INTENSE I – Dr. Francesca Vailati
The diagnosis, the data collection and the increase of VDO
9.00 -11.00 – ADDITIVE dentistry
Dental wear is a frequently underestimated pathology that nowadays affects an increasing number of individuals.
Teeth are wearing down faster, not only for the excessive presence of the acid in the mouth, but also because of parafunctional habits.
Generally, the affected patients are left untreated until more damage occurs and conventional treatments are more justified (subtractive dentistry based on crowns). Postponing the therapy is not the correct attitude. Non-invasive (ADDITIVE) adhesive restorations should be proposed instead, to protect the remaining dentition from further degradation.
- Learn the rational behind an ADDITIVE non-invasive approach versus traditional subtractive dentistry.
11.30 -13.00 – Basic diagnosis
Before starting any dental treatments, a diagnosis of the origin of the tooth wear should be made. Even though loss of tooth structure is often multifactorial, clinicians should try to identify the cause, to explain patients also how the restored dentition will be ageing in the future.
The participants will learn how to recognising the signs of early tooth wear and be capable to predict the type of evolution if the dentition is left untreated.
- Learn to identify the signs of dental erosion.
- Know the evolution of untreated mouths affected by dental erosion.
- Make the differential diagnosis between erosion and parafunctional habits.
14.00 -15.30 – ACE classification and SANDWICH approach
In case of severe dental EROSION, the facial aspect of the anterior teeth may also need to be restored. In this case another veneers, made this time in ceramic could be used. The ACE classification is a clinical oriented classification, which considers the maxillary anterior teeth to evaluate the severity of the dental wear related to dental erosion. Instead of trying to precisely quantify the wear due to erosion, this classification proposes to correlate the damage at the level of the anterior maxillary teeth to the possible options of treatment. Patients are grouped in six categories, and for each of them a dental treatment plan is suggested.
The classification is based on several parameters, relevant for the selection of the treatment and the assessment of the prognosis, such us the dentin exposure, the preservation of the incisal edges, and the pulp vitality.
- Classify patients affected by erosion, looking at the damage of their anterior teeth.
- Propose a treatment based on the ACE classification.
- Lear how to decide if also facial veneers are indicated in the treatment.
16.00 -18.00 – CLASSIC 3 STEP (the Esthetic)
Despite the tendency for adhesive techniques to rather simplify the involved clinical and laboratory procedures, treatment of patients affected by severe dental erosion still remains a challenge.
An innovative approach, called the CLASSIC 3 STEP technique has been developed by Dr. Vailati. The 3 STEP technique is a structured approach to start a full-mouth ADDITIVE rehabilitation with the most predictable result, the minimal tooth preparation, and the highest level of patient’s acceptance.
Fundamental before starting the rehabilitation the communication with the patient and the laboratory technician on the esthetic final outcome. Thanks to a simplified less expensive mock-up, the patient can make an informed decision if he/she is willing to start the more comprehensive rehabilitation.
In this session, the participants will learn how to start developing a full-mouth rehabilitation, starting from two of the three fundamental parameters, the incisal edges and the esthetic occlusal plane.
- Avoid full-mouth waxup.
- Plan an intelligent esthetic outcome for the future rehabilitation.
9.00 -13.00 – The WHITE BITE (the VDO increase)
Since the main objective of the 3 STEP technique is to avoid the removal of healthy tooth structure, while restoring worn down dentitions, an increase of vertical dimension of occlusion (VDO) is always advocated.
The role of the clinician in determining the new VDO is fundamental. Once the project in wax is clinically validated, the posterior teeth are reconstructed, using transparent silicon keys. These keys are loaded with composite and positioned in the mouth to fabricate posterior restorations (the white bite).
Thanks to the white bite the occlusion of the patient could be verified, before progressing to the final restorations. The white bite becomes a test drive to stabilise the patients and to give back their function.
In this session, details on how deciding the increase of the VDO will be given. Special attention to the communication with the laboratory technician in the fabrication of the wax up of the posterior quadrants will be stressed.
- Learn to understand the clinical validity of a more comprehensive waxup.
- Determine the increase of VDO for every 3 STEP rehabilitation.
- The digital wax up will be mentioned, but not discussed in the details, since there are more clinicians who work still in a analogic manner.
14.00-18.00 – HAND ON Fabrication of the white bite
Often laboratory technician do not know how to correctly make the transparent keys, leading to clinical complications during the fabrication of the white bite. Errors, such as incorrect occlusion, or interproximal excesses can be reduced if clinicians are able to evaluate the quality of the posterior waxup first and the quality of the transparent keys later. Examples of laboratory and clinical mistakes will be shown during this practical part, where the participants will fabricate a correct transparent key by themselves. Even with both a correct waxup and a transparent key, potential risks of mistakes may still be present during the II clinical step, when the key is used to fabricate the white bite directly in the patient’s mouth. Critical step could be how clinicians handle the transparent key, the quantity of composite loaded, the quality of composite used, the pressure applied on the key etc. These steps will be evaluated, using clinical examples, while participants will use their transparent key and fabricate the white bite themselves.
- Learn to analyse a posterior waxup.
- Learn to fabricate a transparent key.
- Avoid clinical errors, while handling the transparent key.
9.00 -11.00 – The 14 WORDS, rehabilitation versus reconstruction
During the last day of the course, Dr. Vailati will illustrate the enormous potentials of the 3 STEP technique. This technique was born to treat mostly eroded dentitions; however with time its applications have expanded and today a 3STEP could be applied in every field of Dentistry, from Prosthodontics to Orthodontics. The Additive mind together with the progressive wax become essential in every treatment plan.
- Provide a full picture of the benefit of the 3 STEP approach.
- Give an idea why the 3STEP is an fantastic tool for clinicians to plan and to test drive patients.
14.00-15.30 – Introduction to function and dysfunction
Clinicians are generally not very keen to start treating patients affected by parafunctional habits (e.g bruxism), since they are afraid of the mechanical failure of the restorations delivered. A common attitude is to wait for more damage to occur, to be then obliged to intervene. However, this late intervention is responsible for a further degradation of the original dentition, and a more complicated and expensive therapy. Generally subtractive techniques are then selected and healthy tooth structure removed, leading to further weakening of the dentition. Nowadays, however, these conventional rehabilitations (based on crowns) are very rarely accepted by patients,not only for their biological loss, but also for their important cost.
If dentists are not prepared to treat parafunctional patients, and patients are reluctant to restore their teeth with subtractive techniques, questions on the time of intervention should be raised.
ADDITIVE dentistry can be the alternative to propose to this population of patients, based on an early intervention with the maximum preservation of their tooth structure. In addition this approach allows a test drive to stabilise patients and to see how they react to the new restored dentition.
- Discuss why dentists cannot reconstruct all the different mouths following the same standardised ideas.
- Place attention on the importance of function (#youcantskipfunction).
16.00 18.00 – Photos and case documentation
A solid initial documentation is fundamental for a correct treatment plan.
To avoid waste of time, clinicians should know what is really necessary when it comes to the data collection during the first visit with the patient.
In this session it will be also explained how to register the patient’s occlusion, the type of impression to take, how to mount the casts etc. In addition a list of essential photos will be described. Very few clinicians understand the fundamental importance of documenting their work with photos. Some of them take pictures only to communicate shade to the technicians, other to show the patient aesthetics. Following the 3 STEP technique, instead, there are several photos crucial to document clinical parameters necessary for the treatment plan.
In this part of the course, the participants will be instructed to take only the necessary pictures and they will be capable by looking at those to identify the critical parameters for the diagnosis and the treatment plan.
- Learn how to collect the initial date for treatment planning of a 3 STEP.
- Learn which are the essential photos to take and which clinical parameters are shown in each picture.