Dr Monik Vasant discusses digital dentistry and the minimally invasive concept − including the use of Coltene’s BRILLIANT Crios, Cerec, and Invisalign
“Why would you want to remove 70% of a tooth to make it stronger? Prepping for a crown by removing so much vital material, why do that? It wouldn’t make sense to an architect or an engineer.” Dr Monik Vasant sets out his stall from the very beginning during his talk at the London-based Henry Schein Digital Symposium 2017. Dr Vasant is a general dentist and a leading educator and mentor regarding minimally invasive dentistry. He believes that when a patient sits in his surgery they are there for three principal reasons: they want to improve their appearance; they have expectations they would like met, they want to maintain/improve their dental health.
He projected an image of over-prepped stumps in a patient’s mouth and declared that carrying out such such treatment in order to place veneers should be made illegal. Such activity, even with the patient’s full consent, is buying into a world of problems in the future. Modern bonding technology and composites make smile design so much less invasive. He believes such horrific, radical prepping should be consigned to the dustbin of history, and these images should only be used as a warning object lesson for students. And, he said, composite is a perfectly suitable material for restorations and smile designs. It can take stress, and if it wears away it can be replaced with more composite.
His talk took place during a Digital Symposium, and so, he asked, where does the digital fit in? Answer − everywhere. If a patient presents with a diastema he would take a Cerec intraoral scan and send it through the system’s open architecture to his Invisalign, ClinCheck Pro software to begin orthodontic treatment using clear aligners. Or he might do a digital smile design and get a temp restoration printed. What about direct restorations using composites? Dr Vasant considered some of the historical issues with the material, including: sticking to one’s tools, the possibility of surface defects, that the technique is considered time consuming, and that it can be technically demanding.
Treatment can be simplified by using hybrid composites like Coltene’s BRILLIANT Everglow single shade material rather than layering, but Dr Vasant found problems with long-term aesthetics if the composite is used adjacent to a ceramic crown. It can also be hard to achieve symmetry and optimum shapes, and incomplete polymerisation during curing can lead to weaknesses in the future. How to overcome composite’s potential pitfalls while retaining its very real benefits? Dr Vasant introduced Coltene’s BRILLIANT Crios reinforced composite block, which can be milled to create inlays, onlays, crowns and veneers. The block uses the same material as the BRILLIANT Everglow hybrid composite, but has been reinforced. Its benefits include the fact that a restoration can combine direct/indirect techniques, and unlike direct composites that might only be cured between 75-82% under the lamp, BRILLIANT Crios is at 100% optimum strength from day one, and that means great flexural strength. Its carefully controlled manufacturing process − which involves constant thermal curing − means there is no need for a separate firing procedure, saving time and labour. Thanks to its shock absorbing capabilities BRILLIANT Crios is recommended for restoring teeth worn down by bruxism, and for implant supported crowns. It offers high wear resistance and antagonist wear is benign, plus the milled restoration can easily be repaired using a matching material if it is worn or damaged.
Dr Vasant cited the material’s ability to be milled down to 0.3mm as an example of a material that can be used for truly minimally invasive, no prep dentistry. He listed its uses:
• Mixing direct and indirect restoration
• Ideal for indirects when there is a poor substrate for bonding
• For posteriors when wanting to reduce wear on opposing
• Implant crowns or crowns on vulnerable teeth
• When wanting to reduce iatragenic trauma on round two
He offered that BRILLIANT Crios could be milled from 1.5mm to 2mm for onlays, and 0.8mm to 1.5mm for crowns, 1.5mm for the occlusion and 0.8mm at the buccal surfaces and cervical margins. Bonding is simple, there’s no need for etching, just air abrade and apply One Coat 7 Universal bonding solution with SoloCem or DuoCem.
After presenting a couple of case studies Dr Vasant began his conclusion by asking the question, what’s going to fail first, your dental work or the patient? Unless the patient is very old or sick it will be the dental work. Keeping intraoral scans of a patient’s dentition means repairs can be milled and placed relatively quickly, however, every indication requires individual attention. Direct or indirect milled restorations, Invisalign orthodontics, or a mixture of everything available, Dr Vasant advised that modern dentistry is about using the technique – and the technology – that works best for each case, and to do so consistently and reliably. Digital dentistry makes that possible.
To find out more about Dr Vasant and his work visit www.monikvasant.co.uk
To find out more about Coltene’s BRILLIANT Crios click HERE.
For more information about Invisalign visit www.invisalign.co.uk