive porcelain Veneers can be used to solve a variety of clinical situations. They are indicated any time a mostly additive approach is chosen to increase the volume of teeth by lengthening the incisal edge or adding facial bulk to teeth. Indications include diastema closures, increasing tooth size in undersized teeth or to expand the buccal corridor, restore tooth fractures as well as restoring canine guidance and the vertical dimension of occlusion.

In the case presented in this report the patient had undergone pre-restorative orthodontic treatment and maxillary orthognathic surgery with a mentoplasty to treat a class II malocclusion. After the treatment was completed, he was left with an adapted occlusion with heavily worn posterior teeth and an anterior open bite.

He was unhappy with the appearance of his teeth and thought they were too small and dark (Figs. 1-4). He had been equilibrated and was asymptomatic at the time of the treatment and was seeking a minimally invasive treatment option to address his esthetic concerns without introducing any other changes to his occlusion at this point.

Records including impressions for study models, clinical photographs and bite registrations were obtained and after review by the dentist and technician a Master Diagnostic Model (MDM) was fabricated by Valley Dental Arts laboratory (Stillwater, Minnesota, USA) involving 10 maxillary (#14 to #24) and 10 mandibular teeth (#34-#44) (Figs. 5-7).

The goal for this model was to be able to establish realistic esthetic expectations with the patient and enable us to preview the treatment in the patient’s mouth by injecting a temporary restorative material in a mold created from this model. Functionally, the goal was to establish anterior coupling and canine guidance. Furthermore, the model was used to enable the analysis of the position of each individual tooth, before restoring it, in comparison to the desired post-restorative tooth dimension with the technician and identify areas where tooth preparation/modification is needed.

For some teeth this means they can be treated “prepless” and for others this approach facilitates a conservative, “prep less” tooth preparation only in areas where the natural shape of the tooth extends outside of the desired post-operative tooth dimension or an adequate path of insertion needs to be established. In some cases pre-restorative orthodontic alignment is indicated to facilitate maximum preservation of tooth structure.

Fig. 2: Retracted frontal view

Fig. 3: Retracted right lateral view

Fig. 4: Retracted left lateral view

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case report CLINICAL AND LABORATORY TECHNIQUES

Fig. 5: MDM frontal view

Fig. 6: MDM right lateral view

Fig. 7: MDM left lateral view

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Tooth Preparation and Impression After review of the MDM with the technician the selective tooth modifications were executed. In this case most of the teeth required no preparation and only some minor enamel recontouring was performed reducing some undercuts and particularly on #8 and #9 a slight intra-enamel facial reduction in the middle and incisal thirds of the labial surface of the teeth.

Since we were going to increase the incisal length of the anterior teeth the incisal edge was flattened with polishing discs (Soflex, 3M) and all internal angles were rounded. This flat incisal was going to be utilized as a reference to verify correct and full seat of the Veneers during try in and bonding. No dentin was exposed and thus no temporary restorations were fabricated. In cases were temporary restorations are needed, they can be fabricated from chemical-cure bis-acryl resin using an impression of the MDM and a spot-etching bonding technique. An unretracted Vinyl Poly Siloxane (VPS) impression was taken to serve as a reference of the natural position of the gingiva for the technician. Retraction cord (Ultradent size #000 and Viscostat Clear) was then used for minimal gingival retraction. A second VPS impression was taken for the mastermodel and sent to the laboratory, along with a bite registration and pictures for shade matching, for the fabrication of the ultrathin veneers.

Laboratory Techniques In the laboratory the working models were fabricated from type IV dental stone and mounted in an articulator utilizing the provided bite registration (Figs.

8-12). The master model was left as a solid, uncut model to leave the soft tissues intact and was duplicated to fabricate a refractory model. On the refractory model the soft tissues were slightly trimmed to ensure full coverage of the teeth and develop a proper emergence profile. Silicone guides made from the diagnostic wax-up were used to verify that there was enough space for the ceramic restorations. Vita VM13 (A1 and Bleach shades) feldspathic porcelain was hand-stacked to create restorations that were 0.1mm – 0.3 mm in thickness. The Veneers were carefully divested and were then fit on the mastermodel and a sectioned, trimmed model (Fig. 13). In a final step they were etched with hydrofluoric acid and sent back for insertion.

case report

Fig. 8: Frontal view of prepared teeth with retracted gingiva

Fig. 9: Right lateral view of prepared teeth with retracted gingiva

Fig. 10: Left lateral view of prepared teeth with retracted gingiva

Fig. 11: Occlusal view of prepared maxillary teeth

Fig. 12: Occlusal view of prepared mandibular teeth

Fig. 13: Mandibular sectioned model and utra-thin Veneers

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case report Bonding Protocol for Porcelain Restorations On the day of insertion the patient’s gingival tissues were retracted using a size #000 Ultradent braided cord again in combination with Viscostat Clear. The Veneers were carefully tried in to verify the fit and path of insertion for each individual restoration. The teeth were then cleaned with pumice and then one to two restorations were bonded at a time using the following protocol. The intaglio surfaces of the veneers were cleaned by scrubbing them with 35% phosphoric etchant and then treated with silane (Ultradent) for 60 seconds. In the meantime the teeth were etched with 35% phosphoric etchant.

Then the adhesive of a two bottle system bonding agent (Kerr Optibond FL) was applied to the enamel and the veneer and the veneer was inserted using a nano-filled flowable composite (3M Filtek supreme flow B1). The

Fig. 14: Unretracted post-operative smile*

Veneers were tag cured using a 3 mm wide light guide on 3M Elipar light and excess in the margin area was removed with a brush prior to fully curing the bonded restorations. Excess was then further removed with a #12 scalpel blade interproximately and along the facial aspect of the tooth and the lingual areas were cleaned and polished with rubber polishing cups (Enhance and PoGo by Dentsply). Additional interproximate polishing was performed with ultra-fine metal finishing strips (Brassler/USA). This process was repeated for all the restorations and in a final step the static and functional occlusal contacts were verified.

The patient was very happy with the result and has had no problems. He is wearing a flat plane splint at night time and has been asymptomatic. Figure 14 shows the result 12 months post-insertion.

Fig. 15: Retracted post-operative frontal view

Fig. 21

Fig. 16: Retracted post-operative right lateral view

Fig. 17: Retracted post-operative left lateral view

*(Porcelain Veneers by Jenny Wohlberg, AAACD, Valley Dental Arts, Stillwater, MN, USA)

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case report

Fig. 18: Post-operative occlusal view of the maxillary arch

Conclusion Maximizing the preservation of enamel, especially in the gingival, is the primary key to long-term success when bonding porcelain veneers. Thus, ultra-thin veneers in combination with enamel recontouring, rather than conventional substractive preparation methods were dentin is unnecessarily exposed, should be the primary choice of today’s clinician. The recontouring should stay within the enamel layer, particularly in the gingival third, and should only be performed to establish a path of insertion or to create definitive incisal finish lines that help to facilitate

Fig. 19: Post-operative occlusal view of the mandibular arch

proper seating of the restoration. Only in cases of subgingival margins should a gingival finish line be created. Close collaboration between the dentist and the laboratory technician is required to achieve maximum success. Detailed tooth-by-tooth analysis combined with the application of contemporary laboratory and bonding techniques make maximum preservation of tooth structure a possibility.

Therefore, additive restorative techniques like the one described in this report should be the main choice for esthetic rehabilitations with bonded porcelain restorations.

References Puri K, Puri N, Dodwad V, Masamatti SS. Restorative aspects of periodontal disease: an update part 1. Dent Update. 2014 Jul-Aug;41(6):545-8, 551-2.

Reeves J. Periodontal health--challenges in restorative dentistry. Prim Dent J. 2014 May;3(2):73-6.

Burnett RR, Diaz R, Waldrop TC, Hallmon WW. Clinical perspectives of periodontal and restorative interactions. Compendium. 1994 May;15(5):644, 646, 648-55.

Strassler HE. Minimally invasive porcelain Veneers: Indications ofr a conservative esthetic dentistry treatment modality. Gen Dent 2007; 55:686-694 Gurel G, Sesma N, Calamita MA, Coachman C, Morimoto S. Influence of enamel preservation on failure rates of porcelain laminate Veneers.

Int J Periodontics Restorative Den 2013; 33:31-39.

Magne P, Belser U. Bonded Porcealin Restorations in the Anterior Dentition: A Biomimetic Approach: Quintessence Publisher Co, Inc: 2002.

Pahlevan A, MirazeeM, Yassine E, et al. Enamel thickness after preparation of tooth for porcelain laminate. J Dent 2014; 11:428-432.

Ferencz JL. Maintaining and enhancing gingival architecture in fixed prosthodontics. J Prosthet Dent 1991; 65:650-657.

Serino G, Wennstroem JL, Lidhe J, Eneroth L. The prevelance and distributon of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol 1994; 21:57-63.

Silness J. Fixed prosthodontic and peridontal health. Dent Clin North Am 1980; 24:317-329.

Materdomini D, Friedman MJ. The contact lens effect: Enhancing porcelain veneer estetics. J Esthet Dent 1995; 7:99-103.

Horvath S, Schulz CP. Minimally invasive restoration of a maxiallary central incisor with a partial Veneer. Eur J Estetic dent 2012; 7:6-16.

Friedman M. Multiple potential of etched porcelain laminate veneers. J Am Dent Assoc 1987; 115:83E-87E.

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new products Don’t Spend Your Days Worrying About Online Privacy Stop worrying about a breach of privacy in your office. Compass Cyber Security works to keep your information, and your patients’ data, safe from unauthorized parties. Working online always comes with a risk, but working with Compass Cyber Security will help to minimize that risk so you can focus on what matters: your practice and patients.

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FotoDent Provides a 3 in 1 Tool for 3D Printing

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As technology evolves, so should you with FotoDent. 3D printing is the newest technology in dental research and development. Keep you office and lab up-to-date by taking advantage of a product that will produce everything you need with this 3 in 1 generative production system. Use FotoDent to understand why 3D printing is so popular.

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YM Dental Lab is producing the most innovative printing technology available to dentists today. With the Stratasys 3D printer and a skilled team of technicians to rely on, 3D printing just became a realistic addition to the office and lab. Whether it’s digital impressions or surgical guides, Stratasys 3D Printer can do it all for you.

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Day-to-Day Work Flows with XLDent Software XLDent provides the newest, easy-to-use digital software to make your team’s day-to-day workflow a breeze.

Find everything you need to make patients’ appointments seamless and allow your team to have the resources they need at their fingertips. Work with the XLDent support team any time to ensure you’re getting a full experience om this tablet-friendly software.

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Let Digital Dentistry Enter Your Office with the Form 2 Digital dentistry is changing the way dentists work. Bring digital dentistry right to your office with the Form 2, which allows 3D printing on a quick and easy basis. Patients will appreciate the accurate and speedy data given to them at their appointments and you’ll appreciate the loyalty of your patients and the Form 2.

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Dental Marketplace

Contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: karen@newcom.ca Toll free: CDA 1-800-268-7742 ext 6770 • Toll free: USA 1-800-387-0273 ext. 6770

Associateships

EDMONTON, AB

FULL TIME Associate required for a busy General practice. Large established patient base, great staff in place. Office hours from 8am – 5pm NO Saturdays or evenings. Excellent long term opportunity.

Please Email resume to: smiledoctors1@hotmail.com

TORONTO, ON

Full time dental associate needed immediately for busy group practice in downtown Toronto. Seeking dentist who is comfortable with a fast paced environment. Excellent earning potential.

Please forward your resume to: dentistrywithcare15@gmail.com

PARRY SOUND, ON

FULL TIME ASSOCIATE wanted for established state of the art dental practice. Located in friendly Parry Sound on beautiful Georgian Bay! We are looking for a full time / 4 days per week Associate, no evenings or weekends at this time. A great opportunity!

Please send resumes to: Lisa Tait, Office Manager lisa@dentistryonthebay.ca

CORNWALL, ON Part-Time position available in sophisticated office with excellent staff and team environment. Must be compassionate and maintain the highest quality standard of care for all patients.

Hours: 2 days per week with growth opportunities.

E-mail: dralma@dentistryatcornwall.ca

FORT MCMURRAY, AB Fantastic opportunity in a busy mall practice. If you want exceptional Income with freedom and time off come join us.

Contact Dr Jones at 1-780-940-7251

DENTAL ASSOCIATE

Practices & Offices

MULTIPLE LOCATIONS IN ONTARIO Exciting full and part time associate opportunities available for Barrie, Mississauga, Stoney Creek, Etobicoke and Scarborough.

We are also looking for an orthodontist.

E-mail: yourdentaldream@gmail.com

15 MIN. NORTH OF PICKERING, ON Associate Dentist Wanted.

Part-time leading to full time. Potential Buy in. 2 days to start. Digital Xrays and Paperless Office.

Contact: 289 818 1538 or email CV to associatedentaljobs@gmail.com

EMERYVILLE, ON Available December 1, 2016 Existing Dental office for lease in Emeryville, Ontario. Approximately 12 minutes from Windsor. Spacious suites, modernized and well decorated with hardwood flooring and ceramic tile. Also has ample parking. Growing area with new developments. Building also has a busy cosmetic surgeon. Opportunity for cross promotion.

Contact Cate at 519-670-3138 or cate@coleclinic.com

Careers

SOUTH CALGARY, AB FULL TIME ASSOCIATE REQUIRED We are now accepting resumes for our full time, Wednesday to Saturday Associate position. Our busy assignment clinic, located in south Calgary, currently provides all aspects of family and general dentistry including general and advanced cosmetic dentistry, “Invisalign”, digital x-rays, Velscope to name just a few of our services and all are supported by a highly skilled and happy team. We also offer reserved patient parking for our 6 days a week clinic which includes 1 evening. Only Dentists with a minimum of 3 years experience will be considered and Invisalign, Cerec plus Dentrix knowledge preferred.

Please forward your cover letter and resume including references to airlies@shaw.ca.

WINDSOR, ON Part-time associate wanted - 2 days a week. Family friendly office with great staff.

Contact: Dr. G. W. Hanaka T: 519-258-5271, ghanaka@aol.com

GENERAL ANESTHESIOLOGIST

ONTARIO We are in need of a general anesthesiologist in several of our practices in Ontario. Our greatest need is in our Hamilton practice, which has a waiting list of patients. We need someone as soon as possible to fill this need. This clinic has already been performing GA so it already has it facility permit and an experienced support staff.

E-mail: trish.carere@teethfirstdental.com

Hygienists

NORTHERN MANITOBA

Looking for two energetic hygienists to work in dental clinic in Northern Manitoba, very good income can be made.

To apply please e-mail: chris.p1933@yahoo.com

Equipment WINNIPEG, MB For Sale: Three 3M True Definition Scanners, under 2 years old each. They are all in perfect condition and have been under warranty and regular maintenance with 3M. Please contact Carly at tel: 204-925-4746 or e-mail: rykissortho1@gmail.com

CAMBRIDGE, ON

Associate position available for 3-4 weekdays only to take over an established associate patient base. Wide range of comprehensive treatment is possible.

Send resume to cambridgeassoc@yahoo.com

RECRUITING

This is a unique opportunity to join a very progressive and modern dental practice in an affluent neighbourhood in Toronto. We are seeking a dentist with a minimum of 10 years experience to join as a part-time associate working traditional hours of the week. This practice also employs restorative dental hygienists which permit the associate to focus on comprehensive treatment planning and more sophisticated procedures, as opposed to performing traditional restorative dental work. We offer a lucrative compensation package, consistent with a qualified dentist with experience.

Interviews will commence in October of 2016.

Please email your resume to Oral Health Labs Box 46 – karen@newcom.ca FALL 2016

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SASKATOON, SK

Campus Dentist University of Saskatchewan in Saskatoon is currently looking for an energetic, friendly, outgoing, enthusiastic individual for a very unique opportunity in a modern university setting.

Please email us: marzena@campusdentist.com

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