Dear Dr. DiTolla,
Thanks for another great issue of Chairside.
We were disappointed that we received the
Fall 2011 issue on Jan. 2 and the contest
deadline was Dec. 30.
I am using Capture® impression material
now and am very happy with it. I am using
the green light body. Is there any reason
why you favor the purple medium body over
the green?
I impressed my first no-prep veneer case
(tooth #8-11, with an implant on tooth #7)
this week. Your DVD videos are great! To
prepare, I watched the video online on
tissue contouring and placement of no-prep
veneers ("Diagnosis & Placement of No-Prep Veneers"), which was very helpful, in
addition to reading Dr. Robert Lowe's article
in the Winter 2012 issue of Chairside. Is there
a reason why you don't retract the tissue for
these no-prep veneers? Dr. Lowe seems to
make a very strong case to do so. Either
way, I contoured one area and did pack cord
(no offense!).
What cement are you using to cement these
veneers?
Once again, thanks for teaching me the
dentistry I practice with every day!
- Robert M. Lieder, DDS
Baltimore, Md.
Dear Robert,
Thanks for the kind words!
That early due date was a mistake on
our part, and we will do our best to
make sure it doesn't happen again.
I use the medium body (purple) as
my syringe material, just to make sure
it doesn't tear because I get it to go
about 1 mm into the sulcus with the
two-cord technique. Also, it will often
set in contact with the #00 cord, which
can increase the chances of it tearing.
The medium body prevents that
from happening.
Because the margins of no-prep/minimal
prep veneers tend to make a little
speed bump on the tooth, due to there
typically being no prep at the margin,
I prefer to leave that bump at the free
margin of the gingiva, rather than
placing it subgingivally. With conventionally
prepped veneers, I always
place the margins subgingival.
As for not retracting the tissue, that's
just my personal preference. You
won't go wrong following Bob Lowe's
method when it comes to any aspect
of clinical dentistry. He continues to
be one of my clinical mentors, which
is why his articles are in nearly every
issue of Chairside.
My favorite veneer cement continues
to be the translucent shade of NX3
Nexus® Third Generation from Kerr,
which is something Bob Lowe and I
definitely agree on.
Hope that helps!
- Mike
Dear Dr. DiTolla,
I enjoyed reading the "Figures in Dentistry
Spotlight" on G.V. Black in the Fall 2011 issue
of Chairside. Unfortunately, there was no
mention of his most important contribution
to dental literature, "The Pathology of the
Hard Tissues of the Teeth," first published in
1906. Most dentists have never heard of this
book, but as I was studying ways to control
caries with a medical model, I ran across a
reference to the book. It took awhile to find
a copy, but when I finally read it, I was totally
blown away by the advanced understanding
that G.V. Black had about the microbiology
of caries. His chapter on treating children
is more advanced than any pediatric dental
text I have ever read, and I have read them
all. I would encourage you to take a look
at this classic. Attached is a little paper
that talks about G.V. Black's volume in the
context of advances in cariology.
Best wishes,
- Steve Duffin, DDS
Portland, Ore.
Dear Steve,
Thanks for sending me your paper.
I really enjoyed reading it! With
your permission, I would love to
publish your paper in a future issue
of Chairside.
- Mike
Dear Dr. DiTolla,
First, I want to say how much I enjoyed
your recent webinar ("State-of-the-Art
Impression Techniques," hosted by Catapult
University). What a great way to learn!
I hope it becomes a regular occurrence.
Can you e-mail me about the burs you use
for your crown preps? What brand do you
use? I like the whole idea and am looking
forward to trying the technique. I plan on
doing a lot more BruxZir crowns.
Thanks again,
- Grigg DeWitt, DDS
Salinas, Calif.
Dear Grigg,
Thanks for the kind words!
The burs I use to prep are from the
Reverse Preparation Set from Axis
Dental, available through all dental dealers. It's a universal prep technique
that works for all materials, although
as the next letter in this section points
out, the strength of BruxZir® Solid
Zirconia is starting to change how
much we have to reduce, especially at
the margin.
- Mike
Dear Dr. DiTolla,
First, thank you very much for your
educational support and updated dental
market information. The latest issue of
Chairside (Vol. 7, Issue 1) includes your
very interesting and helpful article "BruxZir®
Solid Zirconia Anterior Esthetic Challenge."
I would appreciate it if you could give me
information about labial and palatal crown
thickness (Figs. 31-34). I wonder why you
used a shoulder preparation technique
when the BruxZir website says that feather
edge is acceptable?
Cordially,
- Alex Zavyalov, DDS
New York, N.Y.
Dear Alex,
Good question! I guess the best
answer is that having spent the last
20 years prepping all-ceramic crown
preps at a certain thickness, old habits
die hard. My Reverse Preparation
Technique uses a round bur to ensure
that I get 1 mm of reduction in the
gingival third to help the esthetics and
the emergence profile. As you pointed
out, BruxZir® Solid Zirconia is the
one monolithic material (besides cast
gold) that can handle a feather-edge
margin, and we are just getting started
with a Minimal Prep Crown Project to
see just how little we can reduce an
anterior tooth and still have a decent looking
BruxZir crown. Imagine if we
could prep a tooth and stay within the
enamel, yet be able to cement a highstrength
all-ceramic crown, rather
than bonding a veneer. So, yes, even though I did not prep conservative
margins on those teeth, you certainly
can prep those types of margins with
BruxZir crowns. Even if you were
worried about esthetics on the facial,
you could still prep a conservative
margin on the lingual.
- Mike
Dear Dr. DiTolla,
Regarding Dr. Ellis Neiburger's article in
the last issue of Chairside, "Is It Time to Do Routine Adult Pulpotomies?"
(Vol. 7, Issue 1), there should have been
more discussion about using lasers to sterilize
the pulp instead of formocresol, and
other options instead of IRM, like MTA.
- Brian Danielsson, DDS
Ridgecrest, Calif.
Response from Dr. Neiburger:
Dear Brian,
The article focused on time-tested
pulpotomy techniques that, in light of
the world's poor economic situation,
can be done easily, quickly and
inexpensively. Laser sterilization of
the pulp chamber is relatively new,
has only a small amount of research
to establish efficacy and requires laser
equipment more costly than a $10
bottle of formocresol. It holds promise
and should be further investigated.
