Calling Dr. Howard, Dr. Fine, Dr. Howard 
Author Message
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Having participated in SMD for the last several
 months, there is an issue we have touched on
but never confronted directly.   The ADA gives
us few if any parameters of care for all the
choices of materials and techniques we have
today.  With the myriad of restorative materials  
dentists have access to, and the plethora of
techniques it is becoming more difficult  to
choose the best strategy in restoring our patients
teeth.

For example when doing a composite inlay or
onlay, when does one use the direct technique,
the direct-indirect technique, or the indirect
technique?  When does the dentist select  an
all ceramic onlay over a composite onlay or a
fiber reinforced composite onlay?

Indirect veneers offers another wide range of
options.  Do we do conventional porcelain,  
pressed ceramic, composite, opalescent, or  
polymer-glass ceramic material?  Do we do
the no preparation, conventional {*filter*}-incisal
preparation,  or the 3/4 veneer preparation?

Crowns provide even more choices.  At what
point do we select to do a crown vs. the bonded
onlay or even the 3/4 veneer?  In the aesthetic
zone do we use a {*filter*} {*filter*}PFM,  a full 360
degree PFM,  a pressed ceramic, a Captek like
material, a slip cast poured material (ie. Spinell
or Inceram), a CAD-Cam generated core with
ceramic material (Procera), or a fiber reinforced
polyglass ceramic material?

I would like to have some feedback on your
thoughts concerning material selection for
cosmetic onlays, veneers, and crowns.  Also
what guidelines you use to determine the type
of preparation.

And now a the trivia question for the day.  
Dr Charles Henry Land considered by many
dentist as the father of esthetic dentistry
invented and patented the porcelain jacket
crown and porcelain inlay around 1900.  
His grandson became even more famous and
surpassed him in name recognition.  Who was
his grandson and what was his most notable
contribution?

Respectively

Stan Goloskov



Sun, 19 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Quote:

>And now a the trivia question for the day.  
>Dr Charles Henry Land considered by many
>dentist as the father of esthetic dentistry
>invented and patented the porcelain jacket
>crown and porcelain inlay around 1900.  
>His grandson became even more famous and
>surpassed him in name recognition.  Who was
>his grandson and what was his most notable
>contribution?

Poloroid Land camera??

Also useful if not on land, however the Poloroid Sea camera cannot be
used on land.

He invented it when his grandfather said, "Hurry up." I can't wait all
day for you to take the picture of this porcelain hjacket."

Cheers,

Joel

````````````````````
PS- I believe that the gransdon's name was Nomans.

Quote:
>Respectively
>Stan Goloskov



Mon, 20 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Good guess Joel but no cigar.  Or this is not
another Kodak (Poloroid-Land) Moment.  Dr.
Land was the paternal grandfather of this
icon in American History, and in fact often
made toys out of porcelain for this person.

Quote:

>>And now a the trivia question for the day.  
>>Dr Charles Henry Land considered by many
>>dentist as the father of esthetic dentistry
>>invented and patented the porcelain jacket
>>crown and porcelain inlay around 1900.  
>>His grandson became even more famous and
>>surpassed him in name recognition.  Who was
>>his grandson and what was his most notable
>>contribution?
>Poloroid Land camera??
>Also useful if not on land, however the Poloroid Sea camera cannot be
>used on land.
>He invented it when his grandfather said, "Hurry up." I can't wait all
>day for you to take the picture of this porcelain hjacket."

````````````````````
Quote:
>PS- I believe that the gransdon's name was Nomans.



Mon, 20 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Hello Stan!

Quote:

>ie. Spinell

I just want to ask if anyone ever seen a
Spinell break. I did today. I put it there
4 yrs ago. And it broke!

How do you handle a pulpitits under one
Spinell inlay?

Hans Lennros D.D.S.



Wed, 22 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Hi Hans,

Quote:

>I just want to ask if anyone ever seen a
>Spinell break. I did today. I put it there
>4 yrs ago. And it broke!

No, but I had an Inceram crown which is slightly stronger
break on a lateral incisor.  At that time I cemented
it with a componomer.  There was a blurb on CRA
of expansion of glass ionomers and componomers
causing delayed fracture due to expansion.  Over
the last several years have switched exclusively to
resin cements for all ceramic restorations.  As we
know crack propagation is a problem that may show
up years later.  Fortunately incidence is low, and if
we are in an aesthetic zone it's tough to beat the all
ceramic restoration.  I believe it was Dr. Leonard
Abrams who said, "some people use cooking.net">food as a weapon".  
Quintessentially, our patients can break any restoration
we put in their mouths if they try hard enough.

Quote:
>How do you handle a pulpitis under one
>Spinell inlay?

I don't do Empress or Spinell inlays, Only
Sculpture/Fibercore or Concept
I assume you are talking about an irreversible pulpitis
In that case I don't, my endodontist friends do.  I do
provide them new disposable diamond burs prior to
access opening.    

Sincerely,

Stan Goloskov



Wed, 22 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Hello Stan!

Spinell was supposed to be the strongest ceram
ever made. And it was. I think the tooth with a
pulpitits clausa under a Spinell cemented with
Panavia is "done". It has to be extracted. I have
managed to get in 'on the side' but that's not a
funny business.

Quote:
>have switched exclusively to resin cements for all
>ceramic restorations.

Which one? How does that work with Inceram?
Cemented on one side and bonded on the other?

Quote:
>Sculpture/Fibercore or Concept

Is Concept from J&P aswell?

Hans



Fri, 24 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Hi Hans

Quote:

>Spinell was supposed to be the strongest ceram
>ever made. And it was. I think the tooth with a
>pulpitits clausa under a Spinell cemented with
>Panavia is "done". It has to be extracted. I have
>managed to get in 'on the side' but that's not a
>funny business.

Actually Spinell and Inceram are both made for
Vita, and both are slip cast materials.  Inceram has
higher compressive and tensile strength numbers,
but lab needs to use luminaries
to get maximum aesthetics.  Spinell was in-
tended to be in direct competition with Ivoclar's
Empress, due to it's more transluscent core.
Spinell's numbers are still ~2x Empress.  I'm
not sure how important this is.  As you may know
right now Procera seems to be the flavor of the
month, having the highest compressive and tensile
strength #'s of all ceramic materials.  The fact
that the core is cad-cam generated, we may have
less problems with crack propagation.

As for retro-endodontic treatment once the crown
is bonded in place, I think with a carefull access
preparation most ceramic crowns will stand.  How-
ever those that don't, treat as if crown is enamel
and reprepare crown restoration.

Quote:
>>have switched exclusively to resin cements for all
>>ceramic restorations.
>Which one? How does that work with Inceram?
>Cemented on one side and bonded on the other?

Panavia  21 or Insure (Cosmedent).  
With Spinell and Inceram bond to tooth structure and
cemented to crown (but due to the microscopic
anatomy this surface forms great mechanical
lockage)

Quote:
>>Sculpture/Fibercore or Concept
>Is Concept from J&P aswell?

Sorry not sure, however, at present time using
Sculpture/Fibercore almost exclusively due
to increased strength and want I percieve as
better esthetics.

Stan



Fri, 24 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Hello  DrCnBseen

My experience of Spinell is that is a material not
suited to be used in teeth. A basic rule in dentristry
(as I was thaught) is that everthing that's been put in
also shall be possible to remove. Spinell doesn't.

Anyone who ever tried to drill in Spinell knows what
I mean. Spinell had a core impossible to penetrate.
Inceram, let alone Empress, are "easy" in this sense.
I haven't heard if Vita Zahnfabrik anymore advertise
Spinell. Pulpitis is an extraction indication if there
is a Spinell. Therefore it cannot compete with Empress.
I am surprised that Vita tried to give Empress a match
with Spinell.

Quote:

>As you may know right now Procera seems to be
>the flavor of the month,

Probably it's only for the month. Procera has failed
to declare why there are so many All-ceram fractures
after some time. Even if it is a Swedish material and
I am a Swede I must say it is no good quality yet.
I have several colleques with the same experience.

Even on the Swedish dental list I am on it is often
discussed and majoroty of opinions are similar to mine.

Quote:
>The fact that the core is cad-cam generated, we may
>have less problems with crack propagation.

This cad-cam thing is only to impress some patients.
The process "in the end" is the same. (okay, you may
save a day or two in the mail).

Quote:
>As for retro-endodontic treatment once the crown
>is bonded in place, I think with a carefull access
>preparation most ceramic crowns will stand.
>However those that don't, treat as if crown is enamel
>and reprepare crown restoration.

Do you use ceram etch?
Quote:
>>>have switched exclusively to resin cements for all
>>>ceramic restorations.

Then you cannot use Inceram.

Quote:
>>Which one? How does that work with Inceram?
>>Cemented on one side and bonded on the other?

>Panavia  21 or Insure (Cosmedent).
>With Spinell and Inceram bond to tooth structure and
>cemented to crown (but due to the microscopic
>anatomy this surface forms great mechanical
>lockage)

Don't quite follow you here. Ceramic crowns bonded
and cemented are different. And it is only a few cerams
you can bond. A mechanical lock is what we have had
the last hundred years (with all the old phosfatas cem).

The ida to use bonding procedures at all is to get a
totally bonded construction.

Quote:
>Sorry not sure, however, at present time using
>Sculpture/Fibercore almost exclusively due
>to increased strength and want I percieve as
>better esthetics.

I have heard so much good about Sculpture/Fibercore
that I'll star with it. Do you make inlaybridges in this
material too?

Bye for now,
Hans
PS: What is "slip cast materials"?



Sat, 25 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Subject: Re: Calling Dr. Howard, Dr. Fine, Dr. Howard

Date: Tue, Jun 9, 1998 2:14 PM

Hello  Hans,

Quote:

>My experience of Spinell is that is a material not
>suited to be used in teeth. A basic rule in dentristry
>(as I was thaught) is that everthing that's been put in
>also shall be possible to remove. Spinell doesn't.
>Anyone who ever tried to drill in Spinell knows what
>I mean. Spinell had a core impossible to penetrate.
>Inceram, let alone Empress, are "easy" in this sense.
>I haven't heard if Vita Zahnfabrik anymore advertise
>Spinell. Pulpitis is an extraction indication if there
>is a Spinell. Therefore it cannot compete with Empress.
>I am surprised that Vita tried to give Empress a match
>with Spinell.

Have only used Spinell twice.  Fortunately haven't had
to remove crown.  Not sure why it should handle differ-
ently then Inceram.  Usually Use Empress on incisors
and cuspids.  Use Inceram on bicuspids, cuspids, and
extremely discolored incisors.  Not a hard and fixed
rule, try not to mix ceramic materials in the smile zone
when possible.  Fracture and or failure rate of both
materials has been extremely low.

Quote:
>Probably it's only for the month. Procera has failed
>to declare why there are so many All-ceram fractures
>after some time. Even if it is a Swedish material and
>I am a Swede I must say it is no good quality yet.
>I have several colleques with the same experience.
>Even on the Swedish dental list I am on it is often
>discussed and majoroty of opinions are similar to mine.

Haven't tried it, now I surely will wait till more reports
come out.

Quote:
>Do you use ceram etch?

Fluoric acid at least 5 mins, flush with water, phosphoric
acid 30 sec. again water flush.  Fine for empress or feldspathic
or aluminous porcelain.  Please correct me if I am wrong but
you can't etch the aluminous core of either Inceram or Spinell.

Quote:
>>Which one? How does that work with Inceram?
>>Cemented on one side and bonded on the other?
>Panavia  21 or Insure (Cosmedent).
>>With Spinell and Inceram bond to tooth structure and
>>cemented to crown (but due to the microscopic
>>anatomy this surface forms great mechanical
>>lockage)
>Don't quite follow you here. Ceramic crowns bonded
>and cemented are different. And it is only a few cerams
>you can bond. A mechanical lock is what we have had
>the last hundred years (with all the old phosfatas cem).
>The ida to use bonding procedures at all is to get a
>totally bonded construction.

Does not seem to influence success rate so far.  
Only one Inceram failure so far-several hundred
placed over the last 5-7 years (some even with
componomer).  But LOOK OUT for next week.

Quote:
>I have heard so much good about Sculpture/Fibercore
>that I'll star with it. Do you make inlaybridges in this
>material too?

Have three Encore anterior bridge of 3-5 year duration.
This is suppose to be the precursor.  Patent sold from
DaVincis to Jeneric Pentron.  Just inserted first two
Sculpture/Fibrekor 3 unit inlay bridges.  One on a dentist
wife.

FYI:

Sculpture/Fiberkor     Targis/Vectris           Glasspan                
resin {*filter*}d               Fiber reinforced        Flexible
fiber strips for                Framework-              Ceramic
framework                               prewetted fiber ropes

Fibers preimpreg-               Fibers saturated        Hand Sat-
nated with resin                resin voids elim-       urated with
                                                inated with vac-        resin (poss-
                                                uum pressing            ible voids)

Available in 5 shades   1 shade only            1 shade only

Flexural strength               Flexural strength       not reported
1000 mpa                                1000 mpa

Heat/pressure glaze     No glazing capibility   NA
is clear non sticky

Easy to polish                  Diffucult to polish

Quote:
>PS: What is "slip cast materials"?

Slip casting is the art and science of preparing
stable suspensions and forming ware by building
up a solid layer on the surface of a porous mold
that sucks up the liquid phase by means of cap-
illary forces.  Soudoun refined the slip casting
technique to produce a high -strenght alumina
coping with the particle size of 0.5-3.5 destined
to be veneered with the aluminous-type veneer
porcelain.

"Esthetics of Anterior Fixed Prosthodontics"
p 106 Dr. Gerard Chiche

Adhesively Yours,

Stan



Sun, 26 Nov 2000 03:00:00 GMT
 Calling Dr. Howard, Dr. Fine, Dr. Howard

Thanks, Stan.

I learn a lot from your posts!
Cheers,

Joel

`````````````



Sun, 26 Nov 2000 03:00:00 GMT
 
 [ 10 post ] 

 Relevant Pages 

1. Calling Dr. Howard, Dr. Fine, Dr. Howard

2. Calling Dr. Howard, Dr. Fine, Dr. Howard, the sequel

3. Calling Dr. Howard, Dr. Fine, Dr. Howard

4. Calling Dr. Howard, Dr. Fine, Dr. Howard

5. Calling Dr. Howard, Dr. Fine, Dr. Howard

6. Ping: Dr. Howard McC--

7. Dr. Howard H. Wayne?????

8. Dr. Howard Farran...

9. Open Letter to Dr. Howard Pollick

10. Open Letter to Dr. Howard Pollick - short version ....

11. Calling Dr. Haley, calling Dr. Haley .....

12. Calling Dr. Eichen, calling Dr. Eichen


 
Powered by phpBB® Forum Software