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Dear Dr. DiTolla,

Love all of your information. It’s most helpful. I am wondering why it seems that products manufactured by Parkell do not get any respect? We have been using Brush&Bond® (Parkell, Inc.; Edgewood, N.Y.) as our bonding agent for posterior composites for years, and the incidence of post-op sensitivity is negligible, and it does not de-bond. Ever. We also use it to cement our IPS e.max® crowns (Ivoclar Vivadent; Amherst, N.Y.), with GC FujiCEM™ 2 (GC America Inc.; Alsip, Ill.), and we have zero problems with post-op sensitivity or with the crowns falling off. It just doesn’t happen. Please give me your thoughts on Parkell’s products, in general, and Brush&Bond, in particular.

Sincerely,

– Todd Babineaux, DDS
New Iberia, La.

Dear Todd,

I really don’t know why Parkell doesn’t get more love: They have some great products! I heard about Brush&Bond at one of Dr. Gordon Christensen’s courses many moons ago, and started using it and was never disappointed! At any given time, I am using seven or eight different bonding agents with seven or eight different cements, trying to simulate everything our dentists might be doing to make sure that particular protocol works well with, say, BruxZir® Solid Zirconia (Glidewell Laboratories; Newport Beach, Calif.).

Brush&Bond, Blu-Mousse® (Parkell, Inc.), AccuFilm® (Parkell, Inc.), C&B-Metabond® (Parkell, Inc.) … most companies would love to have just one of those! I’m not sure what they do in yearly sales, but I may have just stopped feeling sorry for them!

Don’t stop using B&B when it’s working so well for you! Sometimes your original self-etch material may still be the best.

– Mike

Dear Dr. DiTolla,

First of all, congratulate Megan on the news of her pregnancy.

I have used the Reverse Prep Kit (Axis Dental; Coppell, Texas) on lower second molars for BruxZir crowns, using the 0.6 mm depth cutter for occlusal reduction when space is tight. The Glidewell technicians have called me and said that this is not enough reduction. They said that since they allow room for cement space, 0.8 mm is needed, and they prefer 1.0 mm. What’s up with that? Is my 0.6 mm depth cutter useless?

Thank you for your help.

– Len Klayman, DDS
Northbrook, Ill.

Dear Len,

You are right. The 0.6 mm is just fine. The only caveat is that if the occlusion needs to be adjusted, it has to be done on the opposing tooth.

Here are the real numbers for BruxZir Solid Zirconia:

0.6 mm – minimum thickness to avoid fracture in function

1.0 mm – ideal thickness when you are able to achieve it

1.5 mm – maximum-strength thickness (the thickness of the crown in the hammer test)

And yes, I will pass your best on to Megan, and you can continue to use your 0.6 mm depth cutters.

Best,

– Mike

Hi Dr. DiTolla,

Love your show. Question: I scan my preps and love the greatly reduced seating time. When I do have to adjust, it’s always slightly below the contacts. Every time. Occlusion is almost always "spot-on," but the gingival embrasure space just below the contacts always needs tweaking. Is this a software issue?

– Mary Swift, DDS
Dallas, Texas

Hello Mary,

Thanks for the kind words!

Actually, what you describe is more of a design issue than a software issue. Specifically, it’s a designer getting sloppy and violating a principle we refer to as the "contact circle." Essentially, it states that all tooth structure apical to the contact area needs to be flat or concave. The only no-no is convex, which sounds like what you are getting. I will look up which department is fabricating your crowns and make sure they strive to keep that contour correct for you. Please write back to me if you get time in a month or two, and let me know if they are doing better.

Thanks!

– Mike

Dear Dr. DiTolla,

I am looking forward to seeing you present in person at the Mid-Atlantic Dental Meeting. As a customer of Glidewell Laboratories, I have enjoyed your articles, tips and CE presentations. My question for you today is: What would be your material of choice for a mandibular bridge, teeth #22–27? The patient is a 74-year-old female, and her bite is open in the anterior. I believe that this span is too long for monolithic lithium disilicate. So would you go with solid zirconia, a layered zirconia, or the tried-and-true PFM?

– Marea White, DDS
Bedford, Texas

Dear Marea,

Thank you for the kind words!

I typically only use a PFM bridge when I am worried that the patient might be able to break a BruxZir Solid Zirconia bridge. However, in a 74-year-old female with an anterior open bite, I am about 99.99 percent sure that won’t happen. Additionally, with a BruxZir bridge, you can prep more conservatively on #22 and #27 than if you used PFMs.

Make sure to write that the patient is 74 years old on the lab slip, and if you could take a digital picture of your desired shade tab next to #22 or #27, that would be very helpful, too!

See you in D.C.!

– Mike

Dear Dr. DiTolla,

I read your article "Valplast® – Flexible, esthetic partial dentures" (Chairside Perspective, Volume 5, Issue 1, April 2004) with great interest. I am a general dentist and have been in practice for over 10 years. I have done countless Valplast® flexible partials (Valpast International Corp.; Long Beach, N.Y.) with great success. Patients just love the comfort and esthetics of the partials. But recently, I had one case in which the patient complained about the partial. The patient stated, "My Valplast partial is poorly designed and defective and caused my tooth to break." The patient had been wearing her partial for months. May I ask, do you think her statement is valid and makes any sense at all? I do believe, as you have stated in your article, that all Valplast partials are tissue-borne, not tooth-borne. Based on this reasoning, I hardly think that her partial is the sole cause of her tooth breaking. Her broken tooth could have been caused by a multitude of factors, e.g., undesirable occlusal forces, chewing habits, parafunctional habits, or any number of perio problems. I would greatly appreciate your input.

Best regards,

– Hung Le, DMD
Newark, Del.

Dear Dr. Le,

You are correct when you say that there is typically a multitude of contributing factors to why a tooth might break. I don’t recall seeing any teeth break off at the gum line that didn’t have some sort of cervical caries that weakened the teeth in that area.

Certainly a cast clasp, such as an I-bar, on a conventional partial denture puts a fair amount of stress on a tooth, although that typically leads to mobility rather than fracture. And yes, a Valplast partial is essentially a tissue-borne prosthesis, which is why it never seems to "snap" into place like a conventional cast partial denture.

So while I agree with you, that does not mean there is any way to change patients’ minds once they believe they know what caused something. Much like in a marriage, there are times when you have to nod your head with a smile, while secretly knowing you are correct!

Best of luck!

– Mike

Chairside Magazine: Volume 9, Issue 1

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