dentalinfotoday

[dentalinfotoday]

 I find that it is helpful to leave several hours during my working week that are not to be scheduled with patients for me to treat. This allows me to tackle tasks that require thinking or may be time consuming, unpleasant or both.  I can't speak for other dentists, but some of these activities make me anxious or put me in a less than positive mood... Probably it is best not to treat patients when dealing with some issues. 

Four years ago, I started teaching part time at NYU College of dentistry on my day off (Friday) and Thursday morning for three hours. Prior to working at NYU, I left open time on Fridays or Thursday mornings for non clerical activities. As much as I enjoy teaching , I don't like having limited time  to for my non clinical hours and was forced to deal with these activities between scheduled patient appointments.

Two weeks ago I requested to limit my teaching hours to Fridays and I have resumed my old habit of scheduling time consuming clerical activities on Tuesday or Thursday mornings, when we do not have a hygienist in the office. I find that my general mood has improved and I can handle these activities in a non hurried manner when I have no patient interactions. 

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/06/why-do-dentists-have-some-time-booked.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 The short answer is there is no one best crown for every situation, but more and more dentists are opting for all ceramic crowns.... either Zirconium or lithium dislicate. They are used in different clincal situations. Please be aware that This post is not intended to be a deep dive into the subject, but may answer may questions about all ceramic crowns

So what be the appropriate indications for using the different types of ceramic crowns ( full thickness milled zirconium , Porcelain fused to Zirconium, full thickness lithium disilicate( pressable or milled),  and litium disilicate layered with porcelain. How to make sense of all these choices? Ok , lets try and clarify the different options and which is best in different situations. 

Presently, monolithic zirconium crowns are the most commonly made crowns by dentists nationwide. These come in three Primary types; High opacity, medium opacity and high translucency. The opaque version is somewhat stronger and fracture resistant than the other two and is primarily used for restoring molar teeth, since strength and not esthetics are a patients primary concern.  For most premolar teeth the translucent type is chosen unless the teeth holding the crown has a cast metal post or a large amalgam core. In that event a more opaque version of the zirconium restoration is probably a better choice. 

While some dentists are using a protocol that allows the use of composite cements and bonding to lute in these crowns, most dentists are using resin modified cements for luting these restorations, since they are easier to use and the clean up of excess cement is easier.

If greater esthetics is desirable for a zirconium crown, the decision can be made by the dentist and the lab to coat the buccal and occlusal with porcelain.  These crowns are termed porcelain fused to Zirconium. While these are highly esthetic, they are less strong than any of the full thickness zirconium crowns.

Lithium dislicate is often used in the anterior region, since these are highly translucent and. can be customized with either micro or macro layering on the labial surface of these crowns. While these are best luted with composite cements, some dentists opt for resin modified glass ionomer cements due to their ease of use.  It should be noted that  these crowns are considerably stronger when luted with composite cements as opposed to the resin modified option.

Sometimes for shorter tooth preparations , lithium disilicate is a better choice since bonding may be a more secure luting option  since short preparations may have compromised  retension especially when other types of dental cements are employed.

For patients with a deep bite who need an anterior crown,  zirconium may be the best choice for a crowns lingual surface, because it is more fracture resistant when compared to either porcelain or lithium disilicate. 

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/05/what-type-of-crown-is-best-for-me.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 It seems that our entire society is experiencing a consolidation of services. Amazon, for example,  essentially drove most of the smaller book sellers out of business.  Then Amazon added other types of goods and now it is the behemoth of vendors seemingly selling anything the heart desires. We have seen the advent of large pharmacy chains that are providing medicines (Walgreens, CVS, Rite Aid) and they have more or less eliminated other smaller privately owned  pharmacies. Presently large hospital systems are swallowing other smaller hospitals as well as purchasing privately owned medical practices. 

The same trend can be observed in dentistry, where investors have funded chains of dental offices that are buying existing privately owned dental practices.  Many of my graduating seniors at NYU College of Dentistry have received generous offers with starting salaries that are over $150,000 per annum . These dental chains often have modern well appointed offices and spend considerable amounts of money on advertising. Their fees are generally are reasonable and I am sure they attract a considerable number of new patients. 

One of my colleagues sold his practice to one such chain with the understanding that he continue to work in the practices after its purchase. Privately he complains that he no longer  is able to dictate the way his former practice is run.

 They operate using a business model that  emphasize efficiency and volume of procedures. In my opinion the consortiums running these chains hope to grow their billings enough to eventually sell their growing practices to another investment group or do an IPO so that they can cash out with a hefty profit.

Personally I would be wary of going to one of these for my dental treatments since they seem equivalent to "fast food dentistry" and as we know fast food is attractive, but a steady diet of eating could be detrimental to our health.  Fortunately many people share my concerns and my own dental practice is still healthy. My staff and I get to know each patient and tailor our treatment plans to their needs. We never "over treat" and spend a great deal of time explaining the reasons for our treatment plans. One important function of a dentist is to help our patients make truly informed choices about their treatment, including which treatments are most urgent and which may be performed later (Staged treatment). 

When I see my longtime patients, many who have been coming to our office for fifteen years or more, they often comment on how well we have maintained their teeth and I always reply that it was a "team effort" since they chose to come to our office and follow our recommendations. Our success could only have been accomplished with their cooperation and many could have chosen to go to other dental offices closer to their homes.  They recognize the importance of proper dental care and we are honored to have been chosen as their preferred dental provider.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/05/fast-food-dentistry.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 I get asked this question a lot by my patients. While in the last year we were seeing fewer patients, starting in this March I noticed an increase in patients scheduled in my office. Many of these patients were  "lost in action" during the protracted Covid Pandemic. Many  returnees mentioned that after their recent booster and the simultaneous lull in New Covid cases in NYC, they felt safe enough to visit us. 

While my staff and I were happy to see them again, many have experience dental problems and put off seeking treatment until after they were full vaccinated. The truth is that with or without current vaccination seeking dental treatment is a safe option and probably is preferable to delaying dental care indefinitely until the pandemic is over. This is especially true because our pandemic seems to becoming endemic ( it is here to stay... Like the season flu or the risk of contracting a common cold). 

I am not implying that proper precautions should not be maintained. Our office has air purifiers through out our space and all my staff is vaccinated and wearing appropriate PPE( masks and gloves) while treating patients. All patients are screened prior to treatment and patients who report experiencing recent health problems that might be covid are asked to wait 10 days before having an appointment in our office. Patients are instructed to leave their masks on until they are seated in an operatory and have their temperature checked upon entering the office.

If you haven't seen a dentist in the last twelve months we will be happy to see you. Appointments can be booked over the phone [phone]) or by visiting our office website at: lspindeldds.com and using our book and appointment button. 

Most patients have reported that they are happy with the steps we have taken to keep them safe and were glad that they came in for dental treatment and you will probably feel the same as well!

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/04/in-this-march-i-noticed-increase-in.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 I have been practicing in my own private office since 1984 and the business has not changed that much with the exception that it seems that insurance companies are facilitating a race to the bottom. New dentists signing up for a plan are told they must accept lower reimbursement schedules. Although dentists are not allowed by the law to set their billing rates with each other, insurance companies can in effect force lower rates for dentists signing up for the first time. Its seems to be a reverse type of "price fixing" scheme. 

This has the effect of lowering the net profits for dental practices, since after all the overhead bills are paid, what is left over is "profit" that goes to the owner. Traditionally in an owner operated dental office the dentist ended up being paid a percentage of billings. While it used to be common for fee for service dentists to be paid about 40 percent of their profits, most practices have seen the owner / operator's percentage shrink. This is probably due to the increase in salaries, rents and other bills while our overall billings may be diminishing due to increase competition from practices that accept most insurance plans . 

Meanwhile there seems to be an increase in the number of "corporate dental offices" that are buying existing practices and hiring young associates at high salaries. I suspect that these practices are operating on slim or nonexistent profit margins. Could it be that they are operating similarly to how Amazon started out. Amazon didn't make a profit for many years but was able to drive most competitors out of business. 

In fact many businesses have been started by owners whose primary plan is to build up their billings to a high enough level that they can arrange for a profitable IPO on a stock exchange, whether or not their company makes a profit. The founders then can cash out with a tidy profit and the new management is left with the chore of seeing that their new purchase can start generating a health return on their investment.

It really alludes me how a practice that pays their associates extremely well, but accepts lower fee insurance plans, can generate a 10-15% return for their investors after all the bills are taken care of. To me this seems a little reminiscent of Ponzi scheme. If I was thinking of investing in one of these corporate dental offices, I would carefully examine the books to see if it was indeed too good to be true.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/03/are-corporate-dental-offices-to-good-to.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 Dentists, like most people, are creatures of habit. For many years we have been told by laboratories to provide 1mm shoulder or chamfers for our ceramic crowns. While this may make it easier for our labs to fabricate restorations, but now that they are predominantly fabricating milled zirconium and lithium disilicate restorations this amount of chamfer depth is more than the minimum needed. For those of my readers who are wondering what a chamfer or shoulder refers to, it is a shelf that provides the finishing line for this type of restoration.  Since this area is not the part of the restoration that has to deal with occlusal forces, probably all that is needed is about  a .5mm deep chamfer (or shoulder).  Since conserving tooth structure can ultimately influence the success or failure of a crown and the tooth supporting, preserving tooth structure is very desirable. The deeper our chamfers are, the closer we get to a tooth pulp when we are preparing a vital tooth (one without a root canal). Also, the teeth supporting teeth are subject to flexing forces and are more likely to sustain a fractue when deeper chamfers are used. This is especially true when we are dealing with a tooth that has a root canal, since it already has been hollowed out by the required hole created to provide endodontic access. 

An argument could be made to make a slightly deeper chamfer to allow for additional digital relief of undercuts caused by preparations with small undercuts so possibly .75 mm could be an advisable depth to compensate for small undercuts at the base of a preparation.  That being said, a far better time to correct undercuts is before taking a a final impression. This can be accomplished with small additions of bonded composite to eliminate undercuts in the preparation.

Clearly it is time for dental schools to change their core curriculums to encourage shallower more conservative crown preparations especially for all ceramic crowns. Yes, most crowns still benefit with more generous occlusal clearance (1.25-1.5 mm) and most lab technicians still prefer that 1 mm of clearance should be ideally provided for the area of the incisal 1/2 of the preparations used for all ceramic restorations. They feel this amount is desirable because it helps them create more esthetic restorations as well as making them less prone to fracture.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/02/how-deep-chamfer-or-shoulder-is-needed.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

We are a family dental practice specializing in Implant and Cosmetic Dentistry. Probably  my dental practice is somewhat out of step with the directions most businesses are going. There seems to be a general movement away from owner /operator businesses. No matter which way we turn there seems to be the trend toward consolidation of businesses This supposedly helps to “increase efficiency and cost effectiveness”. As far as I can see , this trend has not improved the general level of service and satisfaction that customers receive. Instead, this trend has resulted in fewer choices for consumers and often less competition between providers.

When calling these businesses  we are often forced to spend a fair  amount of time listening to automated messages while we wait  to possibly speak to an actual representative. This trend has already impacted the delivery of medical care and will likely increasingly effect dentistry as well.

In our “old fashioned” dental office we have no automated message that callers are forced to deal with . and instead  my office manage answers phone calls cheerfully. She treats each caller with the respect they deserve and patients often point out how lucky I am to have her working for us.

We accept delta and Cigna dental insurance and are willing to help our out of  network patients figure out their reimbursements  prior to performing our more costly procedures( crowns, implant restorations, multiple restorative restorations or perio treatments )

My staff and I remain committed to providing up to date dentistry in a caring and careful manner.  Although we are not their most inexpensive option, we do not provide unnecessary dentistry and make sure our patients fully understand why treatments are needed . We intend to remain committed to providing this type of dentistry for as long as we can. 

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/02/what-kind-of-dentistry-do-you.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 I have been using N95s since June of 2020 and have treated numerous unmasked patients while in my office and at NYU College of Dentistry. Actually I "double mask" using a type II or type III surgical mask as an outer covering. The second mask keeps my N95 from getting overly soiled and allows me to get multiple uses out of each N-95 mask. The masks I wear are "genuine" and not counterfeits. The have a NIOSH label and actual numbers stamped on the masks. These masks are either given to m by the dental school or purchased in batches from Schein dental.

For most of this time I have taken the subway home from work and lately the trains are getting more crowded. Invariably there are multiple riders either not wearing a mask or wearing one improperly (often they are seated next to me). To the best of my knowledge, I have not contracted Covid. My conclusion is that N95's offer significant protection from Covid, including the Omnicron varient.

We have been giving out N95 masks in our dental goody bags that patients receive after their teeth are  cleaned. If they desire we give them on lesson on how to don and wear their new gift mask as well. While most of the patients are pleased a surprising number report that they don't like wearing the N95 masks. Usually we discuss the benefits of wearing them while on public transportation and shopping in stores. 

I explain that these may take some getting used to but will tend to keep them safe while they are out and about.  Hopefully my patients will benefit from wearing these masks and at least for a while avoid getting a breakthrough case of Covid. Even if Covid is here to stay, it seems prudent to avoid getting it for now, since some of the medicines that can be utilized in treating patients are in short supply and hospitals still have their hands full dealing with new Omnicron infections.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/01/do-n95-masks-protect-adequately-against.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

  The answer is apparently not, at least in my experience. Last November I received a Re-credentialing packet and I gathered all the appropriate paper work, filled out the application as instructed, and scanned everything into a pdf format on my computer. I emailed everything to the address indicated on the application ([email protected]) and asked them to let me know if anything more was needed. When I received no response, I assumed that all was well.

This Monday my office manager brought me another letter informing me that Delta had contacted me multiple times asking me to re-certify and I had not responded and if they didn't hear from me shortly they would be forced to take me off their panel. I looked over the information and now they had a different email address to send the application and documents to ([email protected]). I forwarded my original email to the new address.

Buried somewhere in the new paperwork was a phone number (Credential Unit 866-689-7884)  that I could call, but when I called there was a recording informing me that they couldn't speak with me because they were busy "processing" their credentialing paperwork. This seemed pretty ironic since they had never acknowledged my original application. They did send me back an automatic email reply that they had received my inquiry about re-credentialing ( after I forwarded my application to the new email address). 

Just to make certain , I had my office manager send a completed set of paperwork via Fedex as well (signature required). While I understand Delta maybe short on staff right now due to Covid, I really do not feel sorry for them. Our office has been continuously open since June of 2020. It hasn't always been easy for us, but thankfully my staff and I are all vaccinated and doing fine. We are fully staffed and continue to take the steps needed to keep ourselves and our patients safe.

We have hepa air purifiers in all our rooms, and carefully disinfect rooms after each patient's visit. All instruments are scrubbed and sterilized before each use and all personal wear the appropriate PPE (personal protective equipment). Before we see patients our office manager carefully interviews each patient to screen out those at higher risk for having covid and when our patients arrive we check temperature and an oxygen levels using a pulse oximeter. 

 We answer our phones and book most patients appointments for the same week that they call and we also offer online booking of appointments on our website, 24 hrs per day. 

Possibly it is  too much to expect Delta to commit to the same standards they insist on for their own participatint dentists. The least they could do is answer their phone or at least have a answering system that allows us to leave a message. Unbelievable!

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2022/01/re-credentialing-with-delta-is-easy.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

I  believe that using a Waterpik as an adjunct to brushing and flossing can help my patients keep their gums healthier. I have already covered the reasons in earlier posts but suffice to say it facilitates fluid exchange of sulcular fluid around the roots of the teeth and can cut down on gingival inflammation. 

Many of my patients, who live in apartments with relatively small bathrooms, complain that they don't want to use a waterpik in their bathroom because it needs to be plugged in. They have often commented that they would be more likely to use a smaller battery operated model. The problem is that most of the battery operated models are much less powerful and probably less effective.

When I went to the Greater New York Dental Convention at the end of November I stopped by the Waterpik booth and asked them what they had that was new and they showed me a battery operated model called the Ion Professional. It is smaller than their standard plugged in models and it has a rechargable nickel cadmium battery that they claim can hold a charge for up to one week.

I took one home and tried it out and it works as advertised. While I'm not sure it is practical to use in the shower ( another frequent patient request) it works fine sitting on my bathroom sink, without needing to be plugged into a socket. The water reservoir is easily removed for filling or cleaning and the stream it produces is plenty powerful. 

My sole complaint is that I keep spraying my bathroom mirror when I use it because I turn it on before placing the wand with spout in my mouth ( the instructions recommend placing the wand in your mouth before turning on the unit). I am sure if I keep using it, I will get the hang of it. Over all I give this unit a big thumbs up!

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/12/does-water-pik-have-model-that-doesnt.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

As of December 6 th Mayor de Blasio announced that  all private-sector workers must provide proof of vaccination to their employers, and all employers must keep a record of each worker's proof.  In addition employer's must:- Post an official sign-in document in an obvious spot. After December 27th employees must show proof of their Covid vaccination to work in-person.

This mandate applies to dental offices and their staff as well and Dentists must comply or face fines from the city. At this point it is hard to believe that some dental staff have not been vaccinated and the vast majority of our workers have been. That being the case, it is time for the last hold outs to get their vaccine or get furloughed without pay. 

Of course this minority has the option of seeking a job outside of NYC, but I can't think of a good reason not to get vaccinated. I have heard most of the arguments against vaccination, but none of them are convincing and clearly going unvaccinated exposes an individual to greater risks than having the vaccine. Still this hasn't stopped some from "pleading their case to their dental employers, but in the end, Our mayor's mandate is the policy small NYC businesses must follow or risk the consequences. The city has a staffed telephone line that I called to ask for clarification and after a short wait I was able to speak to a city representative who was helpful. Small businesses that would like help with this requirement can call the NYC Department of Small Business Services hotline at 888-SBS-4NYC (888-727-4692).

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/12/nyc-has-mandated-covid-vaccinations-for.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 My son is approaching graduation from NYU  College of Dentistry this spring. Today he had an interview for a possible general practice residency. When he was done he called me on my cell phone to ask if we should have lunch together at my office. I said yes, of course , and went back to my patient who was listening to our conversation. Lately I have been listening to a playlist from my iPhone and my sons call was broadcast to the Tivoli radio that I use to amplify my music (embarrassing!)

David and I got take out food from a Potbelly and ate lunch together in my office. Currently he is planning on joining my practice after finishing his general practice residency. Since he is using the matching program that most of the dental students use, he will not know where he will be doing his residency until match day which is in January sometime. 

New York State requires that newly minted dentists either take part in a residency or practice in another state for a couple of years before they are eligible for a New York State dental license, so David can not join my practice until July 2022.  The fact is,  we are both excited at this prospect and I am looking forward to him joining us at 30 East 40th st. 

In fact I have been thinking about this possibility since he was quite small and would visit our office. I would dress him up in a smock, a mask and gloves and introduce him to my patients as Dr. David. Truth be told, I really didn't believe he would choose dentistry as a career, especially since he excelled in  so many subjects at school including Art, Math and Sciences and Spanish. He decided on a career in Dentistry his Junior year of college. Although I never pressured him to choose dentistry, I was happy when he made this decision, it seems to have been a good decision. He loves and is excited by dentistry and his instructors often let me know that I am lucky to have David as my son.... I agree whole heartedly!

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/12/how-is-david-doing.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 Usually cast posts are indicated for some anterior teeth after a root canal treatment,  especially if when these teeth are prepped for crowns the preparations leave minimal tooth structure. Since cast posts are made of metal they can be thinned as much as is needed, without weakening the core portion.  Another reason. that they are used is they can be fit to rather large oval root canal preparations that do not easily adapt to prefabricated round posts. 

Cast posts are more expensive because they involve a laboratory fee and take two visits , while prefabricated post and cores can be completed in one visit and an impression for a crown can also be completed at this visit as well ( assuming that a long enough appointment is scheduled. 

In my practice, I usually opt for a prefabricated post and core , assuming that it can be used without compromising the final result.  That being said, there are times when only a cast post will work  and I am forced to opt for this more labor intensive and costly mode (probably about 25 % more expensive) of restoration. 

There are a number of techniques for fabricating cast post and core restorations. One technique is "direct". This technique involves using GC resin or Duralay and fabricating a plastic version of the post, directly in the patients tooth. When preparing the canal space an attempt is made to remove undercuts from the canal space. Sometimes some small undercuts will remain, especially when removing them would result in a weakened tooth. It is important that the pattern that is fabricated fit passively. A binding fit is extremely undesirable since once the pattern is cast, it will not seat fully because the metal version of the post is not at all flexible. Inserting a cast post that fits too tightly may cause a root fracture and should be avoided. I usually is best to remove any binding spots in the plastic pattern, prior to sending it to the lab to be cast. 

Also it is much easier to shape the plastic pattern that will be the prepared portion of the core prior to having it cast, since shaping the cast post after insertion can be time consuming. This step is sometimes ignored by harried dental students, especially when they are "running out of time" and choose to send the pattern out with a poorly prepared core portion .They usually find out after trying in their cast post, just how much time the  preparation of a non precious post can actually take. This is definitely a case of a stitch in time saves nine,  since it is always better to spend a little extra time preparing a direct cast post and core to have the proper shape and fit prior to sending it out to the dental lab.

Another popular technique is the indirect cast post and core. This technique involve preparing a post hole without under cuts and taking an elastomeric impression for the lab. The lab pours up a model and fabricates the cast post "indirectly" . Usually the elastomeric material is syringed into the post hole and the stump of the tooth. A plastic sprue may be inserted into the post space after syringing the impression material so that it will help keep it stiffer so that it will be less likely to distort. Then a tray full of elastomeric material is placed on top in order to pick up the post pattern.

A third technique that I prefer is a hybrid of direct and indirect technique. I fabricate a plastic post in the canal that is passive and then pick it up with an elastomeric impression. This technique insures that the post will likely fit but save the time spent preparing  the core directly in the patients mouth. Instead the lab waxes this portion on the model and casts the direct and indirect portions together. This works well and can even be used with a prefabricated plastic post that is matched to a parellel sided post that matches the  Parapost drill that was used.

All of the techniques mentioned can work well but like all things in life, practice makes perfect so dentists need to be well versed in cast post fabrication in order to achieve predictably good results. Using prefab post with composite cores is a simpler procedure and easier to master for most dentists.  That being said, there are times when a cast post is worth the extra effort and knowing how to use this restoration should be part of every dentists skill set.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/11/how-and-why-cast-post-is-made.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

Dentistry is constantly evolving and an excellent dental practitioner has to be committed to life long learning.  I maintain a perfect five star rating on Google, teach at NYU College of Dentistry and really enjoy treating my patients. I continue to actively participate in over 100 hours of continuing education each year and I am a leader of a Spear Study Club that meets almost every month. 

 The writing on the wall clearly shows that our profession is transitioning away from making our patients porcelain fused to metal crowns as  practitioners are making a greater portion of their crowns all ceramic ( mostly either lithium disilicate or zirconium crowns).  I have become adept at utilizing these newer style restorations and am enjoying teaching the newer techniques to fourth year dental students at NYUCD. 

Keeping up to date is an important part of producing predictably excellent results for our patients and during my lengthy career I have witnessed big changes in how dentistry is performed. One thing has not changed. Good work takes time and short cuts should be avoided. Also, a good dental office needs to keep a professional and committed staff; one that treats patients in a caring and respectful manner. Fortunately my staff makes me proud and we have an excellent team!

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/10/some-things-change-but-some-things-stay.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

We all are familiar with this cliche about the importance of early detection. Unfortunately because of their  COVID 19 concerns,  more people are delaying their recare dental visits, often waiting to schedule an appointment only when they notice a new dental symptom. Their choice may be  putting them at greater risk for infections and  the need for more extensive treatments.

 In addition, many of the businesses that are located in Manhattan (my neighborhood) have not yet had their employees return to their offices for work full time.  Many of  my patients, who come in for  their checkup and cleanings,  are traveling from home which may require longer travel times to get to our office. Even if they are coming in to their offices part time, they may be loathe to take time off to visit us if cuts into their in person office hours. Not surprisingly when they do come in, my examinations are detecting more problems at more advanced stages than before the Pandemic. 

Even if , as some experts predict, The Covid virus is here to stay ( an endemic virus), vaccination provides significant protection and getting a booster at appropriate intervals, will ensure that we remain safe. Since most people will have  immunity from the worst effects of COVID,  re establishing our normal schedule for medical and dental visits should be a priority since it will help us maintain our health. In terms of dentistry, patients who maintain proper homecare and come into see their dentist according to recommended intervals, usually save money and certainly have healthier teeth. In addition there is plenty of evidence that periodontal problems and dental infections can be correlated with a greater risk for other health problems (heart disease, diabetes complications and cancer). If you haven't seen your dentist in the last 6 months or more, why not make an appointment today.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/10/a-stich-in-time-saves-nine.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

Why are monolithic Zironium crowns becoming the most popular type of crown for posterior restorations? Probably because they exhibit of a number of obvious advantages . These include the fact that cadcam zirconium crowns have more affordable lab fees, are more resistant to fracture, require less tooth preparation and more biocompatible than porcelains or the metals used in most dental restorations. 

While earlier versions of full contoured zirconium crowns were often too opaque and less esthetic than a well made porcelain fused to metal crown, newer versions are more translucent and are esthetic enough to satisfy most patients who need posterior crowns. In addition, when their margins are supragingival, no grey collar is visible as often is the case with ceramometal restorations. Their margins can be placed either supra or sub gingival and unlike lithium disilicate restorations they can be cemented with resin modified glass ionomer or traditional dental cements without  sacrificing their resistance to fracture.

In addition, they are compatible with a number of different types of finishing lines ( shoulder, chamfer, or 45 degree chamfer) and because they can be milled to a thickness of .5mm , more conservative chamfer preparations will not compromise their esthetics or strength. In addition, after milling their margins can be thinned even further, using an appropriate polishing wheel. This can allow dentists to prepare preparations that conserve cervical tooth structure and keep preparations further away from a tooth's pulp. 

Dentists who are critical of using Zirconium for crowns often point out that Zirconium is harder than either porcelain or Emax restorations and may cause additional wear or breakageof opposing teeth or their restorations. This probably isn't the case when zirconium restorations have their occlusion properly adjusted and their surface texture is polished appropriately after these adjustments are performed. There is also some debate about whether their inner surface bonds well with composite cements, but many clinicians maintain this isn't a problem ,if the inner surface is properly sandblasted and manufacturers recommendations for composite cementation are adequately followed. 

They do have some drawbacks. Since they are digitally designed and milled, these crowns are most satisfactory when a tooth has a more or less ideal preparation with a definitive finsih line. I actually spend more time prepping teeth for these restorations . Unlike crowns made with the lost wax technique or using pressable lithium disilicate, digitally produced cadcam restorations have a more limited ability to compensate for  imperfections in tooth preparation.  I also have found that zirconium restorations can be less ideal for short teeth, and  either bonded lithium disilicate or more old fashioned analogue restorations ( Gold crowns or PFM's) maybe work better for these teeth.  

Another negative feature of Zirconium restorations  is that  adjusting the occlusion or contact areas of these crowns can take more time because zirconium is extremely hard and takes more time to adjust than crowns made of other materials. When adjustments are made using a high speed diamond, water must be used a coolant in order to avoid the formation of microscopic cracks.

Even though they have a few drawbacks, overall , full contoured zirconium crowns are a great option for crowning most posterior teeth, especially when employed by a dentist who understands their strengths and limitations. When teeth are properly prepared and impressioned, inserting them usually take less time than alternative types of crowns and their advantages far outweigh any disadvantages. I personally give them a big thumbs up!

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/10/why-zirconium-crowns-are-replacing.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog

[dentalinfotoday]

 Lately I have been utilizing tibased screw retained implant crowns, using original tibased prefab parts from the manufacturers. These are OK, but may sometimes be a problem. They only come in certain lengths and configurations for the titanium components. Sometimes the metal sleeve is too short to be retentive and sometimes the base of the part can be too close to the bone housing the implant, especially when the bone around the implant is at uneven levels. This can make torquing the implants down difficult since they are not passively fitting.

I have become aware of an alternative to use in these situations which involve having a custom titanium abutment designed and milled to fit passively and then the lab cements on a milled zirconium crown with a hole in it. Voila, the resulting "screwmentable" restoration is better designed and more likely to fit passively. 

I know my labs have been using Atlantis to mill these , but they may also be available by milling centers that are affiliated with implant manufacturers as well. I believe I will be employing these types of implant crowns more and more since they seem to have a better chance to have a more perfect emergence profile for my implant restorations. Yes, they involve some additional expense, but I am willing to absorb that cost if it results in a more well adapted implant restoration.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/09/what-is-screwmentable-crown.html - http://lspindelnycdds.blogspot.com/

#Dentistry #Blog