Dear Dr. DiTolla,

Thank you for the excellent learning I have received from your Glidewell CE videos. I’ve been practicing dentistry for 32 years, and the Reverse Preparation Technique is the best piece of advice for crown and bridge that I have ever learned. Recently I purchased a tube of full strength PFG (Steven’s Pharmacy; Costa Mesa, Calif.), and noticed in the literature that you use PFG Lite for certain indications and PFG for others. Would you tell me the reasons why you use these topicals this way?

– Scott T. Graham, DDS
Clinton Township, MI

Dear Scott,

I use PFG Lite in the vestibule for pre-injection purposes and full strength PFG on attached tissue. That is the only difference. I notice a little more tissue irritation with the full strength if left on too long. Since no one feels the needle go in with PFG Lite, I figure why not use less drugs. If I recontour tissue with a soft tissue laser, however, I use full strength PFG on the attached gingiva. It doesn’t seem to show any irritation and ensures maximum anesthesia.
I hope that helps!

– Dr. DiTolla

Dear Dr. DiTolla,

How has your summer been? I love the new videos. Each one includes some really interesting and refreshing cases. I have a question about Clinical DVD 12 (Vivaneers™ No-Prep Veneers Utilizing Minor Orthodontic Procedures). At 25:45, you use an unusual lip retractor to help apply the medium body material. What is the name of this retractor? I have to get it. It looks so easy to dispense the medium body when using it.

My other question is regarding veneer cases. I fortunately had a couple of cases, #5–12 and #21–28, come my way recently. On both occasions while temping, when I removed the putty matrix every tooth stayed perfectly except the premolars. Do you have any tips on how to make the premolars stay in place and lock onto the teeth like the rest of the anteriors?

As for me, I just purchased the VITA Easyshade^® and SOPRO 770 intraoral camera. I love them both. The image quality of the SOPRO is absolutely incredible and extremely detailed. Check it out if you can.

– David M. Rahr, DDS
Kings Park, NY

Dear David,

The retractor you mentioned is the 5th Hand Retractor (Danville Materials; San Ramon, Calif.). Order it online at ortho-direct.com. While I prefer to have one assistant help me retract while another fills the tray, there are times when you have to do the intraoral portion alone and the 5th Hand Retractor really helps.

I suspect that your provisional issue on premolars has something to do with the prep. When I prep premolars, I prep the facial surface and the occlusal surface of the facial cusp to the central groove. I started doing this because I had too many permanent bicuspid veneers popping off, let alone the temps. When I speak of prepped veneers, I am referring to preps that extend into the dentin.

On minimal-prep cases that are all in enamel, I don’t worry about temps that don’t lock on. I spot etch the premolar in the mid-buccal area, paint adhesive on the tooth, fill the temp with flowable composite, and light cure into place. You will have a small bump of composite to remove from the premolar.

Of course, on a minimal-prep case with no exposed dentin, you could go without the temps on the premolars and tell the patient it is very likely they will break off due to your extremely conservative prep. Sounds like a good trade-off to me!

– Dr. DiTolla

Dear Dr. DiTolla,

I reviewed some of your DVDs this weekend and wanted to say they are so very well done and illustrated. I also happened to review a DVD by Dr. Gordon Christensen, and although the subject matter was good, I found his presentation and delivery to be boring and unappealing.

As I viewed your DVDs, I noticed that some of the teeth in your anterior cases using no-prep and minimal-prep veneers had existing composites. What is your feeling and how do you judge whether a patient should receive such a restoration if their anterior teeth have small to moderate composites, say MBL, DBL or even MIFL? In the past I’ve had cases where I did not know if no-prep or minimal-prep veneers were indicated or if full-coverage should be considered. What is your recommendation for a patient with #14 and #15 prepped for Captek™ crowns and the temporaries splinted together, and during the three-week interval from impression to seating the patient loses their temporaries? The temps were out for about four days. I sent the crowns to Glidewell and I am hoping to see the patient this week.

– Thalia Psillakis, DMD
Pompton Plains, NJ

Dear Thalia,

Nice to hear from you again! Gordon has always been a mentor of mine, and I grew up watching his DVDs and live courses.

It’s pretty much a case-by-case call when it comes to anterior cases with existing composites. Certainly, the more existing composites present, the more I lean towards full-coverage veneers. The higher the recurrent decay rate, the more I lean towards full-coverage veneers. The deeper the veneer prep (like the ones I was taught at LVI), the more I lean towards full-coverage veneers, which is what those deep veneer preps basically were. The higher the esthetic requirement, the more I lean towards full-coverage veneers. I still find that there aren’t many crowns that look as good as a minimally prepped IPS Empress^® case, although IPS e.max^® is getting close. Replacing ugly, existing crowns with IPS e.max crowns and no-prep veneers next to them is becoming one of my favorite cases to do. Unfortunately, there are no hard and fast rules.

When temps are lost I always still try-in the crowns. That is especially true at Glidewell since we have a no-fault remake policy and will fabricate new ones for you at no charge. You will probably need to break out your diode laser to clean up some tissue from around the prep margins, which will also come in handy if you need to re-impress. As for your case, try-in the crowns on #14 and #15 and instruct the patient to bite on cotton rolls for 10 to 15 minutes in an attempt to reverse possible super-eruption. Surprisingly, it seems to work, so don’t give up hope just yet. If the preps had short clinical crowns, this is a perfect time to borrow a page from Dr. Bill Strupp: use Durelon™ for your temp, but only if you have a sonic scaler to remove it. Without a sonic scaler, Durelon is a nightmare!

– Dr. DiTolla