It’s All About That Image! Isolation Techniques For My Cerec Assistants, Part I

In the state of WA, dental assistants can image for crowns! That means you can take a “final impression” and I know, you may be thinking, “big deal”, right? Well, when you think about it, it actually is a pretty big deal. I mean come on assistants… We are trusted with the outcome of our patients restorations! That’s why it’s imperative we know what we’re doing, and we take it seriously. There are a few things that go into capturing a nice crisp image including, isolation, technique, and knowing what to look for. Here, you will find my process for making sure I get the best possible image, every time.

Isolation

So, as I’m sure all my clinical peeps already know, when preparing the tooth for an impression (digital or traditional), isolating the tooth is a key component. Most of us probably use cord with a hemostatic agent and “maybe” half the time that works great, but it’s those patients with uncontrollable heme and tissue that can give us a challenge. I’m sure there are many of you assistants that have techniques that work for you, and that’s great! I’d love to here your tips and tricks for imaging, either here, on my blog or my Facebook page, facebook.com/yourdigitalda.

The most important thing for assistants starting out with Cerec, is knowing when you got the image. This is not something you can overlook in the slightest because, it directly effects the outcome of your crown. You can’t have a single spot on the margin that looks suspicious. Any area where the heme, cord, or tissue is questionable needs to be re-isolated and re-imaged. That being said, I’d like to share some tips that have helped me be efficient with isolating and imaging for crowns.

You usually have a good idea of what you’re dealing with when it comes to the tissue, once Dr. gets into his prepping. So, start by paying attention to the tissue and devising a game plan, that way you can have an idea of what you will want and grab anything extra you may need. I will always pack at least one size 00 cord. If i’m still seeing a lot of tissue near the margin I will then pack another cord usually size 0, but I will occasionally need size 1, right over the initial cord (size 1 for deeper gingival sulcus). This is to widen the space between the crown margin and the gingival margin, and will need to be pulled before taking the image (if the heme is under control, I will sometimes pull both cords for a more clear image, especially in the 4.5 software). The idea is to pull the tissue away long enough to leave a 5 minute working time once you pull the cord out. You are on a time crunch to get the image before the tissue begins to sneak back up to that margin, or it’s covered in heme. The only time I would recommend leaving the second cord in for the image, is if you are able to see the margin sitting higher than the cord you packed and there is no tissue touching any part of it. These are the patients with a deeper gingival sulcus. If you pack the second cord and you’re still seeing some heme or questionable areas, you can then start by using a micro brush with your hemostatic agent to help clear up those small problem areas. If I have more than a couple of those feisty areas, I will sometimes have the patient bite on a folded up 2 x 2 after micro brushing. This helps a ton, because the prep is dry and often ready to image when you take the 2 x 2 out. In extreme cases, where there is a ton of heme and tissue, I will pack my cord, then use a product from 3M called, Retraction Capsule. Click here for the product picture and video. This product works well because the tip is long and narrow and reaches under the tissue when dispensing. This acts as a hemostatic agent as well as cord. Now, I don’t use this all the time because for one, cost, and two, it doesn’t keep the tissue away like cord does, on it’s own. When I do use the Retraction Capsule, it’s almost always after packing my first cord and getting a feel for what I’m working with.

Another product I have used in more difficult situations is Epi-Pellets. These are more of a last resort for me because they are time consuming. The longer they sit there, the more effective they are. The Retraction Capsule sits for 2-3 minutes, is rinsed thoroughly, then it’s ready to go.

By gauging the prep and surrounding tissue, you should be able to quickly make a decision on which route to take and what you will need to grab.

A quick overview goes like this: if you’re dealing with more of a tissue problem and you’re not seeing a ton of heme, then you can quickly decide you’re going to pack two cords and that should take care of it. If you are more worried about controlling the heme, you can pull out you Retraction Capsule and have it ready. Once you find what works best for you in those different situations, you will become efficient no matter what the case may be. It’s about being able to plan ahead for the worst and tackling the problem right off the bat. You know we’ve all been there: We try the easiest way first, hoping that you can somehow make it work and when it doesn’t, you’re starting over, waiting for images to load, going back to acquisition phase and cutting stuff out. It’s all very time consuming when you could have started tackling the problem from the get go.

A great image is considered a great image when the prep and margins are crisp, clear and without any questionable areas of tissue, heme, or cord (or anything for that matter). You can design a beautiful crown, but you won’t have a quality restoration without a crisp image! Your isolation is key to a great image, which is imperative to produce a quality restoration that’s sealed well and lasts the patient many years.

As assistants, in the State of WA, we are allowed to take the images for crowns, bridges, and implant crowns (which are final impressions). That means that we are trusted to produce a quality restoration for patients, and sometimes a failed restoration leads back to those small details that we were trusted with. Paying attention to detail is important when getting an image, designing a crown or implants, and stain and glaze. This leads me to my next tip for Assistants learning CAD/CAM.

Know What You’re Looking For

Checking the margin can be a stressful task. Remember, that the image of the margin can make or break your restoration. One little piece of cord over the margin and you’re back to the isolation step.

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Why Cerec Users Should Utilize Assistants and Add Implants to Their In-Office Workflow

Take it to the next level assistants!

According to the ADA webiste, more than 5 million implants are placed each year by dentists in the United States. So, we know the patients are there and the need will only continue to grow. General practices have the ability to, not only, place the implant precisely with an in-office surgical guide but can also load the implant and create custom implant abutments and screw retained implants, all from your own office. No lab fees! Once you learn how easy it can be to rely on your team and keep more of those restorative appointments in-house, it’s hard to refer out and give money away to a lab!

Assistants Are Capable

Maybe Doctors feel it means a ton of work and money to get assistants trained to use the Cerec, or maybe they just feel more comfortable using that lab that they have trusted in for years. Well, let me tell you how good it feels to be able to confidently rely on your team for extraordinary results, because it feels pretty damn good (excuse my excitement)! Trust me, the team, more often than not, is interested in keeping Doctor happy. So, worrying about them not doing things the way Doctor likes, should not be something that lasts long. For example, I quickly learned that my Doc likes broad contacts for his crowns, he likes the cusps and anatomy to resemble the adjacent teeth, he’s very picky about the snap the floss gives when seating crowns and will remake it if there is even the slightest discrepancy in the verification bitewing. Those are just a few examples of specifics he likes when us assistants design a crown. Implants have some similarities and differences in what he prefers and we know that. You see, these are things you will learn as you train to run the Cerec in your office. Once you learn what your Doctor prefers, you can begin to take a load off of him/her and broaden your skills in the dental field.

Stop Throwing Your Hard Earned Money at Labs

In addition to having the ability to trust your team, you are saving a crazy amount of money by keeping things in-house. For one, implant crowns from a lab are typically one of the more expensive restorations. You can create and manufacture multiple implant crowns with Cerec for the cost of one lab crown. The process for the patient and the team is time-consuming when sending cases to a lab. You take an impression, wait for the lab to fabricate the crown, and hope that the shade you have in your head is somehow going to teleport to the mind of the lab tech that takes the case. If it’s a molar and it comes back a shade or two off, the patient will likely say, “it’s fine,” or “it will do since it’s in the back.” To me, those are not the words I want coming out of their mouths. Lab crowns involve impression trays, light-body and PVS material, impression copings, charges for models, replicas, abutments and crowns. Cerec saves you and your patients from dealing with that gag reflex they can’t control. You have options as far as customized abutments with crowns and screw-retained crowns chairside, and you can do it in a single visit. Yes, I said single visit! Having control over things like that, not only saves your practice money and increases profit, it impresses the patient by saving them time, avoiding goopy impression materials, giving them the most innovative care and being able to listen and deliver on their needs.

Some labs don’t use genuine parts, which increases the risk for failure and can void warranties. We know how much Doctors like to be able to back their work! Our office uses Straumann when it comes to implant systems. Call me bias, but they are one of the leading implant companies in the world. Although, I love to use Straumann, especially since they have their own genuine TiBase called, Cerec Variobase, you don’t have to use an implant company that has their own Cerec compatible products. It may sound complicated but as long as you are using one of the many companies Sirona supports including: Nobel, Astra, Hiossen and more, you can easily order the correct size TiBase kits for your implant system. You do that math and tell me you don’t see a significant savings and profit by keeping implant crowns in-house! Also, because you are able to streamline the implant appointment, you will see a growing interest in the procedure from patients.

An article published on 1/1/2017 by Dr. Gary L. Stafford called, “Dental Impressions: The Digital Alternative,” discusses the direction we are heading with digital impressions and cites an interesting survey on just how many critical errors are identified in traditional dental impressions. You can read this article here.

Testament to Success

Our practice is a prime example of the impact that having the technology to stop passing out referrals and shipping impressions to a lab, can have. When we started doing the full implant process in-office, we saw an outstanding rise in the number of implants we place and restore. We were able to lower the cost to patients by keeping everything in-house and in 2017 we placed and restored 10 times the implants we did the previous year. We expect that number to continue to rise. If we can do it, so can you!

Assistants can help build and grow your practice in so many ways, but digital dentistry is where it’s at! If you don’t have a Cerec, get one! When we, as assistants, show interest in being an investment, it gives the Doctor incentive to take action. Digital dentistry is the only direction for a growing practice if you ask me (and all the literature on where digital dentistry is headed). Allow your team to explore their potential by adding to your digital workflow. If you own a Cerec but aren’t utilizing it to its full potential, you’re not getting the most out of your investment. Either way, your practice has so much to gain from what the digital world of dentistry is offering.

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Dental Assistants: 3 reasons to dig deeper into the digital world of dentistry

 The Land of Opportunity
As DA’s, you boost confidence in people and give them the ability to take on the world. A lot of you spend weekends away from your families, getting the training necessary to give your patients the most innovative dental care. You are passionate about people and most DA’s would agree that dentistry is something you do because you love to do it. We all know we wouldn’t show up every day to see those lovely patients that can’t put their phone down for more than 5 minutes at a time if we didn’t enjoy what we do! And now, what the digital world has opened up, is a land of opportunity. Some of us already rock the digital world with our skills in designing beautiful smiles unique to each person that sits in our chair; It’s those of you who have yet to get the full experience that I’m compelled to share what I gained from CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) and why you should dig deeper into the digital world of dentistry.

1. Expand Your Skill Set
Cerec offers you the chance to broaden your skills; Something for you to take pride in and shake that common stereotype of being nothing more than “spit suckers”. And guess what? With Cerec you can take the image (in WA State) for crowns, bridges, surgical guides and implants. You can dive into your creative side and design beautiful crowns and implant crowns for your patients. With an MCX or MCXL milling unit, you can design and mill surgical guides. You can find advantages of using Cerec for implantology and workflow at Sirona. The opportunities are endless!

2. Happy Patients Happy Assistants
From the time you seat that patient to the time they are dismissed, you will spend the most time getting to know them. Sometimes that means you get to hear all about the 7 cats she has including their names and personalities, but more often, you’re getting to know what they expect from their visit and what they want done with their smile. When you deliver on that with a gorgeous Cerec crown that you designed and hand crafted, it makes for a pretty rewarding day at the office! As assistants, we love to be busy. We wouldn’t do this job if we didn’t. CAD/CAM dentistry keeps you busy no matter what stage of training you’re in. It’s hands down the most fulfilling part of the job!

3. Be an Investment to Your Practice
In the dental world, assistants are typically compensated by experience and skill. CAD/CAM dentistry, at its full capacity, is a skill that will save your Doctor money and increase the profit for your practice. When systems are in place and followed, it’s worth it to invest in your skills so that he/she can in turn profit from keeping things in-house. By trusting in your abilities, doctors can see more patients. This applies to new Cerec users and those of you who are doing crowns, but not utilizing the Cerec for all that it has to offer. Either way, as a Cerec trained assistant, you are worth more to your practice and I wouldn’t let anyone tell you different!
Dr. Suneet Bath, owner of Impressions Dentistry located in Olympia, WA, has been using Cerec for over 10 years now and he’s had his team trained and running his machine since he got it. He has been my employer for 2.5 years, but more importantly, he’s been my biggest supporter in taking on new challenges with the Cerec. When asked why he feels investing in your team is important, he stated,
“It is important to invest in your team for many reasons. When you do so, you empower them to grow professionally and personally. This allows their confidence to grow and they do more procedures. They want to learn more and their career advances. This all leads to an increase in their job satisfaction.”
And it’s so true! As we get comfortable and confident in our jobs, most of us will look for more. It’s natural for us to want to reach new milestones.
Dr. Bath replied confidently when asked what he gets out of it by saying,
“A lot. Their increased knowledge takes pressure off you when they do some of those procedures you can delegate. This allows you to be more productive. As they learn more, you want to learn more, so you do different procedures and again, you are more productive. Your confidence grows and your work gets better. You are now a pinnacle in your community and as a result, you are more satisfied with your job.”
If that’s not team work, I don’t know what is!
Lastly, here’s his take on what Cerec contributes to the topic.
“You are looked at as the leader in technology which inspires your team and impresses your patients. You can have an in-house lab that produces extraordinary results and you do not have to change much about what you do, besides allow your crew to take charge. You will save tens of thousands of dollars and make crowns that last longer and that patients like more. So, what’s not to like?”
Sounds like a win-win to me! Continue reading “Dental Assistants: 3 reasons to dig deeper into the digital world of dentistry” →

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