Post on 11-Aug-2020
transcript
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.
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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
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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
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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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Percentage of Population:
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
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The S Type
Supportive
Steady
Stable
Secure
Serve
Sweet
Submissive
Shy
Status Quo
Sentimental
Sameness
Sucker
P
E
O
P
L
E
RESERVED
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Percentage of Population:
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
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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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Percentage of Population:
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
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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!
Fixed Prosthodontic Landscape
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
x
x
What Color is This?
X
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
Taking a Matrix Impression
• Try in the tray first!
Taking a Matrix Impression
• Try in the tray first!
Taking a Matrix Impression
• Bleed the cartridge twice
Taking a Matrix Impression
• Load the tray, don’t overfill
Taking a Matrix Impression
• Pucker up!
Taking a Matrix Impression
• For a closed or stock tray, stabilize using a claw grip
Taking a Matrix Impression
• Evaluate the impression
• Taking the matrix impression
• Preparing the matrix
• Dispensing the provisional material
• Seating the matrix
• Light curing the provisional
• Trimming, Adjusting, Polishing
• 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
• Taking the matrix impression
• Preparing the matrix
• Dispensing the provisional material
• Seating the matrix
• Light curing the provisional
• Trimming, Adjusting, Polishing
• 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
• Taking the matrix impression
• Preparing the matrix
• Dispensing the provisional material
• Seating the matrix
• Light curing the provisional
• Trimming, Adjusting, Polishing
• 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
• Taking the matrix impression
• Preparing the matrix
• Dispensing the provisional material
• Seating the matrix
• Light curing the provisional
• Trimming, Adjusting, Polishing
• 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
• Taking the matrix impression
• Preparing the matrix
• Dispensing the provisional material
• Seating the matrix
• Light curing the provisional
• Trimming, Adjusting, Polishing
• 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
• Taking the matrix impression
• Preparing the matrix
• Dispensing the provisional material
• Seating the matrix
• Light curing the provisional
• Trimming, Adjusting, Polishing
• 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
Fixed Prosthodontic Landscape
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
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Contact Info
• Dr. Tim Bizga• Like Dr. Tim Bizga on Facebook
• @DrTimBizga
• 2thLectures.com
• Email: 2thLectures@gmail.com
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