1st Edition

Hello there!

Still contemplating whether this course is for you?

Well, let us give you a little secret tip to help you be a little more slick with your adhesive indirect cementation!

Do you struggle with PTFE? What even is PTFE? Have you tried using it, got so muddled that you just gave up?!

Well, we are here to help you out. PTFE is a hugely versatile, cheap and effective aid to so many treatment protocols, we think it is a wonderful addition to the array of materials used to make modern adhesive dentistry great!

Have a look at the image below, does this look familiar to you? Have you tried isolating teeth like this but just given up because it’s just so fiddly and it stresses you out?!

Well, let’s break down this photo to make things a little more palatable!

Ok, so what’s the clinical tip then?!  

Here it is!

Use your paintbrush that you use to sculpt your composites with, to help wallpaper the PTFE over and around the neighbouring teeth to get it snug at the cervical margin and make post-cementation clean-up as easy as possible!

PTFE? Paintbrush? Cementation under rubber dam? Secondary clamps?

Is all this a little overwhelming?

Well do not fret! We are here to help you step into the future with our course on modern adhesive restorative principles!

Happy cementing!

Zahid and Zo

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2nd Edition

Dear ReCreators!

This week we’ve got 3 for the price of 1!

3 clinical tips that is! Here are 3 changes that will help enhance your resin retained bridges:

1. SOFT TISSUE management: Often you will find a discrepancy in the gingival zeniths when restoring an anterior space with a RRB. A simple and predictable way of modifying the soft tissue at the pontic site is by using an essix retainer with a composite pontic. By adding a bit of extra composite to the pontic and getting the patient to wear this full time for a few weeks you can slowly develop the ideal pontic site. Alternatively you could use a small RPD for this. Both these methods also allow for you to assess the ideal proportions of the pontic prior to final delivery:

2. JIG for cementation: Relocating the bridge at cementation can be a challenge, in particular if a single abutment is being used. Theres nothing worse then getting to the final stage and a positioning error making the difference. A locating jig decreases the risk of this occurring significantly and also allows the bridge to be held stable whilst you are cleaning up the excess cement. Ideally you ask your lab to make this (simple enough with some acrylic). If for some reason this isn’t possible or they have forgotten to do so, then you can make this yourself chair-side, using some puty and the working model with the RRB in situ (make sure to cut some small notches to allow access for clean up)

3. RETENTION: Finally don’t forget long term retention for your patient, in particular if they are young. Teeth move and it is common to see anterior RRBs which are out of position. When you ask the patient if the bridge was like this at cementation they will often tell you that it was fine initially and over the years they have noticed the change in position. An essix retainer is a simple solution to prevent this happening for your cases:

If you found these tips useful then let us know either by email or on socials!

Look forward to seeing you soon

Zo and Zahid

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3rd Edition

Dear ReCreators!

This weeks clinical tip is one of our most requested: how to record centric relation (CR) for full mouth rehabs/tooth wear cases/splints etc

Theres a more detailed discussion of this we will have on the 2-day Restorative course, but in the meantime here is a summary of the 3 main methods we use routinely  

Lucia jig:

How to use it: This can be fabricated chairside with some acrylic or purchased prefabricated (this tends to be my go-to, as below). Reline the jig onto the central incisors, with some bite registration material so it is stable when biting. This should result in the flat anterior platform being the only area of contact against the lower incisors. Now encourage the patient to periodically clench, slide backwards, forwards and side to side. This will start the deprogramming process- usually takes around 10-15min of letting the patient clench and then rest in this position. You will notice the mandible relax enough for you to be able to easily manipulate it at this stage. If you place some articulating paper on the platform and get them to move in excursions a backward arrow will make a point that marks CR (see second image). You can then record the position using bite reg material on the posteriors. I have used an additional stage in the example below (third image) using flowable composite on the jig as a third registration point which helps me guide the mandible into this position

Pros:

- Slow, controlled method of predictably finding CR

- Feels more stable and easily reproducible compared to the leaf gauge  

- Inexpensive jig

Cons:

- Does not allow you to record at different vertical heights (which would be useful when opening OVD)

Leaf gauge:

How to use it: plastic leaves are inserted to prevent the back teeth from meeting. The patient is encouraged to slide back and forwards and periodically clench. Leaves are slowly removed until you have a single point of contact (note this as the initial contact point for future cross reference against your articulated study models). Insert one extra leaf and record this position as CR.

Pros:

- Allows for you to set the desired vertical height and record this for the lab

Cons:

- Risk of over distalising the mandible

- Less stable/control due to the flimsy nature of gauge compared to jig

Kois deprogrammer

How to use it: This is a lab made device that has a small anterior platform for a single point of anterior contact and posterior disocclusion. The patient is required to wear it full-time, only taking it out to eat or clean. The patient is reviewed weekly over 3-4 weeks, at each visit, you check the position of the anterior contact with articulating paper. Once the position is consistent over 2 weeks this is considered to be CR. A bite registration is taken at this point. This can be used as a diagnostic tool as it gives you an idea of where the interreference is occurring.

Pros:

- Longer term deprogramming, a more reliable position?

- Diagnostic tool- the mark may move forward instead of backwards, highlighting an anterior interference/constricted envelop

Cons:

- Patient compliance

- Additional lab stage

- Arbitrary vertical position set

This is a critical but dense topic (!) and a lot easier to show in person with the various devices.  

If you found this email useful, then let us know by tagging us in your socials. What topics should we cover next?

Zo and Zahid

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4th Edition

Dear ReCreators,

After a few weeks off, heres this weeks clinical tip on creating primary anatomy and form with your anterior restorations.

We get losts of questions asking what kind of composite we use for anterior work or how to shade match for these cases. However the single biggest factor in getting your anterior restorations to blend in seamlessly is the primary anatomy you create. This applies whether you are restoring a simple class 4 restorations or bonding onto several anterior teeth

Here are 4 key aspects I always check and adjust once I have placed the composite  

1. Incisal embrasures: look at the white arrows marking the incisal embrasure regions. We want the central embrasure to be narrow, slightly wider at the laterals and widest at the canine. Keep these symmetrical and adjust with a coarse soft flex

2. 3 planes of adjustment: Notice the 3 lines on UR1. These mark the 3 planes that all adjustments are made on the tooth. They corespond to the differnt angluation you should hold your hand piece when marking adjustments at different paerts of the tooth. Keep this consistent across all the teeth

3. Line angles: notice the vertical mesial and distal line angles marked on UL1. These represent the transition from the flat surface of the tooth to the curved portion. By having them further apart you will make the tooth look wider, by having them closer together the tooth will look more narrow. Again keep this consistent to the contralateral tooth for symmetry. You will find marking this with a pencil useful.

4. Buccal grooves: Note the blue triangles on the UL1. These mark the developmental grooves found on most anterior teeth. By enhancing these you will highlight the proximal line angles and create a more natural aesthetic.

We will be going into detail during the practical part of the course: the kind of burs we use and in what order to create life like anterior restorations.

Zo and Zahid

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6th Edition

Hi ReCreators!

Its been a while since our last clinical tip, so let’s jump straight in.

A common issue we find with class 4 anterior restorations is trying to mask the transition line between tooth and composite:

There are a few key factors to consider to minimise the risk of this error.

1.       Pre op assessment: its important to identify the cases where there is more risk of the transition line showing. Typically if the tooth is more opaque and uniform in colour (generally older patients with a greater proportion of dentine) you have a reduced risk of this being an issue

2.       Creating a long bevel: a 2mm bevel is considered ideal to mask the join line. We aim to place a more opaque dentine shade to cover the first 1 mm, before a final enamel shade covers the entire 2mm.

3.       The ‘reverse triangle technique:’ This is a simplified version of the above long bevel. We place a more opaque dentine layer first. This is thickest at the join line (more coronal aspect) and thinnest towards the incisal edge. An enamel layer is then placed in a reverse relationship that is thinnest at the join line and thickest towards the incisal edge. Consider the images below to see this in action:

We can simplify this concept further diagrammatically:

On the 2-day Restorative course we go into a lot more detail to help you seamlessly integrate your anterior restorations. It’s a busy 2-days as we cover all things modern adhesive dentistry:

-          Rubber dam (practical’s)

-          Anterior composites (practical’s)

-          Posterior composites (practical’s)

-          Adhesive tooth wear protocols

-          Adhesive onlays

-          Verti preps

-          Bonding protocols

-          Restorability assessment

-          Optimising your mental health and mindset

If you haven’t already booked onto the course the final date of the year is in Birmingham and seats are going fast. We have attached the course outline for reference.

To reserve your spot follow the link to leave a deposit: Click Here!

Look forward to catching up with you guys soon

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Zo and Zahid

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