Whether using composite or porcelain, veneer artistry is critical to the form and function of a patient’s bite. While articulating paper can only show the location of bite contact, T-Scan allows dentists to see timing and levels of force across their dentition, helping them reduce fracture potential.
In this case study, authored by Dr. Robert Kerstein (DMD), T-Scan was used in tandem with articulating paper to measure high force contacts during a veneer patient’s bite sequence. As the results showed, T-Scan was able to capture potentially damaging forces that were missed by articulating paper.
Patient Overview
This case details a 25-year-old female patient, who, three years prior to these photographs, had six maxillary anterior veneers placed. Unfortunately, over the three years of intraoral service, she experienced mid-facial cracking on two of the original six veneers. This patient was obviously unhappy with the quality degradation of her original veneers and wanted to replace all six. Subsequent to the consultation visit, they were removed, new provisional veneers were fabricated, and then six final new veneers were seated after they were returned from the lab. As the coloring and esthetic shape were both correct, the six new veneers were bonded into place. The excess cement was removed, and the veneers were highly polished lingually where they met the tooth structure, and facially at the gingival margin. Following veneer placement, it is essential to assess the occlusal function with the T-Scan, especially in protrusion. Veneers often require protrusive force control, as their incisal edges are brittle, and too much occlusal pressure applied to the incisal edges can lead to both incisal edge failure and mid-veneer cracking, as was the case for this patient.
Click here to read the Case Study PDF
About the Author: Dr. Robert Kerstein DMD
Dr. Robert B. Kerstein received his D.M.D. degree in 1983, and his Prosthodontic certificate in 1985, both from Tufts University School of Dental Medicine. From 1985 - 1998, he maintained an active appointment at Tufts as a clinical professor teaching fixed and removable Prosthodontics in the department of Restorative Dentistry. In 1984, Dr. Kerstein began studying the original T Scan I technology, and has since that time, also studied the T-Scan II, the T-Scan III, T-Scan 8, T-Scan 9, and now the T-Scan 10 technology. Dr. Kerstein has conducted original research regarding the role that occlusion and lengthy Disclusion Time plays in the etiology of Chronic Myofascial Pain Dysfunction Syndrome. His now 35 years of research with all versions of the T Scan Digital Occlusal Analysis System, has led to his becoming a leading author and researcher in the field of Computerized Occlusal Analysis. Dr. Kerstein has been published in the Journal of Prosthetic Dentistry, the Journal of Craniomandibular and Sleep Practice, Quintessence International, Practical Periodontics and Aesthetic Dentistry, the Journal of Computerized Dentistry, the Compendium of Continuing Education, the Journal of Implant Advanced Clinical Dentistry, Cosmetic Dentistry, the Journal of Oral and Maxillofacial Implants, and Advanced Dental Technologies & Techniques. Additionally, Dr. Kerstein has published a 2-volume research handbook about the T-Scan computerized occlusal analysis technology. For many years now, Dr. Kerstein has lectured both nationally and internationally, about Prosthodontics, Implant Prosthodontics, Digital Occlusal Analysis, and treating muscular Temporomandibular Dysfunction with Disclusion Time Reduction Therapy. Visit his website at www.drrobertkerstein.com
How long have you been doing what you’re doing?
I have been in the industry since 1999, had a laboratory in Johannesburg and did a stint in the USA for four years as well, before settling in Hermanus. My focus on anterior work introduced me to the essence of intra oral and lab-side photography.
You have done a recent case using e.max Press Multi – tell us about it:
Using microscope magnification for the past 13 years has made me realise how important it is for materials to be homogeneous – even more so when you want to photograph these cases and display them during presentations.
Living and working in a small town often means developing relationships over the years, and I like to have confidence that what I do, will stand the test of time.
I love layering and the artistry of layers, but unfortunately you do lose strength and for this, and many other reasons, I choose e.max Press Multi, as I do not need to layer. It offers the same 500MPa strength all the way through the restoration, still maintaining a natural transitional appearance. I also incorporate cross polarisation photography alongside digital shade determination techniques where digital try-ins can be done, ensuring the correct material selection is done and providing better shade matching results.
Although e.max Press Multi is more technique sensitive than conventional pressing techniques, the final results and predictability of the material makes it worth every step.
On this specific case it was a patient requiring a multidisciplinary dental approach and 2+ years down the line, orthodontics, bone grafting, soft tissue augmentation, implantology and prosthodontics were completed.
Digital planning was incorporated with 3-D printed mockups to visualise the final result and everything was finished off with e.max Press Multi full coverage crowns.
What’s challenging when only restoring one arch, like for example the upper arch in this case, is that a patient often wants a lighter colour upon restoring teeth, but you still need to blend the shades and create harmony – you can see in this case that the upper crowns are slightly lighter than the natural lowers, but still within the same shade family. Thankfully the dentist who bonded these restorations also uses the Ivoclar range of products, like Variolink Esthetic luting composite. This really benefits the patients when the dental team completes restorative work within the same family of materials, and as you can see the results speak for themselves.
I am so grateful that digitisation has enabled me to work with clients from all over the country and hopefully, internationally, in the future.
For product details on e.max Press Multi click here.
“Gosh where do I start? I am having so much fun. It’s really awesome! I have been in the trade for so many years and always have fun, but this is the best fun I’ve had with lab work!
It offers so many exciting new techniques for new materials. It’s also such a time saver, we put in disc and just walk away and it’s done when we get back in an hour or 30mins. So the lab is definitely more efficient time wise. We have stopped using our old milling system completely.
The metal milling is superb, it’s one of the reasons why I got the machine. This week I put fine metal milling to the test with an exciting case – it was in three stages, and included my first telescopic crown, which I normally do by hand. I had a few issues with the fit, but was able to adjust the milling strategy with the help of Johan from Ivodent and now we have perfected the friction fit.
It’s great to be more involved in the CAM side, becoming more aware on how the units are nested and understanding the CAM side a bit more has improved our accuracy has improved.
We have installed it in our boardroom, an impressive sight - all our visitors are commenting on it.
I am most impressed by the PMMA, it works so well for temporary crowns.
It’s such an improvement from our previous milling unit. The interdental separation and contours of the teeth means it just needs a light hand polish and it’s all done. When milling, the surface is ultra-smooth, no milling lines. It is also important to have a good compressor with a reservoir to handle pressure drops.
I am looking forward to milling bars and have just received a screw seat tool from Ivodent – a special cutting tool to cut flat surface screw seats and of course I can’t wait for the Ivotion for milling dentures. Ivotion is proving to be the solution for dentures on implant structures. This is one material for the full structure of the denture with no teeth breaking out and is easy to reproduce if there is problem – I am really interested to see how it works.”
For more details on the PM7 click here.
IVOblog Team Testimonials from Hout Bay Dental Studio for Ivoclar’s Variolink Cement
The team at Hout Bay Dental Studio waxed lyrical to IVOblog with their experiences using our #IvoclarVivadent Variolink Esthetic Adhesive Cementation System.
Dr Andy Effting from HBDS: “I love Variolink Esthetic. The fact that no adhesive is required on the intaglio surface of the e-max restoration minimizes slip risk. This combined with its setting reaction which allows ample opportunity to clean-up excess cement whilst in the rubbery stage, prior to polymerization, makes this a cement with great ease of handling. The ‘3 second” pre-cure setting on the Ivoclar curing light is also extremely useful here.”
Dr Nic Pretorius HBDS: ”Variolink Esthetic has great handling properties. The working time regarding both workflow and setting reaction allows enough time for a relaxed cementation. Different shade selections substantially increase the final aesthetic result with an easier, more natural match.”
Dr David Malan HBDS: “Variolink Esthetic cement has taken away the stress and time consumption of cementation. Variolink Esthetic offers a cement that is colour stable, easy to clean, has a long working time and an excellent bond strength for predictable results. The adaptability of this product regarding cement shades, curing methods and ease of use, makes it an all-in-one bonded resin cement."
Are you looking for an amazingly simple and efficient esthetics for the permanent cementation of demanding indirect restorations?
To book for an one-on-one Zoom with Ivodent’s clinical specialist Dr Stephné Fenwick, please email [email protected] to discuss Variolink Esthetic Adhesive Resin Cement.
#IVOdeal: You will also qualify for a limited 4-piece #IvoclarVivadent Esthetic Adhesive Cementation System for only R1 725 excl. VAT! A huge saving of R2 850 excl. VAT!
Click here to buy Variolink Esthetic Adhesive Cementation System.
Do you have patients who are interested in planet-friendly and holistic alternatives for their daily oral care regime? If you do, proudly South African brand Olgani Naturals has you covered.
Olgani has always been committed to using natural and organic ingredients. They took it one step further recently, introducing a range of zero-waste toothpowders in recyclable glass jars. The powders contain non-abrasive botanical ingredients and natural minerals that are blended together to promote dental and full body health.
People have used powders to clean their teeth since ancient times. Recent studies have shown that they may actually be more effective than some toothpastes at removing dental plaque.
The determination to create an all-natural product range where each product is safe to use and designed to target a specific aspect, is at the core of Olgani’s belief in proper oral care. The products are also boosted with natural and edible health benefitting ingredients – as good for your body as your teeth. 😊
The Olgani oral care range offers five kinds of toothpaste, two types of mouthwash and two tooth powders, all formulated for specific needs and are enriched with health benefitting and nourishing ingredients:
• The new Charcoal & Cocoa All Natural Toothpowder helps whiten the tooth enamel, prevents sensitivity and supports gum tissue. Its ingredients include charcoal and turmeric to whiten the teeth, liquorice to prevent cavities, coffee oil to improve blood flow in the gum tissue and vitamin E to support the gum tissue. It also contains echinacea to stimulate the immune system, cocoa to improve mineral absorption into the teeth and a blend of essential oils to prevent bad breath.
• The new Sage & Wintergreen All Natural Toothpowder helps to prevent plaque and cavities, freshen the breath and prevent periodontal disease. It contains green tea to strengthen the gum tissue, liquorice to prevent cavities, ginkgo biloba to improve blood circulation in the gums, olive leaf to control bacterial and viral infections, goldenseal to control fungal infections and rice flour to polish the tooth enamel.
The powders contain 50% more active ingredients than the toothpaste and can be used for brushing without water.
• Detoxifying Charcoal Toothpaste helps removes stains, whitens teeth and detoxifies.
• Mighty Cocoa Toothpaste – offers an effective option for treating dental sensitivity by utilising Theobromine rather than fluoride, whilst hardening tooth enamel.
• Herbal Refreshing Toothpaste helps to control dental plaque and gum sensitivity.
• Mineral Rich Evening Toothpaste enhances the natural process of tooth remineralization.
• Clove & Xylitol Mouth Wash helps to fight inflammation of gum tissue, fungal infection of the mouth and bad breath.
• Sage & Spearmint Mouth Wash helps prevent the build-up of dental plaque due to its mild antibacterial properties, stimulates the production of saliva and reduces the volume of harmful bacteria in the mouth.
• Fruity Orange Kids Toothpaste (2-12yrs) contains Xylitol and Liquorice extract due to its beneficial properties in oral care - helping to strengthen teeth and gums for proper development.
Instead of glycerine in Olgani’s formulae, the principle of ‘oil pulling’ is used, using sesame and coconut oils to create a unique signature blend – NutrireB. Added to this, is a base of rice flour and sea salt. Rice flour is rich in minerals and vitamins, is non-abrasive yet thoroughly polishes the teeth. Sea salt is a natural preservative, regulating the pH and stimulating the production of saliva, your body’s natural mouth wash. The range is free of fluoride, SLS/foaming agents, artificial preservatives, flavourants and colourants, artificial anti-bacterial agents, silicones, parabens, micro-beads, synthetic oils and sweeteners.
If you or a team member would like more details or to try Olgani, we have toothpowder samples, please email us at [email protected] and we will get your rep to be in touch.
If you wish to buy and offer Olgani from your practice you can order online here. If you do not have an account with us you can apply for one online with this form.
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The answer to efficient, predictable, and reliable cementation of Zircoium oxide restorations! - by clinical consultant Dr Stephné Fenwick
I’d like to introduce you to the most cost-effective self-adhesive, self-curing resin cement. With a light curing option, #IvoclarVivadent Multilink Speed, together with the universal cleaning agent Ivoclean, make this product the ideal combination for the cementation of your Zirconia restorations!
Multilink Speed plus Ivoclean equals THE answer to efficient, predictable, and reliable cementation of zirconium oxide restorations!
Ivoclean is the universal cleaning paste for all your indirect restorations, making it the ideal choice to reliably remove saliva and blood from the fitting surface of your restoration after try-in. The complete removal of plasma proteins and phosphates, ensures optimal micro-mechanical interlocking and chemical bonding of the cement to the restoration. This is critically important for zirconia as we rely strongly on the mechanical bond and can form part of the solution to your zirconia restorations debonding.
Multilink Speed - the self-adhesive, self-curing resin cement with light curing option, is perfect for all your retentive indirect restorations. Its reliable self-curing properties make it the trustworthy choice for your zirconia and metal based opaque restorations. If your zirconia restorations are debonding when cemented with a resin cement, it probably does not have the advanced self-curing advantage that Multilink Speed has to offer, or it may be that your fitting surface is contaminated.
The true self-adhesive properties of Multilink Speed, with integrated adhesive monomers within the cement, mean it does not require the application of etch and/or bonding agents to the tooth prior to cementation. Add to this, no silanating agent/zirconia primer needs to be applied to the surface of a zirconia restoration prior to cementation.
Multilink Speed provides you, the clinician, with simple protocols and easy and fast clean up.
For further details or to purchase online click here.
