The course will demonstrate in detail the layer-by-layer restoration of chewing teeth broadcast on a large screen! Program Philosophy, meaning and content of bleach aesthetics. Prospects for the genre of bleach restoration in direct execution. What advantages does this type of aesthetic intervention offer for the doctor and the patient? What difficulties and dangers can you encounter? Psychology of bleach patients. Features of the doctor’s behavioral tactics. What are the mandatory conditions for the clinical execution of bleach restorations and direct composite veneers to ensure a favorable long-term prognosis? Recipes for shades and layers. 3 main types of white restorations. What composites are best suited for creating bleach veneers? Is there a wide range of white shades? Methods of controlling the thickness and optical density of the material to uniformly cover the previous shade of the teeth. How and with what to reproduce natural optical anatomy (translucent cutting edge and mamelons) when creating bleach restorations. Work using a key or in “free” modeling. The morphology of the anterior teeth as a factor that enlivens the appearance of the restoration. Morphology of the vestibular surface of the incisors. Features of microrelief and the role of texture in aesthetic perception Finishing of frontal restorations. The meaning of finishing. Why is this part of the work critical? Requirements for quality of execution. Finishing protocol. Analysis of the operating characteristics and impact of various rotating tools and polishing systems on the surface of the composite. Finding the most effective grinding and polishing tools. Clinical sequence of work. (in the format of demonstration work on special phantoms from ZenGears). The most convenient options for isolating the working field. Features of preparation and adhesive preparation of teeth. Application and adaptation of the material. Adding portions to the side surfaces. How to avoid darkness in the interdental spaces. Treatment of the cervical part. Formation of morphology, texture and finishing

The course will demonstrate in detail the layer-by-layer restoration of chewing teeth broadcast on a large screen! Program Morphology of chewing teeth. Principles of formation and main anatomical features of chewing teeth. Effective ways to train manual skills. Progressive approaches to learning. The main anatomical landmarks when constructing the chewing surface. Types of fissures, methods of reproduction. Functional aspects of the morphology of chewing teeth. Features of working with composites. Concept of layers and shades of distal restorations. Simple and effective solutions. The most convenient and effective instruments for restoration of chewing teeth. Use of brushes, micro-applicators and modeling resin. Methods for adding “liveness” to distal restorations. Pigmentation of fissures, use of white composites to enhance the depth of the relief. Methods for manual control of the composite shape. Clinical aspects. Methods of restoration of chewing teeth. Occlusal key technique using Teflon tape. Manual modeling technique when working with small and medium-sized defects. Using the "small portions" method. Special techniques for restoring large defects in the absence of obvious anatomical landmarks. Indirect composite inlays and onlays Finishing of posterior restorations. Analysis of grinding and polishing tools.

Program First day Morphology of chewing teeth. Principles of formation and main anatomical features of chewing teeth. Effective ways to train manual skills. Progressive approaches to learning. The main anatomical landmarks when constructing the chewing surface. Types of fissures, methods of reproduction. Functional aspects of the morphology of chewing teeth. Features of working with composites. Concept of layers and shades of distal restorations. Simple and effective solutions. The most convenient and effective instruments for restoration of chewing teeth. Use of brushes, micro-applicators and modeling resin. Methods for adding “liveness” to distal restorations. Pigmentation of fissures, use of white composites to enhance the depth of the relief. Methods for manual control of the composite shape. Clinical aspects. Methods of restoration of chewing teeth. Occlusal key technique using Teflon tape. Manual modeling technique when working with small and medium-sized defects. Using the "small portions" method. Special techniques for restoring large defects in the absence of obvious anatomical landmarks. Indirect composite inlays and onlays Finishing of posterior restorations. Analysis of grinding and polishing tools. Second day Optics of dental tissues. The nuances of choosing the shade of a composite material. Analysis of errors that occur at this stage. Solutions Protocol for selecting the shade of a composite material. Analysis of the optical density of various shades of composite material. Optical and chromatic design of the restoration. Features of imitation of the dentin body, mamelons. Techniques for characterizing mamelons. Configuration of layers of composite material when reproducing teeth of varying degrees of transparency. Reproduction of the Halo effect. Composite material corrections. Correct attitude towards the need to make amendments and improvements. An effective protocol for adhesive preparation of composite material at different times: no more than 2 hours from the moment of polymerization; from 2 hours to up to several years. Morphology of the teeth of the frontal group. The path of self-improvement. Ideology. Basic principles of training Effective ways to train to reproduce the correct shapes of teeth Variants of shapes of the front teeth. Imitation of natural unevenness of the cutting edge Morphology of the vestibular surface. Atlas of shapes and surface characteristics. Texture. Finishing of restorations. Creation of imperceptible transitions when reproducing fragmentary restorations without total vestibular overlap. Adaptation of material. Techniques and tools. Analysis of grinding and polishing tools. Principles and protocols for the most efficient finishing possible. Special techniques and techniques The concept of biological width and its role in restoration. Processing overhanging edges. Clinical aspects of dental restoration Analysis of the most complex and interesting clinical cases of various categories. Closing diastemas. Analysis of the complexities of this category of clinical cases and frequently occurring errors. Principles of correct distribution of proportions. Principles for successful restoration of class III cavities. Formation of a contact point. Analysis of problems of class III restorations. Ways to solve. Distribution of layers of composite material when reproducing lateral defects of various depths. Configuration and shade ratio during restoration of class III teeth of different levels of transparency. Clinical tactics for the restoration of defects of various configurations. Techniques for reproducing a contact point. Treatment of overhanging edges in the peri-gingival area. Polishing the contact point

Program Chapter One: Theory. Brainstorming. Preparation of tooth tissues. Cariesology. The nuances of working with carious cavities of different depths. Modern clinical protocols for direct pulp capping. A new look at lining materials. Do I need to use spacers when opening the pulp horn or treating deep caries? Processing of enamel edges, true goals. How to avoid white stripes. Modified adhesive protocol. In-depth study of all stages of adhesive preparation. Causes of aging of the hybrid zone. Selection of adhesive system. The nuances of using sandblasting of tooth tissue. Principles of proper etching. Medicinal treatment of the cavity using alcohol and chlorhexidine: goals, mechanism of operation, correct protocol for use. Features of the molecular interaction of the adhesive system with dental tissues. Methods for improving the polymerization of a composite. Polymerization process: chemical mechanism, stages. What difficulties may arise during polymerization? The concept of conversion. Ways to increase conversion. Heating the composite. Controlled polymerization techniques. How to reduce polymerization stress to a minimum? Repair of composite restoration. Features of the structure of composites at different stages of the life of the restoration. Protocol for adhesive preparation of composite material at different times: no more than 2 hours from the moment of installation; from 2 hours to a week; from a week to several years. What to avoid when adjusting composite restorations. Chapter Two: Demonstration

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Smile restoration.

Dentist Shcherbakov Viktor Vladimirovich, clinic "Royal-dent" (Moscow)

At any dentist's appointment, there are patients with the need for large-scale reconstruction of the front teeth and smile, but the implementation of such clinical cases is an extremely difficult task. This is due to many factors: competent planning, complex aesthetic development, multi-stage nature, high level of clinical performance, etc.

Many doctors encounter a large number of mistakes on the way to carry out such work, and the end result is often far from perfect. That is why the purpose of this article is a detailed analysis of a clinical case of complex aesthetic reconstruction of a smile with detailed comments and practical advice that, in the author’s opinion, could be useful in practice.

1 - Initial situation: the presence of a diastema and a large number of teeth in the area of ​​the front teeth of the upper and lower jaw; incomplete teething and, as a result, a gummy type of smile; spiky tooth shape 2.2.

2 - In order to reduce the distance between the teeth, place the canines in the correct position and facilitate subsequent restoration, orthodontic treatment was undertaken.

3, 4, 5, 6 – Condition of teeth 2 years after orthodontic treatment. The three jaws of the lower jaw were completely leveled, but the displacement of the upper teeth turned out to be insignificant. Despite the fact that the canine ratio was generally correct. The patient did not have sufficient separation during laterotrusion movement to the left side due to the presence of a small sagittal gap on the left.

7, 8 – taking into account the significant visualization of the gums when smiling, it was decided to increase the height of the clinical crown of the anterior teeth by correcting the zenith of the gums.

specialist in artistic dental restoration, opinion leader of the Dentsply company, laureate of the All-Russian dental restoration championship “Prisma Championship” in 2013 and 2014, member of the Italian community of restorers Style Italiano, lecturer for the GoProject community, lecturer for the Stom-Prom company, photographer, judge international dental photography competition Dental Photography Contest

At any dentist's appointment, there are patients with the need for large-scale reconstruction of the front teeth and smile, but the implementation of such clinical cases is an extremely difficult task. This is due to many factors: competent planning, complex aesthetic development, multi-stage, high level of clinical performance, etc.

Many doctors encounter a large number of mistakes along the way of carrying out such work, and the end result is often far from perfect. That is why the purpose of this article is a detailed analysis of a clinical case of complex aesthetic reconstruction of a smile with detailed comments and practical advice that, in the author’s opinion, could be useful in practice.

In Figure 1, the initial situation: the presence of a diastema and a large number of teeth in the area of ​​the frontal teeth of the upper and lower jaw; incomplete teething and, as a result, a gummy type of smile; spiky tooth shape 2.2.

Orthodontic treatment was undertaken to reduce the distance between the teeth, place the canines in the correct position and facilitate subsequent restoration (Fig. 2).

The condition of the teeth 2 years after orthodontic treatment is shown in Figures 3-6. The three jaws of the lower jaw were completely leveled, but the displacement of the upper teeth turned out to be insignificant. Although the canine relationship was generally correct, the patient did not have sufficient separation during laterotrusion to the left side due to the presence of a small sagittal gap on the left.

Considering the significant visualization of the gums when smiling, it was decided to increase the height of the clinical crown of the anterior teeth by correcting the zenith of the gums (Fig. 7, 8).

Normally, the biological width parameter is 3 mm (Fig. 9, 10). Accordingly, the maximum immersion depth of the restoration edge should not exceed 1-1.5 mm. If it is necessary to correct the gum contour to a greater height, it is necessary to perform perioplastic intervention with reduction of the bone edge of the alveolus.

According to the results of the periodontal examination, the total probing depth was 3 mm in the area of ​​the anterior teeth (Fig. 11). If we add 1 mm of connective tissue attachment to this value, we will find that due to incomplete eruption, the value of the biological width in this case turned out to be 4 mm (1 mm more than normal). Accordingly, work on safe correction of the gum level can be carried out within 2 mm without perioplasty and bone tissue reduction.

In photographs in the lateral projection, the thick biotype of the alveolar mucosa is clearly visible, which is a favorable factor from the point of view of possible complications after correction of gum zeniths (Fig. 12).

Before the start of the treatment procedures, an aesthetic development was carried out, reproducing the intended shape digitally and on wax models (photos of which, unfortunately, were lost) (Fig. 13).

The ceramic work of master technician Sergei Yudakov with teeth whose shape turned out to be closest to the patient was chosen as an aesthetic reference and starting point for creating the vestibular morphology (Fig. 14).

One of the important conditions for the successful reproduction of anatomical details in restoration is subject orientation to a reliable sample. You should not create a form from memory. Our knowledge is often fragmented and imperfect. When we have a natural tooth (or a copy close to the original) in front of our eyes, we can imitate the natural morphology much more accurately and more believably (Fig. 15).

Trying on the preliminary shape in the mouth using a mockup (Fig. 16). This stage is mandatory in the overall complex of aesthetic development activities. Using a mockup, you can conduct preliminary articulatory and phonetic tests, determine how correctly the position of the incisal edge and the overall height of the teeth were set. In this case, excess height and vestibular volume were identified. Appropriate adjustments were made to the wax models.

Correction of the height of the gingival margin was carried out using a diode laser (Fig. 17). Immediately after working with the soft tissues, cervical composite ridges were modeled (under single isolation of each tooth using a rubber dam) in order to prevent the reverse growth of soft tissues in the postoperative period and to form the correct gingival contour. It is important to carefully trim the perigingival areas of the composite to avoid the formation of overhanging edges.

The appearance of teeth 7 days after laser gum correction is shown in Figure 18. Some areas of the mucous membrane did not have time to recover completely.

The shade selection stage is shown in Figure 19. The lower incisors, which have more uniform optical characteristics and without intense white spots, were chosen as a reference point. The closest shade on the TruMatch color scale turned out to be B 1. In order to make the analysis of the optical and chromatic characteristics of the tooth more objective, it is recommended to take photographs using special polarizing filters.

To make sure that the chosen shade is correct, it is recommended to take a small portion of the composite of those colors that are part of the “formulation” of the TruMatch scale sample, apply it portionwise to the tooth surface and polymerize (Fig. 20).

Based on the wax-up models made, a palatal silicone index was obtained for precise positioning of the composite mass (Fig. 21).

The appearance of the teeth after isolation is shown in Figure 22. The previously made composite rollers made it possible to reliably fix the edge of the latex scarf using cervical ligatures with hygienic floss. No preparation was performed using a rotating instrument.

The entire scope of mechanical effects on the surface of the teeth was limited to air-abrasive treatment using a RondoFlex apparatus with aluminum oxide sand with a particle size of 27 microns (Fig. 23). This makes it possible to reduce the acid-resistant surface aprismatic layer of enamel, and also increases the total specific surface area, increasing the strength of the adhesive bond.

Acid dynamic etching of the enamel surface (Fig. 24). It is recommended to shake the phosphoric acid gel throughout use to enhance the etching effect and reduce the content of insoluble calcium monohydrate salts.

Application of hydrophobic resin of the 4th generation OptiBond FL adhesive system (Fig. 25).

Reproduction of the palatal enamel wall using the opal shade of the Ceram -X DUO E 2 composite (Fig. 26). In order to improve plastic properties and increase monomer conversion, the composite material was heated to a temperature of 40 degrees.

Formation of the mamelon structure from the dentin shade Ceram -X DUO D 2 (Fig. 27). To model the internal dentin structures, it is convenient to use a soft silicone trowel in the shape of a cone.

The algorithm for layer-by-layer application of layers of composite mass of various shades is presented in Figures 28-33.

View after application and polymerization of all layers of the composite material. The side walls and contact points were formed separately using individually contoured Mylar matrices using the Radlinsky method (Fig. 34).

Pencil marking of macro- and microanatomy (Fig. 35, 36). The use of pencil marks helps to effectively work on the nuances of vestibular morphology and relief, as well as control the position of the lateral edges.

Anatomical contouring stage (Fig. 37, 38). It is carried out using diamond spade burs with a red stripe on the raising tip. Using a torque-controlled tip helps you better feel the pressure and regulate the cutting activity of the tool. It is important to carry out work at low rotation speeds (up to 10,000 rpm).

Grinding stage (Fig. 39, 40). Performed using Enhance silicone cup and cone heads. These tools should be used without using water to see how the surface texture of the composite changes and, accordingly, to better control the quality of the finish. Enhance heads produce a natural cross-striation pattern.

Grinding of proximal transition surfaces and embrasures using a Sof-Lex disc of low abrasiveness (Fig. 41). You need to work with this tool very carefully, without intense pressure, so as not to weaken the contact density. The rotation speed should not exceed 4000 rpm.

Pre-polishing stage using PoGo polishers (Fig. 42). This tool gives the surface a preliminary shine and removes microdeformations from the surface. In this case, the structure of the microrelief is not disturbed. Among other forms, according to the author, PoGo disks have the best efficiency. They need to be operated at low speeds (up to 8000 rpm) with intermittent movements.

Pre-polishing using dental brushes made of goat bristles (Fig. 43, 44). They must be operated strictly without water cooling (the surface of the teeth must be thoroughly dried before use) at low speeds (up to 8000 rpm). This polishing instrument improves the gloss of the composite and, with a volumetric effect on the restoration, polishes even hard-to-reach interproximal and cervical areas.

Final polishing of the surface using Prisma Gloss Extra Fine paste on a special sponge (Fig. 45). First, the paste is treated without water, then with a slight addition of liquid. After applying this paste, the surface takes on a sparkling shine.

Photos 8 days after completion of the restoration (Fig. 46-58). The soft tissues have almost completely recovered, only in the area of ​​the gingival papillae between teeth 2.1, 2.2 and 2.3 the mucous membrane is slightly hyperemic and slightly swollen, however, given the scale of the interventions, a longer period is required for complete healing. After repositioning the cutting edges, the function of canine guidance was restored. The patient notes minimal discomfort in terms of diction. Thanks to laser gum correction, it was possible to get rid of the gummy type of smile, which significantly affected the appearance.

Lecturers: Shcherbakov Viktor Vladimirovich
Dates: March 25-26-27 - 2016 - Moscow
Number of seats: 24
Venue: To be confirmed
Registration starts: 9-30
Course starts: 10-00
Price: From 15,000 rub.

Cost of participation- from 15 to 40,000

Until February 14, 1 day - 15,000 - after 14 f. - 18 000 (new program - 3rd day)
Until February 14, 2 days - 25,000 - after 14 f. - 30,000 (main program)
Until February 14, 3 days - 35,000 - after 14 f. - 40,000 (full program)

From 2 people - 1000 rubles discount each
From 4 people - 2000 rubles discount each

Day 1 - Basic level.

Part 1.
General theory - Study of equipment. How to choose the right photo combination? - DSLR camera and lens. Operating principles, device, concept of focal length, correct choice of lens. - Review of offers on the market. How not to spend extra money. - Flashes. The meaning of light in photography. 5 lighting difficulty levels. - Study of additional accessories for dental photography: retractors, intraoral mirrors, contrasters, polarizing filters, radio synchronizers, tripods, backgrounds, etc.

Part 2.

Camera settings. - The concept of exposure (shutter speed, aperture, photosensitivity). - White balance. Correct setting. - Adjust settings depending on the situation and goals. We are setting up the participants’ cameras. Demonstrate the creative capabilities of the camera using various settings. Long exposure photography, painting with light.

Part 3.

Practice. Traditional dental photography. - Photo examination of the patient. A complete set of photographs for the work of a dentist. - Portrait photography. Angles, rules. Organization of a dental office for portrait photography. Minimum set. Using softboxes for portrait photographs. - Photo of a smile. Features of shooting, angles. - Intraoral photography. Techniques, angles, working with additional accessories. - Photo-logging of clinical cases. Features of shooting chewing and front teeth. - Assistant functions during photo-logging

During the practical part, a demonstration is given by the lecturer, then the participants carry out the entire photo protocol independently. At the end, errors are analyzed. The shooting conditions are as close as possible to clinical work behind the dental chair.

Day two. Advanced level.

Part 1.

Principles of artistic photography. Aesthetics in everyday life. Why do we need artistic photographs - Artistic lighting. Review of proposals - Rules for working with softboxes. Scope of application. How distance, angle, size and shape of softboxes affect shooting - Various options for using softboxes for dental photography.
Part 2.

Artistic intraoral photography - Various lighting configurations - Artistic photography of anterior and posterior teeth Demonstration + practice on models under the supervision of a lecturer
Part 3.

Shooting in backlighting - What is backlighting. Reception capabilities - How to convey relief, texture and volume using backlighting - Lighting configuration. Various options for softbox layouts Demonstration + practice of participants on models

Part 4.

Part 5.

Subject macro photography - How to take beautiful photographs of crowns, models, dental instruments, extracted teeth. - Shooting on a mirror with different backgrounds - Shooting extracted teeth against the light. The beauty of opalescence. Demonstration + practice

Part 6.

Non-standard photography techniques - High-speed photography. - Lighting teeth with fire! - Throw objects into the water! - Shooting drops

Day 3. Software photo tuning.

Why is software post-processing necessary?
- Features of modern photo editors

Introduction to editing programs

Photo cropping

Software exposure and white balance correction

Creating watermarks, photo signature

Batch photo processing in Adobe LightRoom

How to save bad shots

Sharpening photos

Intensive design.
- Working with layers.
- Artistic techniques.

Recommendations for participants:

1st day- DSLR camera with macro lens and flash for macro photography - Contrastors - Intraoral mirrors

2nd day- DSLR camera with macro lens and flash for macro photography - Contrastors - Intraoral mirrors - Extracted teeth, crowns, jaw phantoms and other objects for subject macro photography - Laptop computer with Adobe Photoshop of any version installed (required) and Adobe LightRoom (desirable)

The requirements are not exclusive, if the participant does not have equipment, they are free to participate and use the equipment available.

3-day
Laptop computer with Adobe Photoshop and Adobe LightRoom installed

Treatment instructions must be strictly followed

program for downloading files from torrent sites http://www.utorrent.com/intl/ru/downloads/win

Sign up by phone. - 8-915-455-61-85!!! Alexander.

!!!
The price includes lunches, coffee breaks and a certificate, as well as a sea of ​​adrenaline and positivity!!!

How to register: By phone 8-800-200-61-31 (free call from mobile and landline phones) or on the website www..ru (full name of the participant, mobile phone number of the participant, details of the organization, form of payment).