Sorry, this is only simple "drill & fill", not implant related
This patient dreads dental visits and wanted everything done in one visit. I usually do the endo and the crown in separate appointments in case the tooth needs to settle down after the endo. I followed our cdocs protocol of preparing, imaging, and designing the crown first. The crown was milled and finished while the endo was being done. I really like this workflow because it is easy to see exactly where the pulp chamber is, minimize the size of the access cavity, and instrument the canals. Measurements are much easier also. This tooth is an RPD abutment so the design was Biocopy. Upon completion of the endo, the crown was bonded in place and the RPD went to place perfectly--as I knew it would. A VERY HAPPY NOTE TO REPORT: I am using 4.5 and I decided to try to copy the Biocopy folder to the Working Jaw folder, cut out the tooth to be crowned, and image the tooth to be crowned after the preparation was complete. I was prepared to trash the Working Jaw folder and reimage it, but this time the cut and reimage technique worked. Go figure.
Thank you all. I think we need to remind the new users about some of the other things that can be done with our technology. Kurt, Wave One Gold cleansing and shaping, NaHCL with PIPS agitation (Fotona Lightwalker) for irrigation, and Wave One Gold gutta percha points with Brassler's BC Sealer.
Charles :
There aren't many dentists that I would allow to work on me ..... I would gladly let you do any treatment on my teeth/mouth !
Winnie
Great post Dr Chuck! It is a great day when you can offer this service to a patient! One appointment versus three! Nice work!
On 7/13/2017 at 1:24 pm, Charles LoGiudice said...Thank you all. I think we need to remind the new users about some of the other things that can be done with our technology. Kurt, Wave One Gold cleansing and shaping, NaHCL with PIPS agitation (Fotona Lightwalker) for irrigation, and Wave One Gold gutta percha points with Brassler's BC Sealer.
Same as Me Chuck! Except for the Lightwalker...although Im using the new Dentsply cordless bluetooth handpiece....you think 4.5 has bugs? SMH
Well done Chuck...
On 7/13/2017 at 7:10 pm, Kurt Kwiatkowski said...On 7/13/2017 at 1:24 pm, Charles LoGiudice said...Thank you all. I think we need to remind the new users about some of the other things that can be done with our technology. Kurt, Wave One Gold cleansing and shaping, NaHCL with PIPS agitation (Fotona Lightwalker) for irrigation, and Wave One Gold gutta percha points with Brassler's BC Sealer.
Same as Me Chuck! Except for the Lightwalker...although Im using the new Dentsply cordless bluetooth handpiece....you think 4.5 has bugs? SMH
Well done Chuck...
Thanks Kurt. I am not a Tweeter, and I don't know the translation of too many email and text message codes. What does SMH mean?
A great service from a great dentist. I second Winnie's comment: you can work on my mouth any time!
On 7/13/2017 at 7:38 pm, Charles LoGiudice said...On 7/13/2017 at 7:10 pm, Kurt Kwiatkowski said...On 7/13/2017 at 1:24 pm, Charles LoGiudice said...Thank you all. I think we need to remind the new users about some of the other things that can be done with our technology. Kurt, Wave One Gold cleansing and shaping, NaHCL with PIPS agitation (Fotona Lightwalker) for irrigation, and Wave One Gold gutta percha points with Brassler's BC Sealer.
Same as Me Chuck! Except for the Lightwalker...although Im using the new Dentsply cordless bluetooth handpiece....you think 4.5 has bugs? SMH
Well done Chuck...
Thanks Kurt. I am not a Tweeter, and I don't know the translation of too many email and text message codes. What does SMH mean?
I think it means: "Shaking My Head"
Winnie
On 7/13/2017 at 1:24 pm, Charles LoGiudice said...Thank you all. I think we need to remind the new users about some of the other things that can be done with our technology. Kurt, Wave One Gold cleansing and shaping, NaHCL with PIPS agitation (Fotona Lightwalker) for irrigation, and Wave One Gold gutta percha points with Brassler's BC Sealer.
Dr. Chuck,
Are you using the single cone GP with a touch and heat and downpacking or do you coat the canal and master cone in BC sealer and use a single cone as your sole obturation material? I have been using the Wave One Gold Gutta Core but I hate it in multi-canal teeth because the melted GP gets everywhere, including over the top of other canals. A single cone technique would be much easier as I don't imagine there would be a problem with visualizing all canals during obturation. Thanks!
Well done Dr Chuck.
Looking at the final x ray and can't find where the margin is.... WOW !!!
On 7/14/2017 at 1:23 pm, Adam Langan said...On 7/13/2017 at 1:24 pm, Charles LoGiudice said...Thank you all. I think we need to remind the new users about some of the other things that can be done with our technology. Kurt, Wave One Gold cleansing and shaping, NaHCL with PIPS agitation (Fotona Lightwalker) for irrigation, and Wave One Gold gutta percha points with Brassler's BC Sealer.
Dr. Chuck,
Are you using the single cone GP with a touch and heat and downpacking or do you coat the canal and master cone in BC sealer and use a single cone as your sole obturation material? I have been using the Wave One Gold Gutta Core but I hate it in multi-canal teeth because the melted GP gets everywhere, including over the top of other canals. A single cone technique would be much easier as I don't imagine there would be a problem with visualizing all canals during obturation. Thanks!
Thank you all for the kind words. Adam, I coat the master cone with BC sealer and slip it in. In large canals I inject a small amount into the canals after coating the gutta percha points. BC sealer is actually the obturation material. The gutta percha cone acts as a piston and drives the BC Sealer ahead of it and laterally. When the BC Sealer sets, it bonds to the canal walls and will not wash out or allow bacterial penetration like other sealers. The gutta percha point also provides a soft core for instrumentation should the obturation need to be removed and replaced. This technique has worked well for me.
Thank you for the explanation and I think I may be moving toward this technique. This is a beautiful result and something I would love to see every time. Dr. Chuck keep documenting beautiful results like this and you will be on the Siroworld lecture circuit in no time, LOL!
Nothing "simple" about this drill and fill Dr. Chuck. This is gorgeous! You are a very skilled dentist. I always love seeing your posts!!
Impressive! Great result, I have a question. The biology looks well protected. I wondered how high the axial walls of the prep are/were approximately? I was always taught to have a minimum of at least 3 mm high, of tooth structure, if possible. If I have had a failure, it's almost always been when I have less than that keeping it bonded long term. So this is very interesting to me. Do you have intra oral pictures as well? Thank you for your input.
Sorry, no intraoral photographs of this case. So I will post a screen shot for you. Not my best prep, but my excuse is a fidgety patient. There is axial wall height, a little more on the buccal than on the lingual. The shoulder is reasonably smooth--could be better--but I decided to prepare a shoulder because the axial wall height, while somewhat adequate, may be a little short in spots because of a short clinical crown. But the short clinical crown limited somewhat how far I could take the preparation apically. But the slightly short prep allowed for the shoulder to be prepared in enamel. The bond to enamel is stronger than the bond to dentin and doesn't degrade like the bond to dentin can. A 1 mm wide enamel shoulder around the circumference of the preparation provides very good retention when retention and resistance form might be a little lacking. So, a good enamel shoulder to bond to can compensate for a short axial wall. 
Thank you that was very helpful. We don't have any fidgety patients here in Colorado, but many do have the munchies 
Great case Dr Chuck!!!!!
I just got this bluetooth motor maybe two months ago and it is very nice - I like the integration with the ipad and the simplicity of it. I don't do a ton of endo but when I do I want it to be a simple process.
Dr. Chuck.....fantastic dental skills in all aspects of care. Your patient shave no idea how lucky they are to be in your care. They need to clone you and put one of you in every dental school in the country as you are the type of Doc that young dentists should admire and aspire to be like. God bless you
dave
On 7/26/2017 at 1:36 pm, Leighton Werth said... I have been looking at Dentsply's cordless bluetooth handpiece. Would you recommend it?
Meh...its quirky. Lots of connectivity problems. Balance is a bit off as well. Try it out.
No Sorry, this is "ART" Dr. Chuck.
You are a true mentor of mine and for many here, in the CEREC world, I admire your passion for dentistry and sharing it with us.
Thank you.
Daniel
On 7/26/2017 at 1:36 pm, Leighton Werth said... I have been looking at Dentsply's cordless bluetooth handpiece. Would you recommend it?
I am not familiar with Dentsply's cordleess bluetooth handpiece. I have the Dentsply/Tulsa Dental Endo motor which is designed to work with the Wave One/Wave One Gold system. I doubt that I will be changing.
