Creating Predictable Outcomes in Dental Procedures





By Lexi Marino February 12, 2021

When dental teams have a predictable working environment inside of the patient’s mouth, they are able to achieve faster, more optimal outcomes. In this piece, we’ll talk through a multi-crown replacement procedure featuring the Isolite® dental isolation system.

Watch this video to learn how the Isolite System helps you:

  • Level-up your dental skills in an ideal working environment
  • Create more efficiency in your day by completing procedures 30% faster

Transcription:

Rolando Mia: Welcome to Dr. Tom’s Case of the Week. Today, we’ll be showing how the Isolite® dental isolation system works in a multiple crown restoration procedure.

Dr. Tom Hirsch, DDS: So, today we’re going to talk about is how to make some money in dentistry. How can we be profitable? The way to be profitable is multiple crown preps, as many crowns as you can do in one visit. Today, we’ll discuss how to do it fun, properly, and safely.

The Case: 4 Crown Replacements

Here’s the case that we’re looking at. Tooth numbers 15, 14, 13, were all wiped out and so was 12.

*Video playing in discussion*

So, here I put the Isolite in the mouth and now I’m going to take off the crown on tooth number 12. The other crowns were all zirconia crowns, and they are really tough to get off. This is why we’re not showing you the whole situation.

I made my slots in it, you can see the porcelain chipping off, but it just falls back there in the back of the mouth. Because it’s back there on the Isolite Mouthpiece, I don’t worry too much about it. I ask for a pair of pliers and reached in there to pick up the pieces. I could have easily left them there, but I wanted to show this for the video.

I handed the pieces to my assistant and then went right back to work trying to take off these two zirconia crowns. There was a lot of drilling to get those two off. Now my assistant has got the free hand. Now, we’re filing off these two zirconia crowns, we’re not going to show all of that preparation work.

Rolando Mia: I noticed Dr. Hirsch, you also put cotton rolls up there.

Dr. Tom Hirsch, DDS: Clinically speaking, do what you need to do. I wanted his cheek up farther and out of the way.

From here, we took the zirconia crowns. You can see down inside the mouth on top of the Isolite Mouthpiece, there’s a piece of zirconia crown. I’m not going to worry about getting that out right now. I want to demonstrate the point that we don’t need to get that out right now.

Don’t Stress When Dental Debris Falls in the Mouth

I’m trying to pop that crown off, and it’s bonded on so well that I had a hard time getting it off. The teaser that we showed in the very first part of the video, showed all those crowns and all those pieces of crowns collected to the back of the mouth, so I didn’t worry about it.

The patient had a lot of very deep decay on the distal of 14 and 15 on the lingual of 14 and 15. After, I prepped the area was really bleeding substantially. This is what I use to stop the bleeding, it’s made by Ultradent, it’s Astringedent X. This should definitely be in your armamentarium. It stops bleeding immediately.

Now I’m retracting the tissue, I’ve got all four teeth, retracting the tissue. I use Ultrapack from the Astringedent. Putting that xird in there really deeply. You can certainly go in there with a laser. I don’t really use lasers all that much.

Create Ease in Digital Scanning

Everything is all retracted, we’ve got those four preps retracted, I built up the deep decay on number 14, right there on the lingual. Now we’re going to get ready to image, and right before we image we’re going to remove all the retraction cord. So, I’ll take a little K-Y Jelly and I’ll put a little bit of that on my finger and then I’ll just put that right inside the Isolite mouthpiece. On the back of the camera I put some Vaseline, and that way it slides really nicely and easily right across there.

So we just made a set of provisionals. This is another thing that you should get in your office, a steam cleaner, just to steam clean everything before you cement. Now we took the provisionals, another trick, Vaseline your provisionals on the outside, your cement cleans off super easy.
You can see there’s, all the bleeding is controlled, there’s no hemorrhage at all. We put that in, and we cure it. Not much more time than prepping one crown. I have him bite down on the occlusion.

Achieve Faster Procedures

I prepped four crowns, very productive, and why was I able to do this? The Isolite allowed me to do this. It kept the tongue out of the way and the patient’s mouth open, so I could just focus on exactly what I was doing. I didn’t have the patient sitting up, spitting out, swallowing, which was nice.

Rolando Mia: During the course of this, you can see multiple different benefits throughout the procedures. Dr. Tom’s “Case of the Week” will continue and he’s going to highlight different aspects of how the Isolite is used. In this case we highlighted that, the mouth was left open, pieces were falling down, no problem with the patient, the patient looked very comfortable, and procedure really smoothly.

Thank you for taking the time, Dr. Hirsch.