10 Minute CEREC Bridge Preparation POV. GoPro Hero 8. Teeth 28-30. Omnicam and MCXL

Thanks for tuning in again. This is another point of view video recording of a bridge preparation from tooth number 28 to tooth number 30. I think the angulation is pretty close. It's from a head mounted camera with a 3.5 magnification ocular. It should be pretty accurate. However, the angulation is slightly different from what I see in my eight power surgical loops. So there are a couple of times when the handpiece or my hand will actually block the view when in reality, through my loops, it's not blocked. I'm looking to get a slightly more slightly high powered ocular for the camera lens so that it's not quite as grainy, there's a little bit of graininess, it's not quite as clear. And then I've got to update some of the white balance settings on the camera to improve that some of it gets a little bit washed out. But generally, I think it's a good video. So the total elapsed time on the preparation is roughly 10 minutes. There's some edits here that you won't see there's some little transitions where there's some fades from one clip to the next, where I had to change a burr or we had to refill the distilled water bottle. But yeah, generally, it was about 10 minutes. I usually tell my patients that each tooth preparation for a crown assuming a normal situation takes about five minutes. However, sometimes they're a little bit longer depending on the situation, you know, upper second molars can be a little more difficult to get to just because of access. Sometimes the lower posterior teeth can also be a challenge just because of access. Anyway, all that being said, the elapsed time on the preparation was roughly 10 minutes, give or take here there. And then immediately after this preparation video, it'll jump right into a screen recording of the bridge design. So this whole appointment, we had a lot of three hours for this patient. The actual time the patient was in the chair was, I think, I think we had the patient in the chair for about 90 minutes at the beginning. And then there was a roughly one hour delay. And then for the cementation after, maybe it was longer than that, after the patient returned from a break, after leaving the office while the machine was milling the bridge and we were firing it in the furnace, the cementing took 45 minutes or so, plus the post-op x-ray and some occlusal adjustment. So maybe it was three and a half hours when we totaled that all up. But at the beginning, you know, if you break it down, 15 minutes of anesthesia, plus a little bit of prep time, if you get started on the preparation at about the 30 minute mark into the appointment, and get all the scanning, imaging, designing done by about the first hour, including the preparation, then honestly, you should be able to complete a bridge like this in less than three hours. I usually give my patients an opportunity to leave. So we're not necessarily sitting there, but I want them to know that they don't have to leave. Some are embarrassed or uncomfortable leaving with an un-faced or with, you know, their teeth prepped down. So this patient did leave and then came back a little while later. Turned out to be a great case. I've got some post-op pictures I'll try to plug in here in a little bit. Our post-op x-rays rather, I am looking at the post-op x-ray, my lead assistant missed the x-ray that included the entire abutment, anterior abutment. So it's a little bit cut and then there's some extra cement which she removed from underneath the pontic space. But the bridge itself looks good. I did not get an intraoral post-op picture. I wish I would have. Maybe on a recall, we can get one from the patient on a recall appointment. So great case. I mean, pretty straightforward, pretty routine stuff. I usually do, you know, as much as possible in one appointment. So the patient has a quadrant of dentistry they need. I have no problem doing the bridge and a couple of crowns or several crowns or root canals. Tends to be a little more effective. There is some other work this patient needs that we may do down the road. But we had opted, whether it was time-wise or financial reasons, to go and focus first on the bridge. So turned out great. Nice opportunity to create a little video for you. Hopefully you'll enjoy. The point of view kind of enlightens, you know, allows us to see a little bit more. For those of you who may not necessarily spend a lot of time doing dentistry or have not had a lot of experience in the clinical side of things, this is an interesting view. So right here you can see some bleeding in the gums. That's fairly common. You know, I like to tell my patients, you know, gums tend to get angry when we're spinning a handpiece at 5,000 revolutions per second down next to them. They don't like that too much. And that's pretty common. But as you can see later on, a little bit later on, I'll pull out some viscostats and aluminum chloride and scrub it along the gum line. I don't normally use a lot of cord. I don't interact a lot with cord. I haven't used cord in quite a while. Usually I feel like if I prepped the tooth, I know generally where the margin is. And so I have no problem going ahead and outlining my own margin. That begs the question, do you do most of your own crown and bridge design? I really do. I do almost all if not 100% of my own CEREC design. I've been using CEREC since 2006. And I'm pretty quick at it compared to my dental assistants. And I trust several of them to do the CEREC design. But I'm much, much faster. So I feel like there's value in the time saved. Overall for me to take three or four minutes designing a crown or five or 10 minutes designing a bridge versus them taking 30 minutes designing a crown or an hour designing a bridge. I'd much rather just do it the way I'm comfortable with. And, you know, dentists generally have a better grasp on some of the crucible anatomy and, you know, interdigitation of the opposing arches and yada, yada, yada. So I usually do most of my own design work. Here is the viscous stack going in. Like I said, this is aluminum chloride, I generally don't use ferrous sulfate. I personally prefer aluminum chloride, the ferrous sulfate tends to clump. And I'm not a big fan of that. Plus, we get some patients that are allergic to sulfa drugs, and I don't want to risk the ferrous sulfate causing an allergy for a patient who may not have disclosed that. Yeah, aluminum chloride works really, really well, good scrub and rinse and then you get a pretty darn good margin, clear margin. Now, if at this point, you don't feel confident that you can marginate, then putting some port in would be a good idea. I feel pretty comfortable with those margins, especially since I prep them, I know where they are. And like I always tell, you try to coach, if you're ever in doubt as to where your margin is, take it a little bit outside, you can always adjust that margin back when you're bonding in or after you bond in. If you're too narrow, I'd rather be too wide than too narrow. So here's the bridge design, you can see we have it set up as a bridge with the anatomic intersection space, intersection shape rather. Go ahead and image the lower and the upper and then go through the design process, pretty straightforward stuff. Again, this is an Omnicam. This is a six year old Omnicam, pretty clear margins. There's little carries there on the facial at 27. One of the nice things about the software 4.5, you can see that dark shadow there, which turned out to be rock solid, that's just stained from an old silver filling. So I stopped removing it when I discovered that was rock solid in that decay. But the 4.5, I'm sorry, the 5.2 software really improved the imaging of the Omnicam dramatically. So it allowed allowed the Omnicam to function a lot better. One of the offices that I'm partnering in has the newer PrimeScan. And I'm still trying to get used to the touchscreen and the trackpad versus the trackball. I, to be honest, I'm not quite a fan of the PrimeScan yet, primarily because of the trackball and the touchscreen. Granted, I've only used it for a couple of days, but I'm so used to having that tactile feel with the trackball that I'm not, I'm not, I'm not 100% sure I'm going to really enjoy the PrimeScan for a while. But like most things, once I'm used to it, I'm sure it'll be fine. So you can see there, I grabbed a piece of a patient's napkin while I was imaging and didn't realize it for a minute. So we gotta go back and delete that. Delete that memory scan. Anyway, the rest of the design process is pretty straightforward, pretty simple, not a big deal. You can watch the whole imaging process. Transcribed by https://otter.ai