Dr. Jose-Luis Ramirez is the founder and director of the Los Angeles Institute of clinical dentistry.
Tonight we are discussing using porcelain veneers to treat severe wear cases. Treating these patients is not only aesthetic, but it is also treating pain, headaches, and other secondary issues.
Cutting a tooth for a crown weakens the tooth structure and will not prolong the life of the tooth because the patient is still grinding.
While veneers are not the only way, it does help to bring a positive aesthetic that plays out in their lives. There is a lack of guidance from anterior teeth and can help improve the mechanics of the bite.
Zircona crowns force margins below the gum. Occlusion is a mechanical system.
The 3 golden rules: 1. All our teeth need to hit at the same time with the mandible centered. People do not always realize they shift.
Anteriorand canine guidance is imperative.
Overjet is necessary. The jaw needs to open and close without rubbing.
Getting the bite seems to be one of the most difficult parts. While there are different approaches, the principles are the same.
You would not build a house without a design and engineer, but we immediately start cutting in the mouth. To address this, we need good quality photos and casts. Futar is a great product for a quick set. Alginate will not work because you need to pour the cast multiple times. Silginat is hydrophilic and works well in the mouth. Calibration and wax-ups can help us guide best practices.
Once wax-ups are done and the plan is in place, you begin prepping with minimal structure loss by using a supragingival approach. This is a case where digital is not the best approach. A scanner is amazingly accurate, it is the printing process that has error because it cannot currently reproduce the margins with the level of accuracy you can get with impressions. You risk sacrificing tooth structure to improve your scan.
Why is being minimally invasive important? When we do a regular crown, we cut as much as 75% of the tooth structure. The risk of coming in contact with the pulp risks the chance of a root canal. It is also better for periodontal health and is ultimately faster. He feels that the science behind the method supports the approach and is ultimately healthier for the patient. Every time you go below the gum, there is inflammation.
Dr.Ruiz is still practicing dentistry and used the techniques he teaches in his courses every day. This strategy will change and simplify the way you do dentistry.
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