Letters to the Editor

May 8, 2012

Dear Dr. DiTolla,

Thanks for another great issue of Chairside®. We were disappointed that we received the Fall 2011 issue on Jan. 2 and the contest deadline was Dec. 30.

I am using Capture® Impression Material now and am very happy with it. I am using the green light body. Is there any reason why you favor the purple medium body over the green?

I impressed my first no-prep veneer case (tooth #8–11, with an implant on tooth #7) this week. Your DVD videos are great! To prepare, I watched the video online on tissue contouring and placement of no-prep veneers (“Diagnosis & Placement of No-Prep Veneers”), which was very helpful, in addition to reading Dr. Robert Lowe’s article in the Winter 2012 issue of Chairside. Is there a reason why you don’t retract the tissue for these no-prep veneers? Dr. Lowe seems to make a very strong case to do so. Either way, I contoured one area and did pack cord (no offense!).

What cement are you using to cement these veneers?

Once again, thanks for teaching me the dentistry I practice with every day!

– Robert M. Lieder, DDS
Baltimore, Md.

Dear Robert,

Thanks for the kind words!

That early due date was a mistake on our part, and we will do our best to make sure it doesn’t happen again.

I use the medium body (purple) as my syringe material, just to make sure it doesn’t tear because I get it to go about 1 mm into the sulcus with the two-cord technique. Also, it will often set in contact with the #00 cord, which can increase the chances of it tearing. The medium body prevents that from happening.

Because the margins of no-prep/minimal prep veneers tend to make a little speed bump on the tooth, due to there typically being no prep at the margin, I prefer to leave that bump at the free margin of the gingiva, rather than placing it subgingivally. With conventionally prepped veneers, I always place the margins subgingival.

As for not retracting the tissue, that’s just my personal preference. You won’t go wrong following Bob Lowe’s method when it comes to any aspect of clinical dentistry. He continues to be one of my clinical mentors, which is why his articles are in nearly every issue of Chairside.

My favorite veneer cement continues to be the translucent shade of NX3 Nexus® Third Generation from Kerr, which is something Bob Lowe and I definitely agree on.

Hope that helps!

– Mike

Dear Dr. DiTolla,

I enjoyed reading the “Figures in Dentistry Spotlight” on G.V. Black in the Fall 2011 issue of Chairside. Unfortunately, there was no mention of his most important contribution to dental literature, “The Pathology of the Hard Tissues of the Teeth,” first published in 1906. Most dentists have never heard of this book, but as I was studying ways to control caries with a medical model, I ran across a reference to the book. It took awhile to find a copy, but when I finally read it, I was totally blown away by the advanced understanding that G.V. Black had about the microbiology of caries. His chapter on treating children is more advanced than any pediatric dental text I have ever read, and I have read them all. I would encourage you to take a look at this classic. Attached is a little paper that talks about G.V. Black’s volume in the context of advances in cariology.

Best wishes,

– Steve Duffin, DDS
Portland, Ore.

Dear Steve,

Thanks for sending me your paper. I really enjoyed reading it! With your permission, I would love to publish your paper in a future issue of Chairside.

– Mike

Dear Dr. DiTolla,

First, I want to say how much I enjoyed your recent webinar (“State-of-the-Art Impression Techniques,” hosted by Catapult University). What a great way to learn! I hope it becomes a regular occurrence.

Can you email me about the burs you use for your crown preps? What brand do you use? I like the whole idea and am looking forward to trying the technique. I plan on doing a lot more BruxZir® crowns.

Thanks again,

– Grigg DeWitt, DDS
Salinas, Calif.

Dear Grigg,

Thanks for the kind words!

The burs I use to prep are from the Reverse Preparation Set from Axis Dental, available through all dental dealers. It’s a universal prep technique that works for all materials, although as the next letter in this section points out, the strength of BruxZir Solid Zirconia is starting to change how much we have to reduce, especially at the margin.

– Mike

Dear Dr. DiTolla,

First, thank you very much for your educational support and updated dental market information. The latest issue of Chairside (Vol. 7, Issue 1) includes your very interesting and helpful article “BruxZir Solid Zirconia Anterior Esthetic Challenge.”

I would appreciate it if you could give me information about labial and palatal crown thickness (Figs. 31–34). I wonder why you used a shoulder preparation technique when the BruxZir website says that feather edge is acceptable?


– Alex Zavyalov, DDS
New York, N.Y.

Dear Alex,

Good question! I guess the best answer is that having spent the last 20 years prepping all-ceramic crown preps at a certain thickness, old habits die hard. My Reverse Preparation Technique uses a round bur to ensure that I get 1 mm of reduction in the gingival third to help the esthetics and the emergence profile. As you pointed out, BruxZir Solid Zirconia is the one monolithic material (besides cast gold) that can handle a feather-edge margin, and we are just getting started with a Minimal Prep Crown Project to see just how little we can reduce an anterior tooth and still have a decent looking BruxZir crown. Imagine if we could prep a tooth and stay within the enamel, yet be able to cement a high-strength all-ceramic crown, rather than bonding a veneer. So, yes, even though I did not prep conservative margins on those teeth, you certainly can prep those types of margins with BruxZir crowns. Even if you were worried about esthetics on the facial, you could still prep a conservative margin on the lingual.

– Mike

Dear Dr. DiTolla,

Regarding Dr. Ellis Neiburger’s article in the last issue of Chairside, “Is It Time to Do Routine Adult Pulpotomies?” (Vol. 7, Issue 1), there should have been more discussion about using lasers to sterilize the pulp instead of formocresol, and other options instead of IRM, like MTA.

– Brian Danielsson, DDS
Ridgecrest, Calif.

Response from Dr. Neiburger:

Dear Brian,

The article focused on time-tested pulpotomy techniques that, in light of the world’s poor economic situation, can be done easily, quickly and inexpensively. Laser sterilization of the pulp chamber is relatively new, has only a small amount of research to establish efficacy and requires laser equipment more costly than a $10 bottle of formocresol. It holds promise and should be further investigated.