CASE PRESENTATION

The Art, Science, and Business of Dentistry

Success in private practice is like a 3-legged stool—you have to be able to create beautiful art based on good science with a business model in mind. If you do that, your stool will not tip over. So, whether you’re carving amalgams or doing single composites, the challenge is to do beautiful dentistry based on great science, which is why I’ve used Kuraray Noritake products my entire career.

Kuraray Noritake materials are not only clinically superior, but they have tremendous science behind them. Whether I’m rebuilding teeth using CLEARFIL PHOTO CORE, creating a strong bond with CLEARFIL Universal Bond Quick, or cementing KATANA zirconia crowns with PANAVIA cement, I know that everything is compatible and that I’m not only mechanically cementing my case, but chemically bonding the zirconia into place. If you’re not achieving a good bond, or there is postop sensitivity, or your crowns are coming off, it’s because your products are letting you down, and good business means not having to redo your dentistry.

Finally, as the following case will show, balancing the art, science, and business of dentistry also requires excellent communication with your lab, which is exceedingly important. I partner with Jean Chiha, CDT, owner of North Star Dental Lab, to create high-quality restorations using KATANA zirconia.

Case In Point

A 30-year-old new patient came to see me, and the first thing she said was, “Whatever color you want to make my teeth, I want them whiter.” As a dentist, you have to listen to your patient, and when they tell you what they want, the answer has to be “yes,” but with a caveat—the patient needs to understand the full extent of the treatment and any potential ramifications. This patient had an occlusal problem, of which she was unaware, so we had to manage this mechanical challenge while meeting her very high esthetic demand.

Making this 30-crown case even more complex was the patient’s request that nothing be touched with a bur unless it could be reglazed at the lab. The case would involve the whitest block of KATANA (HT-10). As a measure of caution, we had the lab produce a single crown for a bicuspid to ensure the patient was pleased with the work before we moved forward. She loved it.

We began the diagnostic process with models and x-rays. I did my anterior smile design using a diagnostic wax-up, and the case was then done sequentially as follows:

1) upper anteriors to achieve the smile line and anterior guidance;
2) lower posteriors to get our vertical;
3) upper posteriors to maintain our vertical;
4) refining the occlusion and entry protrusion, as well as lateral guidance through the lower anteriors.

Some dentists will try to do these cases by taking everything off at once. But I prefer sequential, which is far less fatiguing for the patient. The patient was temporized, and when the crowns were taken off, we used CLEARFIL Universal Bond Quick, CLEARFIL MAJESTY Flow, and CLEARFIL PHOTO CORE to rebuild the teeth and get them into an ideal shape. Then, the case was cemented in using PANAVIA SA Cement Universal.

The case was completed over 9 months and the patient was thrilled with the result. It was the quality of the materials as well as the communication with the lab to have Jean understand the strict requirements of this case that resulted in its success.

Partners in Beautiful Dentistry

The mission statement of my practice is to provide the highest-quality care for the greatest number of patients while maintaining a balance between the art, science, and business of dentistry. And when you have the right partners for your restorative practice, this is very easily achieved. My partners are Kuraray Noritake, KATANA zirconia, and Jean Chiha—who, together, provide the proper materials and the ability to create beautiful dentistry.

The Lab Perspective

Jean Chiha, CDT, is the owner of North Star Dental Laboratories in Santa Ana, CA, and lectures internationally on dental communication, case planning, and zirconia materials.

What has been your experience with KATANA zirconia?

What makes Kuraray Noritake different is that it has its own raw powder for the fabrication of zirconia, and this gives the material a great advantage over competitors in terms of both quality and speed in the lab. With KATANA, I can sinter one crown to a 3-unit bridge in 90 minutes, compared to others that take 2 or 3 hours. By using this material, following instructions, and adding a little bit of creativity, I ensure that the quality coming out of my lab is always at its highest level.

What made this 30-unit case so successful?

What makes an esthetic case successful is, No. 1, communication and planning. In this case, Dr. Hoos contacted me and said, “I have this patient who has a very high demand. She wants white, white, white teeth.” We always try to understand the patient’s demands, and then we plan the case together. We first work with an impression, because we need to duplicate her function and improve it. As the case proceeds, I mill everything in wax and I copy-mill, sinter, glaze, and send it to the doctor. Ultimately, we were able to complete this case successfully because we understood what the patient wanted, and we communicated and planned as a team.