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Letters to the Editor
Dear Dr. DiTolla,
I have been watching the free clinical videos
on the Glidewell website and am impressed.
Thank you for making these resources available
at a price that’s hard to beat.
If you wouldn’t mind, could you answer a
few questions? These questions focus on
the video “Diagnosis & Placement of No-
Prep Veneers”:
1) Would it be helpful to relate midsagittal
and interpupillary planes to the lab, as in
a Kois Dento-Facial Analyzer (Panadent;
Colton, Calif.), or in your experience is this
not necessary?
2) What brand of retractors were used (two
types are shown)?
3) How do you deal with interproximal contact
issues — hyper or hypo — at try-in,
especially as there is no gingival margin to
act as a stop?
4) How do you know when you need to use
“shade-adjustable” porcelain?
– Vincent Johnson, DDS
Bay City, Mich.
Dear Vincent,
Thanks for writing and for the kind
words! Here are some attempts at answering
your questions:
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www.chairsidemagazine.com
1) It is very helpful to include that
information; however, if you parallel
the incisal edges of your preps to the
interpupillary line, that is our default
way of mounting the cast. That being
said, it is much easier for us to do
that if a Kois Dento-Facial Analyzer, or
even a stick bite, is included.
2) The one I like best is the SeeMORE
retractor from Discus Dental. There
are rumors that they may stop selling
that product, so I am looking into having
it made here at the lab because we
have an injection-molding machine on
the premises.
3) The contact/seating issue is the
worst thing about no-prep veneers.
Sometimes I have the lab make a little
finger of ceramic on the incisal edge
of the veneer to prevent overseating,
but then you have to grind that
all away after bonding it into place.
Really, it all comes down to “feel” and
some educated guesswork. I hate procedures
like that, but I haven’t found a
better way yet.
4) You never have to ask for shadeadjustable
ceramic anymore because
it is now the material we use on all
these types of cases, except for the
ones where we are trying to block out
a darker shade of tooth — something
lower in value than an A3. In those
cases, we either need to opaque the
inside of the veneers or have the doctor
prep the tooth so we can make the
veneer a little thicker.
Since that video was produced, however,
I now do nearly all my veneers
in IPS e.max ® (Ivoclar Vivadent; Amherst,
N.Y.). Because it is three-times
stronger than IPS Empress ® (Ivoclar
Vivadent), I have yet to experience
any of the incisal chipping or breakage
that I did over the years with IPS
Empress. In fact, IPS Empress is dying
a slow death in our laboratory, while
the number of IPS e.max veneers we
do continues to grow. I foresee a time
in the not-too-distant future when all
veneers will be IPS e.max because of
its optimum esthetics and strength.
Hope that helps!
– Mike
Dear Dr. DiTolla,
Just wanted to send you a note to say
how much I enjoy reading your interviews
in Chairside magazine. The two with
Drs. Howard Farran and Paul Homoly are
must-reads for all dentists. Sometimes I
feel you read my mind with your questions.
Keep up the good work.
– Steven Bellantese, DDS
Bronxville, N.Y.
Dear Steve,
Thank you for your kind words. I love
long-form interviews, yet they seem to
be such a rarity in dental magazines
these days. I never feel like I learn
anything from the one-pagers. It takes
a few pages to ask follow-ups and give
someone the space to answer.
– Mike
Dear Dr. DiTolla,
Thank you very much for the practically
helpful educational support your lab provides
to dentists. I wonder if you give written
directions or drawings to the lab technician
about the desired thickness of the wax-up
design (in other words, how much dental
tissue it is safe to prep). As a rule, technicians
overprep teeth on the model, which
leads to extra time to fit.
Cordially,
– Alex Zavyalov, DDS
New York, N.Y.
Dear Alex,
Yes, when I am having a diagnostic
wax-up done, I will often send along
one of my 0.6 mm depth cutters from
my Reverse Preparation Set (Axis