get it, got it, glue it: a comprehensive guide to terrific...

Get It, Got It, Glue It: A Comprehensive Guide to Terrific

Temporization

Timothy M. Bizga, DDS, FAGD

www.2thLectures.com

ABOUT ME

Just Give Me the Facts

• We practice in a different time

• Stickability will only happen if you grow to meet your customers needs (Fortune 500 1956 v. 2016)

• For every 10% you lower your fee, you need to work 3x as much to make up the lost revenue

“Success in dentistry is mainly dependent on doing the basics well”

~Anonymous

“Success is not an accident!”~ Tony Robbins

Why Customers Leave

• 9% Leave because of competitors

• 10% Leave due to other reasons

• 14% Leave due to product dissatisfaction

• 67% Leave due to attitude or indifference (connection issue)

Where is your skill level?

The Law of the Mirror

• You must see value IN yourself to continue to add value TO yourself

• You will never rise about the level of YOUR SELF IMAGE

3 Things Employers Look For

1. Loyalty/ Dependability

2. Positive Attitude

3. Desire to learn new things and keep growing

• Anything that is healthy, keeps growing!

7 Questions of Goal Setting

1. Why do you want that goal?

2. What risks/sacrifices are you willing to take?

3. Once you get there, how will it benefit you AND others?

4. Analyze where are you now…where do you need to go to get there?

5. What day will you reach it? (Vision vs. HOPE)

6. What is the REWARD?

7. Are you willing to take the stairs? (TIME)

Patient types

✓ Never Been to a Dentist

✓Acute needs before

FIXES

Patient types

✓ Dental Phobic

✓Motivated by Pain

Patient types

✓ Last Trip about every 2-5

years

✓No Insurance

✓Be aggressive in

treatment….do not

monitor small things

TREAT

Patient types

✓ Regulars

✓ Learn their preferences

✓Cost Conscience

✓Want the Best

✓Missing teeth

✓Basics and Function First

✓Esthetically driven

What matters to the Patient

• Can I trust you?

• Are you committed to excellence?

• Do you care about me?

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Challenges with Patients

• Time

• Patients don’t tell the whole truth

• We have to marry NEEDS with WANTS

• “A Profession in Transition”

Rapport is Power

• Total responsiveness between people

The Magic of Rapport

1. Rapport is created by feeling of commonality

2. Words are only 7% of communication

3. Matching and Mirroring

– Milton Erickson, MD

– People like people who are LIKE THEMSELVES; or how they would like to be

4. Style is more important that substance INITIALLY

Purpose of DISC

1. To help you better understand YOURSELF

2. To help you better understand OTHERS

3. To help you be MORE PRODUCTIVE and have LESS ANXIETY when dealing with people

4. To treat others as they wish to be treated

• The one who knows this information is the one responsible for using it and applying it!!

Reserved

Outgoing

First Question

1. Am I more Outgoing, or am I more Reserved?

Understanding Yourself …

Everyone is “wired” differently. To understand yourself better, ask yourself these two questions:

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Understanding Yourself... Traits to look for:

Outgoing / Active

Fast - paced

Involved

Energetic

Optimistic

Positive

Enthusiastic

Outgoing / Active

Slower – paced

Cautious

Concerned

Reluctant

Critical thinking

Discerning

Reserved

Outgoing

Their focus is on talking

things out.

Their focus is on thinking

things through.7

Second Question

2. Am I more Task-oriented or People-Oriented?

Understanding Yourself...

Task-

Oriented

People-

Oriented

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Understanding Yourself … Traits to look for:

Task-Oriented People-Oriented

Form

Function

Programs

Plans

Projects

Process

Relationships

Caring

Sharing

Emotions

Feelings

Friendships

Task-

Oriented

People-

Oriented

Their focus is on getting

things done.

Their focus is on other

people and how they feel.

9

P

E

O

P

LE

RESERVED

OUTGOING

T

A

S

K

Remember: Everyone is a unique blend of these four parts.

When you combine these two ways to divide the circle, you will see that they give

the circle four parts, so you can visualize the four temperament types.

Most people have predictable patterns of behavior. They relate to specific personality styles. There are

four basic personality styles: D, I, S and C. They are also known as temperaments. They blend together

to determine your unique personality style. The graphic overview of the Four Temperament Model of

Human Behavior will help you understand why you often feel, think and act the way you do.

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Dominant

Demanding

Direct

Determined

Decisive

Doer

Director

Dogmatic

Dreamer

Diligent

Dynamic

Defiant

The D Type OUTGOING

T

A

S

K

12

Percentage of Population:

Examples:

Basic needs:

10%

Donald Trump, Judge Judy, Dr. Phil, Hillary Clinton

Challenge, Choices and Control

D Types Make Good...

Administrators

Athletes

Boxers

Builders

Business Owners

Coaches

Developers

Directors

Drill Instructors

Entrepreneurs

Executives

Fighter Pilots

Foremen

Government Agents

Law Enforcement Officers

Lawyers

Military / Special Forces

Motivators

News Anchors

Private Investigators

Producers

Race Car Drivers

Real Estate Developers

Sales Managers

Supervisors

Truck Drivers

12

The I Type OUTGOING

Inspiring

Influencing

Inducing

Impressive

Interesting

Impressionable

Important

Interchangeable

Interested in People

Imaginative

Impulsive

Illogical

P

E

O

P

L

E

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Examples:

Basic needs:

25% - 30%

Oprah Winfrey, Ellen DeGeneres, Dr. Tim Bizga

Recognition, Approval and Popularity

I Types Make Good...

Actors

Airline Attendants

Auctioneers

Broadcasters

Clowns

Coaches

Comedians

Entertainers

Evangelists

Meeting Planners

Peace Corps Volunteers

Performers

Politicians

Preachers

Public Relations Directors

Public Speakers

Masters of Ceremonies

Radio Personalities

Receptionists

Reporters

Salespeople

Teachers

Telemarketers

Telephone Operators

Travel Agents

Wedding Consultants

16

The S Type

Supportive

Steady

Stable

Secure

Serve

Sweet

Submissive

Shy

Status Quo

Sentimental

Sameness

Sucker

P

E

O

P

L

E

RESERVED

20


Examples:

Basic needs:

30% – 35%

Dr. Martin Luther King Jr., Paula Abdul, Mother Teresa, Gandhi

Appreciation, Security and Assurance

S Types Make Good...

Artists

Child Care

Workers

Counselors

Customer Service

Representatives

Department Heads

Diplomats

Flight Attendants

Funeral Directors

Human Resource

Directors

Librarians

Managers

Nurses

Painters

Pharmacists

Pastors

Planners

Real Estate Agents

Researchers

School Teachers

Secretaries

Social Workers

Supervisors

Technicians

Veterinarians

Waiters/Waitresses

20

The C Type

RESERVED

Cautious

Competent

Cognitive

Careful

Calculating

Critical Thinking

Compliance wanting

Conscientious

Correct

Conformist

Consistent

Cold

T

A

S

K

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Examples:

Basic needs:

20% – 25%

Diane Sawyer, Clint Eastwood, Tiger Woods, Martha Stewart

Quality Answers, Value and Excellence

C Types Make Good...

Accountants

Architects

Artists

Authors

Bankers

Bookkeepers

Composers

Computer Programmers

Consultants

Dentists

Engineers

Finishing Carpenters

Inventors

Lawyers

Librarians

Mechanics

Military Intelligence

Musicians

Philosophers

Photographers

Physicians

Pilots

Professors

Scientists

Surgeons

Teachers

24

Meet “Al”

Fixed Prosthodontic Landscape

• An average office performs 256 single unit crowns per year

• 256 x 150,000 general dentists = 38 million single unit crown procedures per year!

• Office Profitability of a single unit?

– Full fee vs. Insurance

– Direct vs. Indirect?

• What does this mean to the office?

– Efficiency and Effectiveness

– Consider Retakes!


Protection

Go-To Product

Chlorhexidine Comparison

www.OraCareProducts.com

Chlorhexidine OraCare

Anti-Bacteria Exceptional Exceptional

Anti-Virus Poor Good

Anti-Fungal Poor Exceptional

Neutralize VSC’s Poor Exceptional

Destruction of Biofilm Poor Exceptional

*Without Side Effects

• 2 oz Travel Sets

• 16 oz Patient Sets

• 32 oz Operatory Sets

Size Options

Shade Analysis and Communication

SHADE TAKING FACTS

1. 60% of remakes are blamed on poor color match

2. It takes 5 new crown cases to cover the cost of

one remake

3. Improper color selection causes great frustration

for the doctor, the laboratory and the patient,

losing time and money for the dentist and

laboratory.

Principles of Light

Shade Selection

CLINICAL TIP:

Determine the Shades Needed for the

Restoration Prior to Tooth Preparation

Shade Selection

• A Desiccated Tooth Will

Appear Lighter than Normal

• Select the Dentin Shade By

Examining the Dentin

What is necessary to see color?

• Light

• Object to interact with the light energy

Limitations

What Color is This?

1. MOST CRUCIAL component for shade taking in Dentistry in VALUE

2. Second most crucial component for shade taking is TRANSLUCENCY

3. Third most crucial component for shade taking is CHROMA

4. LEAST CRUCIAL component for shade taking is HUE

Dental Shade Guides

VITA Classical Shade guide

Metamerism

Vita Shade Tabs vs. Colored Background

RULES FOR TAKING shade1. Patient sitting UPRIGHT at an EYE-EYE conversation distance

2. WELL-ILLUMINATED area preferably with color-corrected lighting or Ott-Lites® (sold at Office-Max or Target) held 2 feet from patient

3. Take the shade before you start the procedure

4. Match VALUE first, then CHROMA, then HUE keeping in mind TRANSLUCENCY and its important for anteriors

5. Take a PHOTO

– Be sure to place the shade tab IN THE SAME PLANE as the teeth, incisal edge to incisal edge

6. Recharge your RODS and CONES by looking at an Neutral Gray or Light Blue

7. Lightly wet the teeth and the shade tabs with a clear liquid glaze prior to evaluation

“The Most Abused Impression Technique”

Albers HF. Impressions. 1st Ed. Alto Books; Santa Rosa, CA. 1990.

Sources of impression distortion

• IF YOU ARE PREPPING THE MOST TERMINAL TOOTH IN THE ARCH, YOU CANNOT USE A TRIPLE TRAY!!! YOU MUST USE A FULL-ARCH OR QUARTER ARCH

Closed bite trays should only be used for 1-2 unit cases, with natural occlusal stops

Check it against a lightbox!

Is this a good scenario?

Function of Temps

• Maintain static contacts

• Calm state

• Maintain occlusion

• Trial OVD

What is an Ideal Temp?

Adequate Anatomy

Minimal Inflammation

Emax + Ceramir Cement

Features of Provision Materials

1. Polymerization Choice

– Dual v. Auto

2. Air-inhibited layer

3. Fluorescence

4. Flaking when trimming

– Margin design

5. Fracture Strength

– Clearance

6. BPA free

• Taking the matrix impression

• Preparing the matrix

• Dispensing the provisional material

• Seating the matrix

• Light curing the provisional

• Trimming, Adjusting, Polishing

• Cementation

Taking a Matrix Impression

• Use a impression tray (closed bite, closed tray, quadrant tray, custom tray, etc)

• Create a putty matrix


• Try in the tray first!


• Bleed the cartridge twice


• Load the tray, don’t overfill


• Pucker up!


• For a closed or stock tray, stabilize using a claw grip


• Evaluate the impression







• Cementation

Preparing the Matrix

• The matrix impression can be modified to ensure the provisional:1. Remove from mouth inside matrix

2. Has better interproximal contacts

3. Does not replicate fractures or missing tooth structure

Preparing the Matrix

• The matrix impression can be modified to ensure the provisional:– Has better interproximal contact







• Cementation

Dispensing the Provisional Material

• Bleed the cartridge twice

Dispensing the Provisional Material

• Fill approximately ⅔ of the tooth in the matrix impression, don’t overfill to prevent excess







• Cementation

Seating the Matrix

• When using a closed bite tray, re-seat tray into the mouth making sure it is fully seated and the teeth fit into the impression with the patient fully closed







• Cementation

Light Curing the Provisional

• Let the material set for 90 seconds in the mouth then remove and command set with 20 seconds of light curing

Light Curing the Provisional

• After 20 seconds of light curing, or approximately 5 minutes from the start of mixing, remove the provisional from the matrix

Evaluate the Provisional

• The provisional can be a diagnostic tool

• Remember breakage of the provisional can be related to insufficient occlusal reduction







• Cementation

Trimming, Adjusting, Polishing

• Trimming:–Use a straight nose handpiece

and acrylic burs

–Palm-thumb grip

Trimming, Adjusting, Polishing

• Polishing:–Use a straight nose

handpiece and brushes or rag wheels

–Palm-thumb grip







• Cementation

Types of Provisional Cements

• Resin-Based – containing di-urethane di-methacrylate

• TNE (Temrex)

• Tempbond Clear (Kerr)

• Zinc Oxide Eugenol• TempBond (Kerr)

• Zinc Oxide NonEugenol• Temp Grip (Dentsply)

• Polycarboxylate• Durelon (3M ESPE)

Integrity Temp Grip Technique Tips

• Bleed the syringe twice!

Value Added Clinical Benefits

• Minimizes the threat of post-op sensitivity because desiccation is avoided

• Simple clean-up

• Leaves a clean field for easier definitive cementation

Value Added Clinical Benefits

The amount of money it can cost a practice when a patient has to return to have the

provisional re-cemented (in lost production, time, materials)

Integrity Temp Grip Technique Tips

• Do not desiccate the tooth before seating!

• Moist cementation reduces opportunity for sensitivity

• Barrier results in the cement staying on the provisional and not on the tooth

Formula for SensitivityStart with trauma and then

desiccate

Let’s wrap it up with one last case…

Prep Design

SHOULDER CHAMFER

METAL CERAMIC CROWNS

FINISH LINES

#856 016 Course Diamond

Is this the proper way to take a bite registration?

Thin articulating

Inlays and Onlays

• Triple tray method gives a very stable result, but there are other aleternatives

• FERMIT- Ivoclar✓ Modified Microfill✓ Requires NO-CEMENT✓ EXPENSIVE

• Clip Flow- Voco✓ Works exactly like Fermit,

but not as costly✓ Pink

Second Appointment (approximately 30 mins)

1. Remove provisional crown and residual cement (anesthesia)

2. Fit and occlusal adjustment of permanent crown

3. Final cementation, clean excess cement

10 mins

10 mins

10 mins


Crown Seats

• First remove the temp and clean the prep

• Try-on the crown✓ Check fit, check contacts

(snap floss), check occlusion, check margins (xray), check color

• Legally the dentist must cement the crown BUT…

• You can disinfect the prep

• Review the post-op instructions

Disinfection

In-Direct Tooth Colored Restorations

Full Zirconia (BruxZir) Highly Popular and Growing

PFM Popular but Reducing

Zirconia Based (Lava, Procera) Steady but Slow growth

Lithium Disilicate (Emax) Moderate/Steady growth

Leucite reinforced (Empress) Minimal Use and Declining

Polymer (belleGlass, Sinfony) Minimal Use

Resin Nano Ceramic (Lava Ultimate) Promising and Growing

Feldspathic, Stacked +Fired Ceramic Minimal Use

Permanent cements

Conventional

Glass Ionomer

Self Adhesive Resins

Resin with Separate DBA

BioDynamic Cements

How do we treat this surface?

Question

• Who are you going to be in 5 years?

– Answer: Very much the same you EXCEPT 3 things…

• Books you read

• People you meet

• Thoughts you tolerate in your mind

Contact Info

• Dr. Tim Bizga• Like Dr. Tim Bizga on Facebook

• @DrTimBizga

• 2thLectures.com

• Email: [email protected]

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get it, got it, glue it: a comprehensive guide to terrific...

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