Shrink Wrap Provisional Technique for Predictable Veneers: Part 4

August 24, 2018 Lee Ann Brady DMD

Creating amazing provisionals primes the patient for a positive treatment experience and ensures they’ll be content even before the final veneers. Read on for the last post in our four-part shrink wrap provisionals fabrication series:

Checking Occlusion and Polishing Shrink Wrap Provisionals

After cleaning off most of the excess from the provisional with a universal scaler, extra fine mosquito diamond, and a brownie, use the same diamond to open the linguo-gingival embrasures with the intent that the patient should be able to pass floss through them. This also keeps the tissue as healthy as possible for the seat later on.

Now that you’ve done all your flash trim, you should check the protrusive and right and left excursive occlusion, making sure you have even marks and no fremitus. Check intercuspal position to ensure you have no fremitus there as well, either lying back or with the patient in the alert feeding position.

With everything trimmed and ready to go, the last step is simply to polish. You can use the Brasseler Featherlite porcelain polishing system running in a latch handpiece. Utilize the first of three polishers at about 15,000 RMP, then move to the second polisher at about 10,000 RPM. They can be run at a higher speed, but you’ll get way fewer uses out of the polishers. Finally, run the last of the three polishers at about 7,000 RPM.

If you notice a porosity after cleaning out the residue from the polishing, you can use a Venus Diamond flowable that matches the esthetics of the bisacryl exactly. Fill the void by manipulating the side of the explorer to drag away excess and feather it out. Then simply light cure so that food doesn’t pack into the void.

The final step of this shrink wrap technique is to use Dialite polishing paste from Brasseler in an impregnated bristle brush to create a perfectly smooth finish. The entire process of provisionalization should take no more than about fifteen minutes.

 

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

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E2: Occlusal Appliances & Equilibration

DATE: October 20 2024 @ 8:00 am - October 24 2024 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 44

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night with private bath: $ 290

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Shrink Wrap Provisional Technique for Predictable Veneers: Part 3

August 22, 2018 Lee Ann Brady DMD

Utilizing the shrink wrap technique for predictable veneers necessitates careful attention to materials selection and silicone matrix creation. Once you have created the matrix, cleaned the preps, and fully seated the matrix, you can use a 2 x 2 soaked thoroughly in rubbing alcohol to wipe across and remove the air-inhibited layer.

Cleaning Up the Veneers Preparation

Because of the matrix with the silicone gasket, almost all of the excess matrix material should flake off with a universal scaler. That’s why this technique works perfectly for preps with equigingival or supragingival margins. It works less well if you have a subgingival margin because the gasket separates the silicone right at the level of the existing free gingival margin.

On the lingual, you will have a very thin film of excess material sitting over the unprepared portion of the tooth. You can peel it off using the scaler. These provisionals are not easy to pull off or dislodge from the teeth. That means you don’t have to be cautious. The material will separate as if it has been perforated right where the margin was.

After the use of a universal scaler, you can check all the margins. You’ll realize you have virtually no excess. You can then utilize an extra fine mosquito diamond at 20,000 rpm dry in the speed reduction Brasseler NSK high speed attachment. You should open the facial gingival embrasures so the patient can get floss through them. This will lead to healthy gingival tissues that aren’t inflamed on the day of the seat.

Now switch to a brownie silicone point running dry at 10,000 to 20,000 rpm. A brownie at this speed will cut any kind of resin to create a perfect infinity margin right where the lingual reduction is on the preparations and remove any excess.

What common provisionals technique do you prefer for veneers? To be continued … 

 

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

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This “can’t miss” course will empower Dental Assistants to bring their skills to excellence! During this dynamic hands-on course, led by Pankey clinical team member, Sandra Caicedo, participants will learn…

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Shrink Wrap Provisional Technique for Predictable Veneers: Part 2

August 20, 2018 Lee Ann Brady DMD

Provisionals are an important part of veneers fabrication that requires just as much care and diligence as the final restoration. After acquiring diagnostic and lab records and fabricating a silicone matrix, the next step is to clean the preps with a dilute solution of 2% chlorhexidine prep scrub. Use a syringe tip with a fuzzy end for optimal brushing.

Cleaning the Veneer Preps and Loading the Matrix

The latter process ensures you start off with clean, bacteria-free preps. Rinse off the chlorhexidine and thoroughly dry the preps. With this technique you should spot-etch utilizing 35% phosphoric acid for a 3mm diameter spot on the facial or labial of the teeth.

Keep the etch far away from the margins and interproximals. Leave it for 30 seconds, rinse off, and vigorously dry the preparations. You can use an air/water syringe because a little contamination is fine.

You should then apply GLUMA from Kulzer to every prep, which is a combination of antimicrobial glutaraldehyde and HEMA that prevents tooth sensitivity. The GLUMA excess is dried with cotton to prevent it from getting in saliva or mucous membranes.

Now that teeth are ready, you can load the silicone matrix with a bisacryl material. Load the matrix by moving back and forth along the incisal edge and adding layers to minimize the incorporation of air bubbles. Fully seat it. One of the tricks with this matrix is the very flat occlusal table so you can apply even pressure. Additionally, adequate thickness of the silicone provides rigidity and accuracy with less trim needed.

Let the material stay in the mouth for the full set time, which is a little over four minutes. At that point, remove the matrix for completely hard bisacryl on the teeth.

To be continued …

 

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

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DATE: July 17 2024 @ 8:00 am - July 19 2024 @ 3:00 pm

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Shrink Wrap Provisional Technique for Predictable Veneers: Part 1

August 17, 2018 Lee Ann Brady DMD

Of all the methods commonly used for veneer provisionalization, my favorite has to be the shrink wrap technique. I love it and use it all the time because in my opinion it is the easiest and most predictable method.

The term ‘shrink wrap’ comes from allowing polymerization shrinkage of the material to lock bisacryl onto the preparation. The main advantage of this approach is that it keeps veneer provisionals firmly secured until the final restoration can be placed.

Here’s my take on utilizing this technique in the dental practice:

Predictable Veneers with Shrink Wrap Provisionals

The first step of shrink wrap provisionals is to prepare the teeth. Let’s imagine you are dealing with a patient who experienced trauma such as breaking their teeth in a bicycle accident.

Before beginning the technique, make sure you have all the diagnostic records you need, including all prep records for the lab: facebow, opposing model, final impressions (maybe more than one) with good flash, etc. Once you provisionalize the teeth, it won’t be easy to get access to the preps again.

One of the essential parts of a shrink wrap provisional technique is fabrication of a silicone matrix with a silicone gasket to separate the excess. You should begin with a solid model either of the teeth before they are prepared or of the wax-up. You can carve a 1 mm deep trench into the wax-up by using the cleoid end of a cleoid/discoid.

Put the sharp pointy end right on the free gingival margin of the gingival of the tooth on the model to carve. You can even go a little deeper in the interproximals. Now take that model and fabricate a two stage silicone matrix.

First, create a putty matrix and trim it. Then, load the putty with the light body of the same impression system, reseat on the model, allow it to achieve a full set, and trim. Now you are ready to go to the patient and use lip retractors. Remember to add a little vaseline or lubricant to the lips for comfort.

At this point, I like to use the OptraGate from Ivoclar Vivadent for a latex free retraction device that can handle anything in the anterior. I will have it in during preparation and for impressions so I don’t have to hold the lip out of the way.

To be continued …

 

 

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

Related Course

E2: Occlusal Appliances & Equilibration

DATE: March 24 2024 @ 8:00 am - March 28 2024 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 44

Cost: $ 7200

night with private bath: $ 290

This Course Is Sold Out! What if you had one tool that increased comprehensive case acceptance, managed patients with moderate to high functional risk, verified centric relation and treated signs…

Learn More>

About Author

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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5 Dentists Share Favorite Materials

October 21, 2017 Pankey Gram

Curious what dental materials the Pankey community is currently raving about? 

Sometimes, when you feel bored or uninspired at the practice, you could benefit from trying out new materials. This type of change can simultaneously up your clinical game and get you excited about work again.

Check out the suggestions from 5 Pankey dentists below for inspiration:

Materials Pankey Dentists Love

Dr. Mark Kleive

“My favorite new material is the air abrasion hand piece from Groman Dental – Etchmaster. It’s simple, no big equipment, still a bit of mess, but very precise.”

Dr. Mike Crete 

“My favorite new ‘tool’ in my toolbox is CBCT. In the last two years, I have had a major shift in my diagnostics and treatment planning by using 3D imaging. Although I do not have a scanner in my own office, the specialists that I have a great working relationship with do have them and it has become a great adjunct to our diagnostic and treatment planning process.

I see this technology making huge strides in the coming years and predict it will become the standard of care in dentistry. 2D imaging will become a thing of the past!”

Dr. Lee Ann Brady

“My recent favorite is Cervitec Plus, Chlorhexidine varnish. It is an incredible antimicrobial adjunct for high caries risk patients. It reduces the bacterial count for 3-5 months and is applied at their hygiene visits. It is also great for around temporaries to create fabulous tissue health when seating restorations.”

Dr. Jennifer Davis

“My top two favorite materials lately:

(1) Not a new thing, but it still amazes me. Use of MicroPrime, a Gluma product,  after etching my composite preps. The amount of post-operative sensitivities and/or root canal procedures that come from my office now is amazingly low. Wish I had the foundation for a research study.

(2) I am loving using products to stain provisionals to custom match a tooth to the dentition. I use Protemp as my provisional material most times. They make such limited shades, though. Therefore, I stain with either Cosmodent tints, Creative Color, or Kerr-Kolor in white.”

Dr. Michelle M. Lee

“Not a material, but my mind has been blown with microscopes in the last month from the training I’ve been getting at Penn. It’s just been such a great experience and taken dentistry to the next level in terms of detail, finish, and marginal integrity. I have been loving learning more about this, as well as the integration of microscopes and dentistry with digital workflow! Fun stuff!”

What new or old favorite material are you excited about? We’d love to hear from you in the comments! 

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Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

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Breaking Provisionals: Finding the Flaw in Your Design

October 15, 2017 Lee Ann Brady DMD

The truth can be hard to face: Something is wrong with the design of these provisionals … We may be working on a broken provisional and feel the deep frustration that comes with knowing something went awry.

I challenge you, in these moments, to reframe the ‘problem’ as a mystery to be solved. You are the clinical detective who needs to work backwards a la Sherlock Holmes to figure out ‘whodunit.’

Mystery of the Broken Anterior Provisional

Remaking and adjusting an anterior provisional from the upper right to the upper left canine (for the second time) is a horror story in the making. Before you allow that narrative to take over and call the lab to have them rush the case back, remember to rely on your intuition and technical expertise.

You may not be able to call the lab because you haven’t taken final impressions. Either way, let the provisionals tell you what the flaw in the design is, rather than believe you can run the solution show.

A good first place to look and listen for answers is the occlusion. For example, if the patient reports that they wake up with headaches after you’ve placed the provisionals, you would want to look closely at envelope of fucntion. Is the patient heavy on the centrals and laterals? If so, you can begin the process of adjusting.

Methods of the Dental Detective

As you examine the issue, you may find other clues, such as that the patient is catching on the incisal edge in their return stroke from protrusive. You continue to adjust, beveling edges for a smoother transition. You leave the guidance shared between the canines and centrals, keep it smooth, but even this doesn’t stop the patient from breaking the provisional.

If you’ve ever seen or read a good detective story, you know this isn’t the time to quit. When things seem most opaque, the detective is usually at a breaking point where the parts might finally start to fit together. Once they do this, the flood gates open and they rush toward the explanation.

You will reach this point while adjusting again. In response to what you’ve learned, you begin to shallow the patient’s guidance and share protrusive with the premolars. You decide to shorten lower anteriors and increase overjet by proclining the restoration. Here, you’ve come to the solution. You need to work it out on an articulator perhaps and then go back to the mouth.

The main lesson is that we have the most to learn from cases that don’t go perfectly. Plus, it would get pretty boring if there were no dental mysteries left to solve …

Related Course

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DATE: May 1 2025 @ 8:00 am - May 4 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 39

Dentist Tuition: $ 6800

Single Occupancy with Ensuite Private Bath (Per Night): $ 345

Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

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About Author

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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