Table of Contents
Jumpstart Your Digital Denture Workflow
The 3 Appointment Denture
This is the fastest way to accurately jumpstart a digital denture workflow. This is specifically for patients that have an existing denture.
The first appointment is key. Following are 5 critical steps in the first appointment:
Send to the lab.
Given this information, the lab can send back to you a teeth set-up try-in for your second appointment. If the try-in appointment meets with acceptable results, the third appointment is the delivery of the final denture.
Using Kois Facial Analyzer
There is not a single day that our technical team does not wish all of our clinicians used the Kois Dento-Facial Analyzer - FaceBow. If you want to have the most predictable restorative and esthetic results, the Kois Bow is one of your most valuable tools. This instrument allows you to focus on facial esthetics while capturing condyle relationship and occlusal plane records at the same time.
The Kois bow is basically a fox plane with an affixed bite plate index that allows you to position the incisal edge 100 mm away from the condyle and transfer it to the articulator and facilitates the orientation to the facial midline. Once the incisal edge is positioned on the bite plate all you have to do is level the two planes of the bow to be parallel to the smile line (left to right) and the occlusal plane (anterior to posterior).
One of the benefits of the Kois Bow is that it allows the clinician to easily capture 4 essential records quickly and predictably.
- Smile line - horizontal plane
- Occlusal plane
- Facial mid-line
- Relationship of teeth to the condyle
A major reason to use a Kois bow is that records are easily transferred to the articulator by the lab.
- Simplicity for the lab allows error-free replication of dental-facial relationships; there are no movable parts in the transfer of the Index Tray.
- Combines the function of a face-bow transfer and a stick-bite in the same record, facilitating an accurate smile line, horizontal and midline.
Shade Taking Tips
Following are tips that will help you achieve excellent and predictable results regarding:
- The timing of a shade-taking procedure
- The positioning of the shade tab
- The light source
The Timing of Shade Taking
When should you take the shade? ALWAYS take your shade at the very beginning of the appointment. As you do procedures with the mouth open and saliva evacuated, the teeth dry out and can lighten one shade or more. If you wait until the end of the appointment, you will tend to request shades that are too bright.
The Positioning of the Shade Tab
- Position shade guide with the tooth incisal edge next to the incisal edge of the guide.
- Keep the facial plane of the teeth parallel to the facial surface of the guide.
- Do not hold the guide outside of the mouth or lingual of the teeth.
Ambient lighting in your room and the light source from the flash are both factors in accurately capturing the shade information.
- It is essential to use full-spectrum lighting in rooms where the shades are taken. Use color corrected lighting (5000 K).
- Making corrections to minimize flash bounce back is essential.
- Use a defusing shield over the flash to reduce glare.
Keys to Successful Zirconia Bonding
There are a few key steps to take in order to ensure the most reliable and durable bond when placing zirconia restorations.
5 Steps to Properly Bond Zirconia
- Clean restoration, ultrasonic in alcohol, dry with clean air.
- Sandblast intaglio of the zirconia with alumina oxide 50 or 100 microns at 30 PSI.
- Remove excess sand using dry oil-free air, do not get wet. It is okay to have some sand, it does not need to be 100% clean of sand. DO NOT rinse or steam.
- Paint the inside of the zirconia with an MDP primer, like Clearfil Ceramic Primer plus (Kuraray), or Z-Prime Plus (Bisco). (Figure 1 & 2)
- Cement with a dual-cure resin such as Panavia SA plus (Kuraray), Panavia V5 (Kuraray), or SpeedCEM Plus (Ivoclar). (Figure 3 & 4)
Using an MDP (10-Methacryloyloxydecyl dihydrogen phosphate) primer, and or a resin cement that contains MDP, is the one essential element that must be included in your zirconia bonding procedures. Unlike etchable ceramics such as feldspathic or e.max (lithium disilicate), zirconia requires a retentive prep and the addition of an MDP-containing primer. MDP forms a phosphate bond to the zirconia oxide. Evidence shows that this is the most effective way to increase bond strength to zirconia.