Accuracy, Consistency, Data · The Key to Success: Visualization ... with the nature and...
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4/12/2018 1 4 Accuracy, Consistency, Data
Transcript of Accuracy, Consistency, Data · The Key to Success: Visualization ... with the nature and...
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Accuracy, Consistency, Data
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Text “action” to: 77453
Text RaceData to 77453
TIP Companies that make me fast both on & off
the track• WEAVE
• Dental Intel
• NGENYS
• Ultradent
• Kettenbach
• Clinician’s Choice
• Shofu
• Bisco
• All Star Dental Academy
• Kavo/Kerr
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Weave Mobile App
Take your office with you
-From anywhere you have a wifi or cell connection.
TIP
Remember The Old Appointment Book?
How LONG Did It Take To Answer A Question About Balances, Forgotten
Appointments?
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Reviews text message Weave Reviews Via Cell phone message • Select Ratings to be sent to:
• Google• Yelp• Facebook
• Customize Order of Review Sites
• FYI-A dental/medical office can have more than one listing on Google, Yelp etc.. Because they typically employee more than one doctor as well as the business name (ie. Aesthetic Dental Designs and also Todd Snyder, DDS and my Associate can have a site too, just use different phone numbers and emails)
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—MEG BIRAM
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How good is your diagnosis?
Are you still diagnosing with this??
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50%accurate
Adrian Lussi - 1994 paper in Caries Research demonstrated that an explorer only detected caries in 14% of teeth that actually had decay histologically (Low sensitivity)
How do you diagnose decay??
Is it thru conventional radiographic analysis?Approximately 25% demineralization must occur to see a cavity on a conventional
radiograph. Equates to 40-60% demineralization on the tooth surface.
Radiographs miss 70-80% of occlusal cavities.Digital radiographs provide the ability to manipulate image size and appearance.
67%accuracy
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Thru intraoral photographic interpretation?
How do you diagnose decay??1896
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CariVu Fiber Optic Transillumination TIP
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Routine Bite Wings
Intra Oral ImageWhat do you see #20D
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From 2014…faint sign on 20 distal, nothing really in 2015…but now we have CariVu
2014 2015
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What tools are available and do I have them?
I need to look at things differently or get someone else
to help with the case.
Could I get a better outcome in the case?
PREPARETIP
Look at every case differently
Technology is always changing as are our techniques.
!
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THE Evaluationgo ahead and follow these 5 basic steps
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Chief Complaint | What | Where | When | Why | How | What is the Outcome?
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Visualize key messagesA picture is worth a thousand words…
Make a statementUsing cases, models and photographs
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LEAD
Use diagnostics to tell the story, always moving forward to
the conclusion
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The Key to Success:
VisualizationWhat is the patient’s perception or desired outcome in their mind to create the EMOTION and DESIRE?
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YOU NEED CAMERAS
Photographic Manipulation
• Cosmetic “Imaging” Software• SmileFy app• PreVue app• SmileVision• DentalGPS• DSD
• Digital Agents• Virtual Smiles ($125/image)• DreamSmiles (<$4000 a year?)
• Ivoclar/Kapanu?• Super Toy Box App
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When you hand a Digital Simulation to your patient, you plant a seed of what is possible, a constant reminder of what their potential new smile can be. They can show it to their friends and family, you can put a copy in their chart for follow-up, have them hang it on their refrigerator...!
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CO/MIP= X% of treatment?
CR= X% of treatment?• a d d fadfjas
How and when do you treat?• a d d fadfj as
Aesthetics/Cosmetics- a set of principles concerned with the nature and appreciation of beauty
Occlusion- the relationship between the maxillary and mandibular teeth when they approach each other, as occurs during chewing or at rest.
• a d d fadfj as
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When to restore to CR- when MIP is unhealthy (occlusal disease, wear, fracture, cracks, fremitis, dentin exposure, abfraction, tori, joint pain, muscle pain, recession, loss of vertical dimension, crenations, cheek biting, mobility, migration of teeth)/signs of instability, unreliable/poor tooth contacts, or all teeth in one arch are being worked on.
When not to restore to CR- MIP is healthy and reliable, when mandible cannot accept loads, unhealthy joint.
CR is about control. A stable, comfortable, repeatable physiological position. • a d d fadfjas
No Myalgia or Joint Noise
Just Completed Ortho
Wants a Better Smile
First Case:
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Minimal Prep Case: Wax-up Case:
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Preparation Guides:
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Shade Assumptions
BW, B1, B2, A1, A2
Provisional Techniques
-Free hand
-Beadline Provisionals
-Putty over impression of waxup
-Premade temps?
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EMOTIONFocus on overall appearance
Stay away from little details
“Going to look & feel great”
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Questions?
-Patient wants to fix the small
lateral incisor
-No tooth reduction
OPPORTUNITY
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WAXUP AND BEADLINE IMPRESSION
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Beadline Provisional Mockup Beadline Provisional MockupBeadline Provisional Mockup
Diagnostic Models with a waxup are duplicated. Special over impression is created and used to deliver temporary mockup
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LISTEN For Yourself
Show & Sell Possibilities..
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COSMETICChanges
3 out of 5 • Patient came in to fix small lateral incisors
• Wants “Absolutely” no tooth reduction
• What drives him?• Appearance
• No Tooth Reduction
• Emotion
• Desired Outcome…. Feel Better, more confident?
Results
Confidence, Dating,Work,Emotional Goals
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Cosmetic Dentistry
• Do YOU WANT more Cosmetic Cases?
• Patients desire a change• But don’t know what they want (typically)
• What are their Chief Complaints (pick 3)
• Why?
• And What will that accomplish? Reasoning behind Tx.
• Always look at the big picture
• Take photos
• Write down where they can see their Chief Complaints
How Do We Create The
Intraoral Mockup?
• First take an impression of teeth with a material that allows you multiple repours.
• Want one original model
• One model for laboratory
• Extra model if you need bleach trays or practice preparations
• Photos
• Facebow
• Horizontal Plane Indicator
• Teeth that are too far facial will remain untouched. When photos are taken they will be less obvious.
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Aesthetic ContouringWhat IF? Aesthetic Contouring
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Time??
ROI??
Aesthetic Contouring Aesthetic Contouring
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Aesthetic Contouring
Periodontist
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AestheticsSmile LineGingival Excess & AsymmetryCombination Crowns & VeneersGingival Crown LengtheningFunction(most cases no vertical change)
Difficulties? Aesthetic Combination Crowns & VeneersExisting RCT
Function
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Silginat - Kettenbach
Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
Silginat - Kettenbach
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Wear Facets & Interferences Mounted and Equilibrated
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AACD.
Your Turn What Records & WhenDiagnostic & Prep Reduction Models
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Treatment Plan & Diagnosis
Aesthetics
Gingival Harmony
Function
Preparation Guides
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Preparations & Provisionals2 crowns and 8 veneers
Facebow / Wax Bite
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4 upper & lower trays
60 sec. @ 158°F
Fast, efficient
Virtually custom
30% less impression
material used
Impression Trays
HeatWave by Clinician’s Choice
TIP
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Impression Trays
HeatWave by Clinician’s Choice
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Impression Trays
HeatWave by Clinician’s Choice Panasil Initial Contact (VPS)
Kettenbach
TIP
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Simplified Provisionals**
Siltech Putty Matrix
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
TIP
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Duplicate waxup model in stone
Scribe a 0.5-1mm line with a sharp instrument into the
model where the tissue and tooth come together.
Provisionals (Bead Line Technique)
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Duplicate model with a fast setting polyvinyl impression material.
I have used light and medium body washes with a heavy body tray
material.
Provisionals (Bead Line Technique) Provisionals (Bead Line Technique)
The scribed line creates the Bead Line in the over impression of the cast.
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The Bead Line in the over impression creates pressure along the tissue
and preparation margin. This causes a thin cut or separation of the
acrylic flash from the provisionals for easier clean up.
Provisionals (Bead Line Technique)
The Bead Line Provisional Technique creates less work and risk of damaging tissues and tooth
structure. Typically the process takes 5-10 minutes to make provisionals. Consepsis (Ultradent)
can be placed on the teeth and dried prior to fabricating provisionals.
Provisionals (Bead Line Technique)
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-Visalys (Kettenbach)**
-TempSmart (GC America)
-Inspire (Clinician’s Choice)
-ExperTemp (Ultradent)
Provisionals
Cling 2 for all my full crowns & bridges, retentive inlays & onlays.
My Favorite Temporary Cements
ClearTemp LC (Ultradent)**
TempBond Clear (Kerr)
For either veneers or thin
anterior cosmetic restorations
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-Aesthetics
-Function
-Gingival Embrasures
-Excess cement
-Patient homework & questions
Post-Op Check
From Imaging & Diagnostic Wax-up the entire case was duplicated
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Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Cosmetic Provisionals (Bead Line Technique) Cosmetic Provisionals (Bead Line Technique)
Scribe a 0.5mm-1mm groove into tissue & a little on tooth
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Cosmetic Provisionals (Bead Line Technique) Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
No Polish Necessary if you use a good model
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique) Cosmetic Provisionals (Bead Line Technique)
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Beadline Provisionals
Excellent retention no microleakage
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Tell the patient they will hear pops & clicks
Beadline Provisionals
Wants A New Smile:Aesthetics
No TMJ Problems
Stable Bite
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AACD.
Your Turn
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Incisal position
Gum height
2-4 mm
10-12 mm
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Instant Ortho/Un-Rotating Teeth
• Do initial workup
• Diagnostic preps
• Diagnostic waxup
Images from Bruce Crispin, DDS, MS book entitled “Contemporary Restorative Dentistry”
Sequence
– Reduce all excess tooth structure
– Ideal reduction
– Margin placement
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Cementation**
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Orthodontics
Orthodontic
Many cases require orthodontics or come to us after orthodontics
Options
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Orthodontics Orthodontics
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Orthodontics Orthodontics
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AACD.
Your TurnOrthodontics
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Orthodontics Orthodontics
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Orthodontics Orthodontics
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Take Away
Facial Balance
Arch Shape
-Ralph Waldo Emerson
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Orthodontics Orthodontics
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Orthodontics Orthodontics
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Orthodontics Orthodontics
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Orthodontics
-MAYA ANGELOU
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CC-Pt wants Veneers• Functional Wear on Anteriors
• Masticatory Muscle Pain
• Headaches
• Joint Noise
CO/MIP
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AACD.
Your TurnDeveloping Beautiful Smiles
Assessment:Joint NoiseFacial Muscle PainPoor OcclusionInvisalign Done/RetentionAnterior WearWants to Keep Appearance
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Cause & Effect Diagnosis• Functional Wear on Anteriors
• Masticatory Muscle Pain
• Headaches
• Jaw Relationship / TMJ Disorder
• Obstructive Sleep Apnea (OSA)
• Combination
Supplemental Tests:Sleep StudyCone Beam CT (CBCT)Airway Evaluation
AIRWAY VOLUME
-50mm2 and below have an association with OSA
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TMJ EVAL/Diagnosis
CBCT-Pathology-Jaw position-Bone Appearance-Active DJD/Remodeling
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Orthotic: Superior Repositioning Appliance (SRA)
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Nociceptive Trigeminal Inhibition Tension
Suppression System (NTI-tss)
Jaw Position
NTI type appliances
Jaw Position
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NITE BITE
• 5 minutes to make a Nite Bite appliance for relief of most TMJ discomfort
• Fast fabrication
• Force distribution
• Minimal opening
SRA FABRICATION:Try-in
Check Bite
Adjust Posterior
Shallow Ramp
Trim Trough
Occlusal Reline
Passive Centric & Hold
Mark Depth of Fossa
Trim Excess
Polish
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• Patient wears just at night the first 2-5 days
• Understands they will wear 24/7
• Patient comes back for evaluation every 2-4 weeks
• Passive reline to achieve equal contacts
• Once the bite is stable follow for another 2-4 weeks
Orthotic: Superior Repositioning Appliance (SRA)
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HINGE AXIS RECORDING
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Occlusal Analysis
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The Nuts & Bolts of Veneers
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Simplified Provisionals• Verify shape
• Display at rest
• Protrusive
• Excursives
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CEMENTATION OPTIONS• Glass Ionomers
• Resin Modified Glass Ionomers
• Self Etch Resin Cements
• Bonding Agent w/ Resin Cement
• Calcium Aluminate
• TriSilicate Cement
CERAMIR (CALCIUM ALUMINATE CEMENT BY - DOXA)• Alkaline pH 8.5
• Moisture Tolerant
• Self Sealing
• Apatite Formation
• Insoluble
• Stronger with time
• Semi / Translucent
• Biocompatibility-Excellent
• Bioactivity-Apatite formation
• Sealing Quality-Excellent
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Pre-op
Post-op
Review Patient with Problems-Sleep Study Questionnaire-Sleep Study?-Cone Beam CT (CBCT)
-TMJ Diagnosis (Beamreaders.com)-Airway Evaluation
-Superior Repositioning Appliance (SRA)-Reline as needed.
-Hinge Axis Recording-Proven with different thickness bites
-Diagnostic Model Workup-Discuss Options with Patient
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Questions?
Example-Centric Occlusion
Anteriorly positioned condyles
Occlusion is not ideal Appears to have canine guidance
Weak centric stops and limited number
Patient okay for a few months
Now has joint pain, noise, muscle pain, teeth are sensitive
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Centric Relation
Joint in proper position
Occluding only on second molars
Restorative dentistry & orthodontics (aligners too)
TMJ SIGNS & SYMPTOMS
• Wear facets
• Pot holes
• Abfractions
• Gingival recession
• Mobility
• Occlusal & Incisal wear
• Linea Alba
• Tongue scalloping (Crenations)
Muscle hypertrophy
Muscle tension/tenderness
Muscle rigidity
Limited opening
Guarding on CR closure
TMJ noise
Head and Neck aches
Tooth sensitivity
Ear problems, ringing, buzzing, fullness
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POSTERIOR INTERFERENCE (PREMATURITY)• Centric Occlusion
• Natural growth patterns
• Orthodontics
• Dental work
• Trauma
JOINT REPOSITIONED AND
STABILIZED (CRSTABILIZED)• Splint Therapy
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Normal Disc Reducing Non-ReducingNormal
Remodeling DJDRemodeling
Adolescent
Facial GrowthDecreasedInterruptedNormal
Bones
Disc
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Last Case
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AACD.
Your Turn
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Many different ways to look at a case.
See what is possible.
Implementing for better long term outcomes & health.
TODD SNYDER
(949) [email protected]
www.aestheticdentaldesigns.comwww.drtoddsnyder.com
www.toddsnyderracing.com
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Google Website Speed, Responsive Design and Build Issues/Code
WEBSITE PAGE SPEED IS VERY IMPORANT (and so is relevant content too)
https://www.wordstream.com/blog/ws/2018/01/22/google-speed-update
Jan. 22 2018
https://webmasters.googleblog.com/2018/01/using-page-speed-in-mobile-search.html
Jan. 27 2018
https://www.forbes.com/sites/jaysondemers/2018/01/29/will-googles-new-page-speed-criteria-affect-your-site/#6c3dbe8f6a8f
Jan. 29 2018
July 2018
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CHECK YOUR PAGE SPEED
https://developers.google.com/speed/pagespeed/insights/
CHECK YOUR PAGE SPEED
MOBILE FRIENDLY?
https://search.google.com/test/mobile-friendly?id=De1nibkdCgXmmSqhS04nzw
https://validator.w3.org/nu/?doc=https%3A%2F%2Fwww.blux.com%2F NGenys
Pronounced Ingenious
Websites, Photography, Brand, Social Media and More
www.NGenys.com
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Proof of Work / Transparency
![A-Occlusion - Principles [Read-Only]Ideal bite • Should have point contacts of the maxillary posterior lingual cusp tips and the mandibular posterior buccal cusp tips to the central](https://static.fdocuments.net/doc/165x107/6145d4958f9ff812541fe028/a-occlusion-principles-read-only-ideal-bite-a-should-have-point-contacts-of.jpg)
