Chairside - Glidewell Dental Labs

low. If I’m about to prep away that contact, now the risk
just went up. I can also see visually with the leaf gauge in,
when they’re touching that first contact, how far apart their
front teeth are. Again, if the number is 3 or 4 millimeters
and something changes, I know I’m going to see it and it’s
going to affect my prep.
MD: So the take-home message for dentists is that the most
common trap we’re going to fall into is on those second molars?
LB: Exactly. Then, statistically, are there first molars? Sure,
but it’s a smaller number. Are there people who have it on a
pre-molar? Sure, but now it’s a really small number. Maybe
you do nothing more than stopping before you prep the
second molar and asking if this is the tooth that’s the first
point of contact. I used to get really weird about that when
I thought I had to do a bilateral manipulation, and I don’t
think I’m unique to that. I think that’s a technique where
people aren’t sure what the heck they’re doing. But do it
with a leaf gauge, and it’s super simple. You can learn to do
it with a leaf gauge very quickly, probably one time using it
and having someone explain it to you, and now you have it
on your tray so you can figure that out.
MD: I’m sure that is of the things you teach in your course. In
fact, you do some online courses as well. Is that one of them, the
occlusal therapy course?
LB: Absolutely. I just completed the online course called
“Occlusal Diagnosis: Identifying Risk,” and it really is
geared toward the general dentist, the restorative dentist.
What we talk about is how you do an exam in a way that,
if somebody is going to have risks from joints, muscles
or their occlusion, you can identify those people; those
red flags are obvious. With this group of people you can
say to yourself, I’m going to slow down and get more
information, versus the folks where you can just prep
the teeth.
MD: If people want to find that online and sign up for that
course or watch that course, where do they go?
LB: They just go to my website: www.leeannbrady.com.
MD: Perfect. That would be a great place for them to go.
I was just reading the American Association of Cosmetic
Dentistry’s State of the Cosmetic Dentistry Industry report they
released for 2011, and it talks about how cosmetic dentistry
has really been down. How veneers have been down almost 10
percent since 2007. When you break down the veneer numbers
here in our laboratory, the IPS Empress ® veneers (Ivoclar
Vivadent) continue to shrink and shrink at an alarming rate.
But the good news is, at least for the veneer department, that the
IPS e.max ® (Ivoclar Vivadent) numbers for veneers continue
to grow, and that mirrors what I do for any multi-veneer case
now. IPS e.max is my go-to material, and I love something that
looks essentially as esthetic as IPS Empress, though maybe not
exactly the same in terms of esthetics, but certainly no patient
can tell the difference. I love the fact that it’s three-times as
strong as IPS Empress. Are you finding yourself using e.max
more for veneers as well?
LB: That is a great question. Of my posterior restorations in
my practice now, I can’t tell you what percentage are e.max,
but the vast majority of them are lithium disilicate. For me,
it has really replaced porcelain fused to metal. I do lithium
disilicate almost exclusively in the posterior now. For the
anterior, it’s a place where I’m playing with it. I go to the
research and I look up how important that extra strength
is in the anterior. Really the science doesn’t support that
it makes much difference around materials, and we went
through that for years when we talked about the different
kinds of ceramics in the anterior. Now if you want to talk
about a patient who is a bruxer, who has edge-to-edge
wear, I wouldn’t even think twice about it now. When
people say, “I want to do beautiful anterior veneers and
I’m concerned about strength,” e.max, or lithium disilicate,
is definitely the material of choice. But in patients where
that’s not a concern, I don’t have a strong preference.
I’ll tell you how I do it: I actually talk with my technician.
I send my technician all of the pre-op photographs for the
case. I tell them what the pre-op shade is. I show them
that this is what the patient wants. The patient wants this
much of a shade change in the final restoration. They want
Hollywood, where it’s monochromatic and it’s really high
value, or they want totally natural. I give the technician all
of those parameters, and then I say, “What do you think you
can get me the best results with? What do you feel like you
work with the best to get me those results?” At that point,
it’s really an esthetics decision. I have preferences over what
kind of composite I use for different esthetic situations, and
I want them to know that I happen to like this color system
or this staining system better, but because the ceramist is
the person stacking the material and working with it, they
get to choose.
One of the technicians I work with all of the time is a
huge fan of lithium disilicate, so I have had a chance to
do a number of anterior cases, veneer cases, using lithium
disilicate. What they have done with the esthetics is just
dramatic in the last couple of years. With the esthetics of
Ivoclar’s new Opal series, their ingots and their blocks, it’s
going to get to a place here really, really quickly, where
it’s going to be hard to differentiate, from an esthetic point
of view, what material was used. In that case, sure, why
wouldn’t we use the strongest thing we have out there?
MD: If you look at the numbers of what we’re doing in the
lab, probably the most shocking thing in the last two years
has been how the PFM is literally disappearing. It’s gone from
being about two-thirds of the crowns we made here five years
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