Romero Dental Seminars

Full house today with Dayton Dental Society in Dayton, OH! 🦷✨

Excited to dive into the latest in esthetic dentistry during today’s seminar and grateful for the opportunity to connect with other dentists.

How familiar are you with the Kois Dental/Facial Analyzer?
Do you prefer an ear-bow style facebow?

For me, the Kois Analyzer is the go-to system for mounting the maxillary cast—its simplicity and precision make it a game-changer!

Soon I will be uploading a video reviewing the Kois Analyzer.

Which is your preferred technique for muscle deprogramming?

There are many ways to accomplish this, but for many patients the use of cotton rolls to maintain teeth in both
arches separated for about 10-20 minutes is sufficient to relax the inferior lateral pterygoid muscle.

As seen on this photo, the cotton rolls are placed at the level of the canines and the patient is asked to “gently” hold them with their teeth.

Dr. Mario Romero and his wife Joanna are an integral part of RDS… and sometimes they have a lot of fun together….

Today at 2:00 PM with .alleman.dds

Thank you to all our friends, family and colleagues who have checked on us. We are happy to say that we are back home and safe, and that there were no damages to the office.

Our office is getting ready for Milton. Please pray SWFL. Stay safe.

Not every “esthetic case” needs to be a “Hollywood” smile. I personally think that most importantly, we need to recreate nature.

This case was completed for a 93 year old patient that did not want to go through the “lengthy” process of a bone graft and implant placement. As you can see in the pre-op scan, tooth No. 8 was fractured. It presented with a chronic infection, hyper mobility, tenderness and suppuration. It had been fractured for weeks before the patient came to tue office. After extraction, we gave the patient an essix retainer with tooth replacement.

We allowed 6-8 weeks of healing, prior to preparation of the abutment teeth, scans and temporization. Photos and a very detailed email outlining color personalization, texture, cracks and incisal edge wear were sent to Select department. The layered Zir FDP can bee seen in these sequence of photos, note how all the specifics were added.

The prosthesis was delivered using NX3 RMGI cement from which is very easy to clean (as seen on photos).

The patient was very happy with the outcome, and I am sure it will be there for the rest of his life!

With my manager, flying to Springfield MO!

Dear colleagues, hope you are having a great weekend.

I wanted to share with you today this case I recently completed. This patient was referred to me from a local Periodontist after extraction of tooth #9. Unfortunately the site was not good for an implant. Patient had a diastema between 8-9 his entire life so the periodontist had questions about the possibility of a FDP.

After a digital mock-up (not on photos) that was shared with the patient, we knew that “playing” with the line angles was going to be the way of making 8-9 not appear to wide.

We also bleached his teeth using 10% CP for 55 days. A good advice is to wait at least 15 days after bleaching before taking photos with the shade tabs you think are the best match for the patient. This information, in conjunction with a detailed description of what you are looking for in regards to texture, shape, characterization, etc, is more than enough for a skilled ceramist to re-create nature. In this case we ask the lab not to give us “perfect” teeth, since the patient had natural “less than perfect” teeth. We also asked him to add some stains and recession, wear on incisal edges, texture to mimic “aged” teeth, among other key features.

Once preparations were completed, IDS followed. Is this step crucial? It depends on the philosophy of care you practice. My plan was to “bond” the final Zirconia FDP, so I chose to follow the IDS protocol.

A temporary FDP was cemented with a little bit of flowable composite (place vaseline on each tooth prior to this). This is much easier to clean (in my hands) prior to final delivery, compared with TempBond NE.

Once we got the FDP back from lab (see photos) we were very happy with their creativity.

For boding we followed the APC concept under a split rubber dam.

For me, having the vision prior to ex*****on, is extremely important. As well as working with the right lab, where communication goes both ways, and understanding of what we are trying to accomplish is understood from day 1.

The most important thing is that the patient was very happy with the results.

Hope some younger dentist out there can benefit from some of these steps!

In times where many get “famous” for giving “old” techniques “new” names… I call this my “Bionic” teeth! 🤣🤣🤣

Predictable direct restorations MUST be completed following evidence based protocols… they are not just “simple fillings”.

Once final impressions have been completed and the new denture and overdenture are ready for delivery, you have made the decision to pick up your locator attachment by the lab or chairside. I have done it both ways but recommend doing it chairside. What do I use? I try to keep it as simple as possible, and I have found that EZ pick-up from SternGold works great. A couple of recommendations about this product:

1. When preparing the relieved area for the locator attachment on the denture make sure to give yourself a couple of millimeters in every direction so you get enough of the resin around the attachment, and always have a vent for excess to be expressed on the lingual side of the denture base.
2. ALWAYS apply the Varnish LC primer on the acrylic and light cure it for at least 20 seconds. If you don’t do this step, your locator attachment will spin in the acrylic and eventually come out.
3. Place the attachment onto the locator abutment using the black processing housing.
4. Fill the relieved area with EZ pick-up resin and seat the overdenture until it sets (excess should express out of the vent for you to check setting time).
5. Remove and polish.

Maxillary arch healing after 30 days of extractions, mandibular arch healing after 60 days of extractions and implants. Tissues look as expected while the patient has been wearing his immediate dentures.

I personally like to wait 4-6 months prior to the final denture and overdenture. Initial resorption of the alveolar ridge is highest during the first year, something we want to keep in mind so that we can inform the patient of the possibility of a reline towards the start of the second year. It might be better just to add the cost to the definitive denture so that there are no surprises.

I can’t stress enough the need to be “gentle” during the extraction phase. If you have a molar with divergent roots, split it into three or two parts, and remove each root at a time. If the tooth is single-rooted but is giving you a hard time, remove bone from the mesial and distal so that it will allow you to “tilt” it and remove it without damaging the buccal or lingual walls. The less trauma during the extractions helps with better healing. I love using my surgical handpiece with a #701 surgical-length carbide bur and go deep around the roots, it just makes it so much easier.

On the maxillary arch, after I completed all extractions, I placed a collagen plug inside each socket and secured it with a simple suture. On the mandibular arch I did reflect a flap, notice how I protect the tissue on the floor of the mouth with a single suture, this prevents the large round bur I used for flattening the alveolar ridge before implant placement. Notice how smooth the bone is, with no sharp angles.

When we are talking about terminal dentition, we must look into three major groups of clinical findings: Structural damage, number of teeth remaining, and periodontal damage. These are the pillars of Mitrani’s algorithm. In the case I am sharing with you today we followed this algorithm and decided that the best treatment for the patient was full mouth extractions. There are other two factors that are not part of the algorithm but I feel they are extremely important to help us in the decision-making process and these are the age of the patient and finances.

In this case, finances were an issue so All-on-X was not an option. Follow this case this week since we will be posting the sequence of steps.

The before and after photos for this single anterior tooth ceramic restoration speak for themselves. An almost perfect match was accomplished due to great and reliable communication between the dentist and the lab, but also thanks to the skills of the dental technician. This is very important for us to understand, not every lab out there can obtain these results. The patient was happy with the result, and we were able to preserve tooth #9 intact.

Thanks to Oral Arts Dental Laboratories

How do we select the type of restoration? This decision has a lot to do with the substrate. As seen in the first photo we had the challenge to hide the “dark” substrate present on tooth No. 8. From a ceramic standpoint we only have two options, zirconia or lithium disilicate. Out of these two options, the only one with the ability to block the dark tooth is the 3Y Zirconia.

Remember that the higher the content of Yitria, the more translucent the restoration, and that is one thing you DON’T want for a case like this. The downside to an opaque restoration is that it does not look “life-like”. So, we asked the lab to fabricate an opaque core with 3Y zirconia and then layer porcelain on top of it to create all the features needed to recreate nature and make the new tooth match the adjacent. In photos 2,3 and 4 you have different angles of the final restoration completed by the Oral Arts Dental Laboratories in Huntsville Alabama.