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Inside Dentistry
August 2016
Volume 12, Issue 8
Peer-Reviewed

Melinda Whire, EFDA:

Team Approach in the Restorative Operatory

Understanding and participating in all phases of treatment from diagnosis to delivery allows an EFDA to provide valuable recommendations and support. With proper training and an expanded scope of practice, the role of many dental auxiliaries is shifting from basic assisting to partnering with doctors to ease much of the restorative burden and improve care.

At the completion of the patient’s orthodontic treatment, Melinda Whire, a licensed extended function dental assistant, took a new set of records for final restorative design. She also managed whitening treatment to lift the shade on the lower incisors. The laboratory work associated with the models, mounting, and whitening trays was all handled by laboratory assistant Erickia Rynard, EFDA, who also created reduction guides and a temporary matrix from the diagnostic wax-ups.

All the teeth receiving indirect restorations were prepped, and Whire fabricated provisional prototype restorations with a self-curing bis-acryl composite material (Telio CS C&B, Ivoclar Vivadent). After a few weeks of wear, the prototypes were refined, records of the temporaries were completed, and a final impression with a centric relation bite registration was taken. Final porcelain crowns were luted with Variolink Esthetic (Ivoclar Vivadent).

Craig Yoder, CDT:

Technician-Guided Planning

Craig Yoder, a ceramist and manager of Thayer Dental Laboratory (www.thayerdental.com), gives the study club group an appreciation for the role a knowledgeable technician can play in the treatment planning process. Rather than having to make esthetic and functional compromises late in treatment, ideal outcomes can be achieved with early laboratory guidance.

After reviewing the articulated models and the Diagnostic Wizard, Yoder completed diagnostic wax-ups. He and his team were then able to advise on material choices, prosthetic design, and implant components. The anterior and lower premolar restorations were done with e.max Press (Ivoclar Vivadent) crowns by Thayer ceramist Harold Diedrich, CD (Figure 5).

The mandibular single-unit implant restorations were fabricated with zirconia crowns retained on custom titanium abutments with zinc-phosphate cement. The maxillary posterior implant restorations were designed as screw-retained hybrid-type restorations. The milled zirconia prostheses were based off of scans of provisional prototypes created in-office by Rynard. Cut-backs in the final restorations allowed for the layering of porcelain to maximize esthetics of the teeth and pink gingival areas (Figure 6).

Discussion

Through the support of colleagues, one can find motivation, shared knowledge, and perspective. Dawson Academy Study Club members examine the latest scientific and management trends through modules that feature industry-leading researchers, clinicians, and management consultants. The tools and benefits included with membership are valuable treatment aids. The perspectives offered by colleagues inevitably provide valuable wisdom and have a positive effect on patient care. By sharing the principles of complete dentistry and gaining mutual understanding of interdisciplinary treatment goals, strong bonds are formed between treatment teams.

Disclosure

Michael C. Verber, DMD, has no relevant financial relationships to disclose.

References

1. McKee JR. Comparing condylar positions achieved through bimanual manipulation to condylar positions achieved through masticatory muscle contraction against an anterior deprogrammer: a pilot study. J Prosthet Dent. 2005;94(4):389-393.

2. Dawson PE. Classification of occlusions. In: Dawson PE. Functional Occlusion: From TMJ to Smile Design. St. Louis, MO: Mosby Elsevier; 2007:107-109.

3. Piper MA. Piper’s Classification of TMJ Disorders. Piper Education and Research Center website. http://www.pipererc.com/tmj.asp. Accessed June 22, 2016.

4. Dawson PE. Requirements for occlusal stability. In: Dawson PE. Functional Occlusion: From TMJ to Smile Design. St. Louis, MO: Mosby Elsevier; 2007:345-348.

5. Kerstein RB, Radke J. Masseter and temporalis excursive hyperactivity decreased by measured anterior guidance development. Cranio. 2012;30(4):243-254.

About the Author

Michael C. Verber, DMD
Faculty
The Dawson Academy
St. Petersburg, Florida
Private Practice
Camp Hill, Pennsylvania

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