ADVISORY:

This is NOT a PAID Advertising. This is to provide dental practitioners more information about dental techniques that can benefit your practice and most especially your patients.

ABOUT THE VIDEO:

Learn the really minimally invasive technique of replacing a missing single posterior tooth. This technique is done without doing a full-blown fixed bridge tooth preparation wherein you need to sacrifice 2 natural teeth to support 1 missing tooth or have a RPD fabrication done that many patients don't like due to esthetics and inconvenience or do an implant that many patients can't afford or afraid to go through surgical procedure. This technique is fully done without the need of any laboratory fabrication. This is by doing an inlay-indirect bridge or a maryland indirect bridge just by utilizing your talent as a dentist with the application of simple techniques and innovative dental products.

The video is courtesy of Dr. Stephan Lampl, the CEO and founder of edelweiss Dentistry that manufactures laser-sintered vitrified glass pre-formed anterior veneers, posterior onlays, pediatric crowns and unified post and core. We would like to thank Dr. Stephan Lampl and edelweiss for generoulsy providing us this video for us to share with our DMD Center dental community.

THE GENERAL MATERIALS NEEDED

1. From edelweiss Dentistry
(a) Occlusion VD
(b) Composite Resin
(c) Veneer Bond
(d) Enamel Flow

2. From Dentapreg - Fiber-Reinforced Matrix

3. From Ivoclar-Vivadent
(a) Optra Sculpt Hand Instrument (4 mm Pads)
(b) Optra Gate (Regular + Small)

4. From 3M Espe
(a) Sof-lex finishing and polishing strips, Ref 1954
(b) Polishing Disc coarse, Sof-lex 2382C
(c) Polishing Disc fine, Sof-lex 23825F
(d) Mandrel

5. From Bausch
(a) Paper Holder
(b) Articulating Paper BK 05

6. From Hu - Friedy
(a) PF/DD9/10
(b) PF/DD1/2

7. From Bisco - All Bond Unisversal Tooth Bonding Agent

8. From Ultradent
(a) ViscoStat Clear
(b) Ultra Etch 35% Phosporic Acid

9. From Roeko - Steel Separating Strips 4 mm 570004

10. From GC - Multi-Sep Separating Medium (Only necessary, if the bridge will be fabricated on a cast)

11. From Kerz - Hawe Striproll 687, 10mm/0,05 mm

12. From Kendo
(a) Polisher (green), 9,10.M.100
(b) Polisher (grey), 0390.100

13. From G u. Z. Instrumente
(a) Red diamond flame bur
(b) REF F 862-314-016-8 drill bur

14. From Dentalversender - Microbrush Superfine

15. Others
(a) Mouth Mirror
(b) Probe
(c) Tweezers
(d) Composite Guns
(e) Dental scissors
(f) Rubber Impression Material and Its Accessories

STEP I: THE TOOTH PREPARATION

NOTE: As much as possible always end your tooth preparation on the Enamel.

1. If there's an existing tooth restoration, remove all of it if the following conditions exists:
(a) If the old restoration is not a composite resin
(b) If there's a recurrent caries.
(c) If the old composite restoration is not sound.
(d) If in your judgement, it is necessary

2. If the abutments don't have caries, prepare just an occlusal stop on the side mesially to the missing tooth.

3. If it is Class II, do the following:

• Using a long tapered bur, create a proximal box with a axial wall and ends in the gingival wall for both of the abutment tooth.
• The proximal box should have an overall square shape and rounded internal angles (this type of preparation is suggested to avoid torquing forces applied on the pontic during mastication)
• Occlusal cavosurface should be bevel with a round bur no. 2 while proximal cavosurface is beveled with a diamond finishing bur. ( by bevelling, this exposes the enamel the enamel rods for improved bonding, maintaining the bulk of the restoration, passive seating of the occlusion VD and help break light forces so they blend in the tooth surface)

STEP II: CREATING A REPLICATION

1. Wash and air dry the abutments to remove any debris from the tooth preparation

2. Using a cotton roll completely dry the working field in preparation for the Impression

3. Prepare the rubber impression material.

4. Using a partial impression tray, place a suitable amount of the rubber impression material.

5. Take the impression. Let the rubber impression material fully set according to the manufacturer's instruction

6. Remove the impression tray from the patient's mouth. Quickly wash and air dry the area needed for the second application of a rubber impression material.

7. Apply a light body rubber impression on top of the initial rubber impression taken. Let it set according to the manufacturer's instruction.

8. Separate the 2nd rubber impression from the initial rubber impression.

STEP III: FABRICATING YOUR BRIDGE

1. Preparing Your Fiber-Reinforced Matrix Band

• Using a bowley gauge measure the length of the fiber-reinforced matirx strip or use a piece of waxed dental floss or dental tape to initially act as a trial pattern that can be fitted into the preparations and make this as the reference guide when cutting the actual fiber reinforced matrix band needed.
• Clean the rubber impression cast and prepare the fiber reinforced matrix band strip.
• Using a scissor or blade, cut the desired length of the fiber reinforced matrix band.
• Place a desirable amount of composite resin and spread it on the fiber reinforced matrix band using the Optra-sculpt instrument.
• Properly position the fiber reinforced matrix band and let its ends sit on the prepared occlusal stop of the abutments.
• Initially cure it for 20 seconds.

2. Creating Your Tooth Replacement

• Place a ball composite under fiber reinforced bridge and simulate the shape of the cervical third of the crown.
  NOTE:

(a) Place a celluloid strip underneath to act as a guide when building the cervical portion of the crown.
(b) Use a darker shade of composite resin for the cervical to create a natural transition of shade from dark to light.

• Prepare the edelweiss Occlusion VD. Roughen the inner side of it and bevel the shell.
• Clean and air dry the edelweiss Occlusion VD shell from the debris.
• Apply a coat of edelweiss Veneer bond on the inner side of the edelweiss Occlusion VD. Air thin dry for at least for 10 secs.
• Cure the edelweiss Veneer Bond in the shell for at least 20 secs.
• Roll enough composite resin to make it malleable and compact, then, place it on the inner side of the edelweiss Occlusion VD
• Press the edelweiss Occlusion VD shell on top of the Fiber- reinforced bridge. Apply ample amount of composite resin to build up the crown replacing the missing tooth.
• After build-up, shaping and contouring, cure the built crown for at least 20 secs on each its surface.

STEP IV: CEMENTATION

NOTE: It is highly recommended that rubber dam is used for proper isolation.

• Etch the tooth. Enamel should be etch at least 20-30 secs and dentin 10-15 secs. Clean the tooth with air and water
• Apply a tooth bonding on the tooth abutments and thin air for 10 secs. Cure the bonding agent for 20 secs.
• Place an edelweiss flowable or regular composite resin on the occlusal stops of the tooth abutments.
• Clean and remove the fabricated inlay or maryland bridge from the rubber impression cast and properly positioned the bridge to the patient's mouth.
• Press the wings of the fiber reinforced matrix strip into the occlusal stops of the abutments filled with composite resin. Remove excess composite resin and cure for 20 secs.
• Check the occlusion. Use articulating paper to remove premature contacts with a finishing bur.
• Do the proper finishing and polishing.

ADDITIONAL INFORMATION:

1. The materials listed above are the usual instruments and materials used by Dr. Stephan Lampl when doing edelweiss treatments.

2. edelweiss products is available at Dental Domain Corp., as their official distributor in the Philippines. You may contact them at +63 23 224 1888 or +63 917 586 1349.

3. edelweiss Dentistry and Dental Domain Corp. do provide hands-on training if interested. You may inquire further details on their representatives.

WHAT DMD CENTER ASKS FROM YOU?

1. Provide a feedback of this video either by e-mail at contact_us@dmd.center or in any of our social network page:

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2. Continuously support us and spread the word about DMD Center

3. Apply in your dental practice what you learn from here.

That's it. Happy learning!!!

Thank you.