3 Reflections from a Composite Veneer Case – IC003

Main Podcast: Guys, it’s Jaz Gulati from the Protrusive Dental podcast and today’s interference cast is just three tips I have to share with you. Based on my reflections of doing a composite veneer case recently, patient’s main complaint was actually different to begin with. And actually this is part of the sort of the three little tips I want to share with you guys. So let me discuss three learning points from this case number one will be communication tip. Number two will be how I managed the interproximal part of doing composite veneer. And number three will be the composite refinement tip, I’ve got a bur that I want to recommend to you to use for composite refinement, which I found really useful. So before we come on to that, if you’re listening to me on the Protrusive Dental podcast, then yes, you’re still gain from this because I’m sharing some stuff that is tangible, even though you’re listening and not watching. But it’s probably worthwhile going logging on and actually watching the seeing the images, so you get to see what I’m talking about. But anyway, let’s proceed. So tip number one I have for you is regarding communication. This patient initially came to me and she had busted her upper right five, she went on to get a vertical crown on upper right five in Zirconia, which I’ve done and as you can see, that’s done. But actually her main complaint after was that actually, I don’t like the way my crown looks at the back and she was pointing to her metal ceramic crown on the upper right six, as you can see that she didn’t like the fact that the color was a bit off to that yellow bit too warm. And she didn’t like the fact that there’s a gray line. And we all know why that is a metal ceramic crown is the metal showing through. So when you have a case like this, and you look at this lady smile after her teeth are actually framed really nicely within her lips, she’s 68 years old, she looks great when she tells me that she has an aesthetic concern, instead of replacing this upper right six, because there’s two good reasons why I shouldn’t replace it upper right six. One is that it’s still healthy. The margins still good, even though it’s done many years ago is still a good tooth. But the second reason is because she has a limited opening. And for me to do a good job back there in a limited opening compared to I’m assuming she had a better opening many years ago when the crown was first done to actually be a pension to be doing a disservice for this patient. That’s two good reasons. But the third good reason is will that really massively help her smile. So by changing the upper right six crown to something a bit nicer that says a Zirconia or just a better color with no metal, that may improve her smile and her perception, but really look at the anterior is look at the upper right one, the upper left one and upper left two. Yes, in this particular photo, I’ve just put a composite blob on to check shade. But if you have a look at this original photo, you’ll see that they are, they stand out because they’re discolored and they don’t match the adjacent teeth, which actually have quite a high value. The overall benefit aesthetically this patient might changes the upper right six crown in a very tricky area in a limited opening and a healthy crown. It didn’t make sense to me. So I suggested to her “Look, I understand that you want to improve something but your smile. But have you considered improving something about your front teeth because they don’t match very well?” And she said yes, absolutely. I’ve considered this I just never knew it was possible. So what we can learn from this is that actually, I’m usually very careful about suggesting aesthetic treatment to patients who haven’t listed as one of their goals because you don’t want to come across as salesy and you don’t want to offend the patient, you don’t want to make them aware of an issue which they never thought was an issue. It’s not a nice thing to do. So when the patient actually mentioned that they have an aesthetic concern, or one thing that’s completely fine to do, as part of your consultation, you sort of say, Are there any aesthetic concerns, anything about your smile, not happy about that’s fine, because you’re asking them, instead of pointing something out? You actually ask him you invite him to say something? And sometimes I say no, I’m happy, or they might give you some concerns. But in this case, she gave me a concern, a direct concern herself about the upper right six. So this gave me the opportunity and the invitation to discuss her smile. And I said to her, Angela, to improve the color and appearance of your front teeth, we’ll have a much bigger impact on your smile than changing this upper right crown. And she agreed. So we went on to do the three composite veneers. And when I did them, she was really happy. And she said what they all say they say I wish I’d done this many years ago. And when I asked Now, why didn’t you? And the answer is always the same. I never knew it was possible. So she’s been a regular attender for the last 40,50 years. And I think it’s something that she wanted to have done. Maybe it’s not been in top of mind for that many years and maybe didn’t look that bad 30 years ago, but if I have a long that she’s been upset or unhappy about her front teeth, I think the dentist had been seeing and I’ve been doing a disservice, because something that’s actually going to improve her quality of life, improve her confidence and smile and someone that she’s always wanted. So it’s important to discuss the patient’s smile with them when they invite you to do so, that’s my communication tip I have based on treating this case. The next case, the next tip I have for you is how I manage the interproximal area when I’m doing a direct composite veneer. Now I’ve tried various techniques in the past, including ptfe, double ptfe, or just going ahead and not really worrying about it in bonding to the sort of contours that I want. And then getting a flat plastic and soften it within the PDL, separating the teeth and then polishing and disking it off. But actually the the best technique I use now and what works best in my hands now is the mylar pull techniques. If you’re not familiar with a mylar pull technique, here is a video on YouTube, I’m gonna put the link for down below that you can actually down watch at your leisure and actually see this mylar pull technique being used. And I think it’s really good. As you can see, the mylar is pulled. And this creates a nice smooth interproximal contour. And I’ve actually known about this technique before. And I’ve probably seen this video some years ago. But it wasn’t until I went on this man’s course. That’s Dipesh Palmer. And it was the mini smile makeover course that he actually made it quite tangible for me. And at his course the tip they gave me was to use some wetting resin on the mylar. And that actually helps me to create a smoother interface intra-approximately. So my tip for you is interproximal management. Use the mylar pull technique if you’re not already. And if you are, are you using wetting resin? If not, try it. So I had this tip to Dipesh Palmer with teaching me and mentor me on that. The next tip I have for you and the final one is how I like to finish or shape my composite veneer cases or my composite, anterior composite in general. And it’s actually a bur that I have to recommend, this bur I learned about this bur from going on this man’s course as Thomas Seeley, one of the best dentists I know. And he is someone who taught me how to use his very specific bur to shape composite. And it’s been phenomenal. It’s been a real workhorse in my practice. And it gives me predictable results. So it makes even these average hands produce good outcomes because of the fact that the bur is just such a great shape. So Thomas, thanks so much for introducing me to this bur, I’m going to share this nugget with you all now. The bur is called the Perio bur. So thank you for, thank you to Style Italiano for also sort of teaching about this bur technique. And actually one of my Italian nurses Titi. She taught me that actually, it’s not Style italiano, it’s Style, Style italiano. So actually, it’s Style italiana, not style italiana. And this is the bur as as it’s shown here. And what I like to use this bur for, it’s actually it’s really great for adjusting along the three planes, incisal, the mid and the cervical planes. Because the shape of it, it makes it really easy to access and refined sort of the line angle area as well. So and the fact that you can put it into a slow handpiece makes it very, very easy to use. And it really gives you a control and the tactile feedback. So the perio bur has been an absolute game changer for me in practice. Here is another photo of it in use. And here’s the bur code, the bur code is 83120401 to contact your comment rep in your country to solve that, buy this bur. And if you’re unfamiliar with how to read bur codes, the first bit a three one is the sort of shape of the bur. The next bit the two or four is the So what kind of bur is it, so this is one for the slow handpiece. If it’s 314 that usually means it’s the friction grip, ie fast handpiece and the 012 at the end or the last three digits will always mean what is the size of that bur at the tip. So this bur is 1.2 millimeters at the tip. So that’s my three nuggets. I hope you liked them. If you liked it, please subscribe. And if you’re listening on the podcast, thanks so much for listening. And if you don’t, if you’re not listening to my podcast moment, why aren’t you? Thanks so much. Cheers.