Joshua Polansky

Modern dentistry provides the dental team with many options for restoring the oral cavity. The newer tools like digital impressions, CAD/CAM models and restorations, and full-contour milled restorations, allow us to do many things that were not available in the past.

However, even with the benefits they can provide, these options should not let us forget what was available in the 

. Some of the best dentistry displayed today on the lecture circuit is still done with tried and true PVS impressions and a little 

When we think of conservative dentistry we tend to think of micro-veneers, however conservative dentistry is conservative in every way. If done properly, dentistry can conserve tooth structure, which builds patient trust and is economically sound.

While many patients still face the problem of over preparation, the following case study can guide the reader through the lab process of a no-preparation restoration.

The patient presented with a small incisal chip of his lower central incisor 

. Once the doctor studied the patient’s function to determine if there were any interferences that would translate to the final restoration, a clean polyvinyl impression was taken.

For this no-preparation restoration the refractory veneering technique was applied with 

 To create a refractory die for layering, an alveolar model needed to be fabricated 

 To fabricate the working die, the die needed to be cut out of the cast and trimmed with an angled bur so no undercuts were visible 

 Once the die is inspected for undercuts it should be fixed back into the original impression where a check is made that the die is angled the way a natural root is angled, and that once again no undercuts are visible 

 To aid in the release of the die, once stone is poured into the cast, a thin layer of clear wax is applied to the “root” of the fixed die. The model is then poured with a type 4 stone-GC Fuji-Rock was used in this case-and left to set for its proper setting time.

 The die then is tapped out of the master alveolar cast, and it is imperative to check that the alveolar die is fixed in the exact position as it is in the solid cast. A matrix taken of the solid cast is transferred to the alveolar cast to check the precision of this position 

 Once this is checked, the master alveolar die (Alpha Die) will have spacer applied to the area where ceramic will be built and duplicated. Once duplicated, G-CERA® ORBIT VEST refractory material was poured and put under pressure until set 

 With everything checked the ceramic now can be layered. The first step is to seal the refractory material. This is done by firing a clear layer of GC America’s GC Initial CL-O on the working area at a high firing cycle, 20° higher than the first dentin cycle 

 Once sealed the layering can take place. A light mamelon is built (Fd91/A1) at the incisal followed by an enamel overlay (E-58/Eop-3). This is fired at 910°C.

 Once fired, the restoration is treated with rotary instruments for surface texture and detail. It is then glazed 

 After glazing and polishing, the veneer is ready for divesting. To divest, the refractory material is cut away from the margin areas with 

’s DiaLites™, and the root portion of the die is cut off.

Once cut, the veneer is embedded in a small, thin putty matrix and lightly sandblasted at low pressure until the refractory material is no longer present in the veneer 

 Divested, one can see just how thin and fragile the conservative veneer is 

. The veneer is then etched and treated like a traditional veneer and brought to the mouth for insertion.

 At insert a fixed stick can aid to guide the fragile restoration into place 

, the finish line can be taken down intraorally with DiaLites and silicone burs. The goal is to blend the finish line into the natural dentition for a nice final result 

Through the use of this veneering technique one can see that a nice value match is achieved by using the natural dentition as our underlying color 

 one also can see that we achieved a nice result in form by using the natural dentition as our guide 

With this conservative approach the dental team can restore teeth back to a natural state with no needles, pain or discomfort, reaching a great final result 

Joshua Polansky earned his Bachelor of Arts degree, Summa Cum Laude, from Rutgers University in 2004. While working part time at a dental laboratory, he took advantage of an opportunity to apprentice with distinguished master technician, Olivier Tric of Oral Design Chicago. Mr. Tric opened Joshua’s eyes to a whole new world of possibilities. He continued to acquire technical skills by studying in Europe with other mentors and experts in the field such as Klaus Mutertheis. Joshua earned his Master’s degree in dental ceramics at the UCLA Center for Esthetic Dentistry under Dr. Edward McLaren. Joshua continued his training under Jungo Endo and Hiroaki Okabe at UCLA’s advanced prosthodontics and maxillofacial program working on faculty and residents’ cases. He currently resides in Cherry Hill, N.J., where he is the owner and operator of Niche Dental Studio.

Articles

Conservation appreciation

My father has been practicing dentistry for more than 35 years. He told me back in the “old days,” many lecturers would shy away from doing a single central incisor and just do both teeth. Considering how common the single central circumstance is, it appears that the technician who masters the task will be in great demand.

Modern technology with higher quality materials, digital photography and better shade options enable the technician to create single central restorations that melt into the environment.

Unlike doing two or more teeth, where the dentist and technician have the freedom of altering contours and shades to the patient’s desire, when doing a single central the task is one of working within the limitations and restraints of the existing dentition. A technician who welcomes limitations and restraints gets the chance to exercise his or her true creative ability, and use his or her knowledge of color, form, texture and digital photography.

 The first task in this type of case is to obtain a clean, clear image of the tooth in the surrounding environment. The criteria for this image is proper focus, a wide depth of field and proper image size 

. This image becomes the foundation for the information needed.

 We enter the image into any photo-editing software program. The software will provide us with the ability to view a value image, a saturated image for color and an inverted image for form 

Video extra: See the video below for a demonstration of how to create the different images using Adobe Photoshop.

 Another important image is a shot of the natural abutment shade, which is key when selecting the proper material for the restoration 

 These images help the technician to evaluate the ceramic selection based on the shade tabs fired in their personal calibrated furnace 

 With the photographic information to provide the necessary details, the first bake can be achieved, layering in the details using the GC Initial Zr Ceramic System from GC America 

The technician should limit the number of firing cycles to limit the loss of color that occurs when excessive grinding is required after each bake.

 The technician also has to layer the ceramic in its exact place to replicate the colors from wet ceramic to fired ceramic 

 After the first firing cycle the restoration should exhibit the depth and color we need 

 Once the contacts are adjusted, the technician can now begin the detail work of creating proper form. Colored pencils are a great tool to help guide the technician in the right direction of contour and surface treatment 

 When finalizing the form and surface treatment it is important to check the restoration from every angle so as not to miss any details 

 Once every angle is checked and the first bake and contouring is complete, we can glaze the restoration and add some minor details. It is these details that help differentiate a great restoration from a mediocre one. Some of the details include a halo, and line angle adjustments.

We accomplish this by mixing a low fusing ceramic to our layered ceramic with a 60/40 mix 

 Once glazed and polished we can go to the mouth for our try-in, hoping the steps we took yielded an accurate restoration 

 To check our work we can convert an intraoral image of our restoration to black and white to confirm value 

With accurate form, value and surface texture the single central becomes less of a challenge. The goal of the single central is to blend harmoniously into an existing site and not to overpower the surrounding dentition 

It is through working within the restraints and limitations of the existing site that the technician can exhibit maximum creativity when completing this rather common occurrence in dental practice. 

Joshua Polansky earned his Bachelor of Arts degree, Summa Cum Laude, from Rutgers University in 2004. While working part- time at a dental laboratory, he took advantage of an opportunity to apprentice with distinguished master technician, Olivier Tric of Oral Design Chicago. Mr. Tric opened Joshua’s eyes to a whole new world of possibilities. He made the decision to become a master dental technician following the path that Tric had forged. He continued to acquire technical skills by studying in Europe with other mentors and experts in the field such as Klaus Mutertheis. Joshua earned his Masters degree in dental ceramics at the UCLA Center for Esthetic Dentistry under Dr. Edward Mclaren. Joshua Continued his training under Jungo Endo and Hiroaki Okabe at UCLA’s advanced prosthodontics and maxillofacial program working on faculty and residents cases. Joshua currently resides in Cherry Hill, NJ where he is the owner and operator of 

My father has been practicing dentistry for more than 35 years. He told me back in the “old days,” many lecturers would shy away from doing a single central incisor and just do both teeth. Considering how common the single central circumstance is, it appears that the technician who masters the task will be in great demand. Modern technology with higher quality materials, digital photography and better shade options enable the technician to create single central restorations that melt into the environment.

Simplifying the single central

	The details that posterior teeth possess fascinate many dental professionals. The intricate lobes and forms that posteriors develop in nature are always fun and challenging to recreate when fabricating restorations. Many tools have been developed by companies to aid in this process, however I always have been fascinated by the handmade tools I have seen technicians create to aide in their quest to recreate nature.

	In this article I would like to share three tools I use on a daily basis when creating restorations in my laboratory. I call these tools the three points (Fig. A). They include old soft tissue tips, a glass scriber and an endodontic needle. Through this article, it is my goal to show technicians how these three tools allow for easier and more consistent fabrication of dental restorations.

 The case is a typical everyday posterior restoration that is very common in laboratories across the world (Fig. B). For this patient, the doctor wants a full contour pressed restoration. To start, I wax up the restoration on a solid working model that replicates the intraoral environment in full (Fig. C). 

 Once the wax-up has full, ideal contour, I do a final check from every angle to ensure I achieved all the details I wanted to capture in wax (Fig. D). I have learned to always refer to nature when doing the final check in wax (Fig. E).

 Once I am satisfied with the outcome, I then transfer the full contour wax form to the duplicated master die to achieve an optimal marginal fit (Fig. F). The restoration is then sprued for investment (Fig. G).

 Now is when the first point-the left over soft tissue tip-is extremely useful for investment purposes (Fig. H). The tip is used because it is very soft and flexible and will allow investment to be placed into sensitive areas that are usually difficult to reach (Fig. I). This is a great trick for capturing all the details I want to transfer from wax to ceramic. The results are easy to see when the pressings are inspected after being devested (Fig. J).

 After fitting the restoration I next move on to the surface treatment that gives the restoration texture details (Fig. K). This is where I use the second point-the glass scriber-to characterize fine texture details. The scriber is a carbide point that is designed to allow the user to draw on glass. This comes in handy for surface treatment because it allows the user to have complete control of the surface marks being created (Fig. L).

 Once the surface treatment is complete it is time to recreate surface color and fissure effects that are found in natural teeth (Fig. M). I like to use the third point-a Monoject endodontic needle (Tyco)-to apply the effects using GC America’s GC Initial IQ Lustre Pastes and InVivo stains (Fig. N). 

	There are two ways to use this tool when working with Lustre Pastes. In the first you can use the needle to suck up some paste and then lightly dispense the color into the fissures (Fig. O).

	In the second technique, the barrel of the needle is filled with a medium viscosity glaze liquid and the pastes are picked up dry. The liquid can then lightly be dispensed to draw the stains in the fissure, controlling the moisture of the stains based on how much liquid is being dispensed (Fig. P). 

 Through the use of these techniques and the three points, natural effects can be achieved in the final restoration (Fig. Q). While these techniques and tips can help achieve natural looking restorations, the only way to see how close these efforts have come to recreating nature in the final restorations is to compare them with nature itself (Fig. R).

	Once these techniques are taken to completion with care, the technician should have a restoration that blends harmoniously in the mouth with surrounding dentition from every angle (Fig. S). 

Joshua Polansky earned his Bachelor of Arts degree, Summa Cum Laude, from Rutgers University in 2004. While working part-time at a dental laboratory, he took advantage of an opportunity to apprentice with distinguished master technician, Olivier Tric, who opened his eyes to a whole new world of possibilities. He continued his studies in Europe with other experts in the field such as Klaus Mutertheis. Joshua earned his Masters degree in dental ceramics at the UCLA Center for Esthetic Dentistry under Dr. Edward McLaren and continued training under Jungo Endo and Hiroaki Okabe at UCLA’s advanced prosthodontics and maxillofacial program. He currently resides in Cherry Hill, NJ with his wife, Emma. He is the owner and operator of Niche Dental Studio, a collaborative boutique Dental Laboratory, with his father Dr. Barry Polansky.  

 The details that posterior teeth possess fascinate many dental professionals. The intricate lobes and forms that posteriors develop in nature are always fun and challenging to recreate when fabricating restorations. Many tools have been developed by companies to aid in this process, however I always have been fascinated by the handmade tools I have seen technicians create to aide in their quest to recreate nature.