LazarLearning

In full rehabilitation treatment sequence I found different approaches in the literature.

I tried several of them and now I am using 2 approaches depending on the case.

What I found in the literature is:
1. First upper second lower
2. First lower second upper
3. First posterior second anterior
4. First anterior second posterior
5. Both the upper and lower in the same time

What is your approach and why?

How can we close black triangles in 2 steps, when the space that needs to be closed is bigger? The procedure is a little bit longer in time, but is more predictable.

1. Starting from lingual free hand or using a silicon matrix build a shell that will support the matrix in the next step.

2. Using a sectional matrix adapted for proximal area with lingual pressure with the finger. For this step flow and putty composite was used.
After finishing is also needed, of course :)

What is your approach to do it faster?

There are some cases where I use layering for more natural appearances.

Steps
- Palatal Shape
- Proximal frame
- Halo effect
- Internal layering - dentine and opal effects
- And final layer of enamel
- Finishing and polishing

Wear case done with composite occlusal and palatal and ceramic for esthetics

Ceramic crowns and 22 composite veneer.
2 years follow-up.

Nice biological integration.

Diastema closure is a challenging procedure, because we face two main issues:

1. Split symmetrical (or not) the space between the teeth
2. Restore all the proximal area, from gingival to incisal
embrasure
I found in my practice, that when I have less than 1,5 mm between the teeth (anterior) I can restore ONLY with a COMPOSITE RESTORATION the proximal area without changing too much the esthetic appearance of the tooth - not too wide.
When there is more than 1,5 mm usually I have to add material also on the buccal surface, to change the position of the transition lines, so at the end we will have a COMPOSITE VENEER.
What is your approach?

One of the most challenging procedure in restorative is to fill small spaces. Yes, it is minimally invasive, but it’s quite difficult, because we don’t have access with the instruments and the materials.

Black triangles are one of these situations. In my opinion, choosing the proper matrix and a good fit of it, is the key. A good matrix is one that is rigid and convex and has a shape as close as possible of the proximal anatomy. For that I am using sectional matrices with a small adjustment.

What is your experience with black triangles? :) Would love to hear it in the comments section!

There are only a few spots available at my new course about planning and occlusal equilibration. It is a comprehensive course that will cover key concepts in occlusion, functional anatomy, aesthetic analysis and also hands on training.

Spaces are limited, so be sure to secure your spot! Link in bio!

Space distribution when we have two proximal class 3 restorations in 7 steps:

1- place both matrices
2- restore one restoration
3- remove both matrices
4- finish and polish the first restoration
5- place again the second matrix
6- restore the second restoration
7- finish and polish

I started photographing because of a need. I needed to see all the details, to be able to analyze them. And for being able to see the big picture I needed to have all photos and documentation in front of me. I needed to find the connection between the tooth abrasion, occlusion and “the why”.

My first course that I held was a photography course for dentist. I prepared a chart that helps took all the photos for patient documentation. You can download this chart free of charge from my website! Hope it helps!

I found composite veneers to be more relaxing and less invasive when treating patients with wears and erosions.

Join us for an immersive and comprehensive course designed to elevate your expertise in full mouth rehabilitation and the critical aspect of occlusal equilibration. This specialized training is crafted for dentists seeking to refine their skills and knowledge in comprehensive treatment planning, addressing complex cases, and achieving harmonious occlusion for optimal patient outcomes.

How to proceed when implant is not an option? And a bridge would be too invasive.

For this case I preserved the functional cusps of the premolar and molar and the rest was prepared for an emax press bridge.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

When dental implants are not an option, managing the soft tissue with a small surgical intervention and an ovate provisional design can give the patient a nice aesthetic integration.

Still in love with dentistry :)  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

In cases when we need to close spaces on the anterior region, composite remains the election material at a minim invasive approach. ⠀
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Of course it is operator sensitive and needs some practical skills. To help the dentist, a wax-up with a silicon key is a very nice guide to visualize the morphology and also to split symmetrically the spaces for reconstruction. ⠀
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Another advantage is to create a palatal sheel that will help the proximal matrix to stay in the correct position.⠀
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What is your approach for these cases? Which material do you prefer? ⠀
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Dentistry connects us, brings us together at a course, but ultimately it is more than dentistry. We don’t go solely to a course for new informations, but also for the experience.

When I go to a course or lecture it is not all about the information. It is also to remember things. To refresh. To find new things, new ideas, new trends. Master new skills. To connect. Make new friends. And have fun.⠀
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I am extremely grateful for the opportunity to create E-Shape in 2023. Working and collaborating with was an honor.

I would also like to thank those who purchased E-Shape. It was not only a decision of investing in our program, but ultimately in yourself. And hearing all your positive feedback and understanding that through E-Shape you got valuable insights and practical knowledge, means so much to us. Thank you all!

There are only a few KITs available for the moment. If you’ve been thinking about getting one, now is the time. Don’t miss out on this amazing opportunity to enhance your dental skills. ⠀
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Transition lines are the key stone for a close to nature morphology on anterior restorations.Transition lines are the key stone for a close to nature morphology on anterior restorations.
These lines are the transition between the proximal area and the buccal surface. Also these lines are the extension of the root morphology.⠀
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From buccal perspective they are convergent to the apical, more for canine and less for central. From 45 degrees they are close to parallel.⠀
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With these two rules in my mind, I finish and construct the composite veneers.⠀
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What is your strategy when you construct the buccal part of the frontals?
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The realization of ceramic veneers using digital workflow is the most predictable, in my opinion.
Wax-up digital, digital communication using SmileCloud, predictable to transfer into mock-up, buccal and incisal preparation, less surfaces for scan, edge to edge occlusion.
The most challenging part that I found was the material selection for natural appearance.
What ceramic do you choose for digital veneers?

Probably you know the question - what is more important - Shape or Color?
Both are important and the question really is which one is the first to consider.
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⁣Shape has all the elements that we should focus on - aesthetic, biologic, structure and function. Once we understand the concepts, which is a continuous process for all of us, we can do any kind of restorations.

Based on this I have started the Concept of SHAPE courses
SHAPE Anterior - Composite veneers
SHAPE Preparation - Veneers, crowns, Onlay
E-SHAPE - Direct and Indirect on Posterior



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2 years composite veneer follow-up.

Repolishing was in 10-15 minutes procedure. I used a very nice kit for it. Thank you for the gift!

When I think about adhesion, I place my focus on 3 aspects:

1. What is the substrate? - could be, tooth, composite, ceramic, metal etc.
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2. What is the material that I cement? - e-max press, empress, feldspathic,zirconia, metal etc. ⠀
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3. What cement should I use?
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In this post I present you the step by step cementation for feldspathic ceramic, where my dental assistant prepares the ceramic and I prepare the tooth, to save some time for cementation. ⠀
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How much time takes for you to cement 12 veneers? ⠀
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Diastema closure is a challenging procedure, because we face two main issues:
1. Split symmetrical (or not) the space between the teeth
2. Restore all the proximal area, from gingival to incisal embrasure
I found in my practice, that when I have less than 1,5 mm between the teeth (anterior) I can restore ONLY with a COMPOSITE RESTORATION the proximal area without changing too much the esthetic appearance of the tooth - not too wide.
When there is more than 1,5 mm usually I have to add material also on the buccal surface, to change the position of the transition lines, so at the end we will have a COMPOSITE VENEER.
What is your approach?

You probably have heard “Where is your attention, it is your energy” several times. This quote came my way when I really needed it.

I realized that the best way to achieve my goals is to focus on the present. Yes, maybe check the yearly objectives from time to time, but don't put your energy there.
Because the more I put energy in the present moment, the faster I will achieve my plans without stressing on them. But if my attention is in the future and on my goals, half of my energy will be there too and I won’t be able to work efficiently in the present. So my intention is to focus on my present actions, on my patients and the treatments that I am doing today, and this way I will achieve my goals and yearly plans faster.

Tell me friend, do you agree with this approach?  
 
 
 
 
 
 
 
 
 



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One of the most challenging procedure in restorative is to fill small spaces. Yes, it is minimally invasive, but it's quite difficult, because we don't have access with the instruments and the materials.
Black triangles are one of these situations. In my opinion, choosing the proper matrix and a good fit of it, is the key. A good matrix is one that is rigid and convex and has a shape as close as possible of the proximal anatomy. For that I am using sectional matrices with a small adjustment.
What is your experience with black triangles? :) Would love to hear it in the comments section! ⠀
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5 pros for composite veneers
1. very conservative
2. easy to correct of modify
3. less expensive
4. one sesion - fast result
5. could be long time mock-up ⠀ ⠀
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5 pros for ceramic veneers
1. esthetic stability in time
2. are done by dental technician
3. natural like appearance
4. restore the natural morphology with digital design
5. what else do you consider?

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There are some cases where I use layering for more natural appearances. ⠀ ⠀
⠀
Steps
- Palatal Shape
- Proximal frame
- Halo effect
- Internal layering - dentine and opal effects
- And final layer of enamel
- Finishing and polishing ⠀ ⠀
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