Excellence in Crown and Bridge

Author : Dental Product Shopper
Published Date 04/29/2013
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WEST ORANGE, NJ, April 19, 2013 ? ?It's funny that we call it crown and bridge because I don't really think of crown and bridge anymore when I think about the majority of my practice. I think about direct versus indirect,? said G. Franklin Shull, Jr., DMD, at Dental Learning?s Updates in Contemporary Dentistry meeting. Dr. Shull?s lecture cited a change in dentistry that is occurring in materials for direct and indirect restorations.

Workflow Checklist
Dr. Shull asked attendees to think through their restoration processes like a workflow or checklist; from diagnosis, to prep design, and ending with delivery.

Diagnose-In terms of diagnosing, Shull states that, ?I'm a big occlusion person, however you can't apply all the rules all the time. I think that's something that we know, but we don't always say it.?

Prep Design-According to Shull, the old way of prepping a crown is gone. ?Will we be getting rid of impression material soon? I never thought I would say this, but I really think we're to that point. Now, I'm not a hi-tech guy, and I'm not someone to jump on a bandwagon, but I really think that we have to look at the technology now,? said Shull.

Delivery-Stating quite simply, Shull asked ?Is there a difference between cementation and adhesively bonding? There is, and where does that fall in line? Are you doing the techniques right? Techniques are so technique sensitive, there is a protocol that we must follow.?

Materials Breakdown
Shull spoke about tooth colored options that have been in use for a long time such as PFMs, PFZs, and full countour zirconia. However, according to Shull, a lot has changed in this market. ?I used to do PFMs on everything, that was my go-to. I had good success and I had a great PFM ceramist. But there were always cases that we had problems with esthetically, and even strength of the ceramic on top of the PFM; we've all had chips in those.?
According to Shull, full contour zirconia, which is the strongest tooth colored material on the market, ?had initial issues with its esthetics, but things have changed with zirconia, especially in terms of wear strengths.?

Preparation Design
Near the end of his lecture, Shull posed a question to the attendees:
?Because we were taught in dental school retention, resistance, and form, we knew how to place a nice little bevel if we wanted to use a metal collar because we knew that was the best margin we could get. And in some cases, I still think that's a great restoration. But do we always have to take away as much tooth structure??

In a separate interview with Dental Learning staff, Dr. Shull spoke about lab issues and in doing so, mentioned his relationship with Drake Dental Lab. ?I think we need our labs. I need my lab, I need my lab for advice, I need my lab for a partner in my whole workflow. My lab partners are a huge part of my success,? said Shull.
Dr. Shull also made reference to a product not yet introduced in the United States that he had the opportunity to try out at the International Dental Show in Cologne, Germany last month. ?3Shape now has a scanner that I can plug into my laptop and I can use my iPad as a controller for it. It interacts with my iPad and my computer so now I don't have to have the big cart or big stand up unit. I really think that they have set a benchmark very high. I think that this is going to be the new standard.?