Please enjoy the video…….

The case was completed as a 3i Navigator guided implant. The CT scan was used to create a printed model of the bone and a guide was fabricated based on the model surgery.

This wonderful patient was referred to me as a traditional new patient. She had not been to the dentist for several years and was ready to get her health back in order. During our patient interview, we learned she has always been interested in closing this space between her front teeth. When asked what has prevented her, she mentioned that she wasn’t interested in a perfect result that could only be achieved through comprehensive orthodontics. She was looking for something that made her smile ‘better’ without having to commit to extensive treatment.

During a review of treatment options I advised her that orthodontics and implant treatment (congenitally missing lateral #7) was the best way to achieve the ideal smile. I also mentioned to her that a possible acceptable compromise was restorations on teeth #8 and #9 to close the space completely or almost completely. I mentioned that the only drawbacks were possible ‘black triangle’ near the gumline trying to close the space and the appearance of very wide front teeth.

Since most things are visual, she jokingly said she would love to preview what that would look like. I quickly responded that she was in luck. I had a very extra minutes (more like an hour) and i would be happy to work this with Photoshop while she was in the office. Without being exacting, I quickly did some cosmetic imaging and showed her the potential outcome (no promises).

She looked at the picture and said when can we start. We went over some basic ballpark figures and then decided to proceed with models and records to determine if the imaged result is even possible (which of course is possible). By giving my patient the extra 10 minutes and having the tool in my belt to quickly perform cosmetic imaging we are on the way to creating case acceptance.

The beauty of using cosmetic imaging is the multiple benefits. The patients gets the opportunity to see the possibility (seeing is believing), I get to enroll her further in choosing the work, and most importantly (in my opinion) is I get to go over with her the compromises (possible black triangle, non proportional teeth, etc) visually. The end result is a win-win.

So during your free time, take the opportunity to explore treatment a bit further with your patients. Learn to use cosmetic imaging in your arsenal. And remember, this imaging was literally done in less than 10 minutes using Adobe PHotoshop Elements (less than $100). You don’t need fancy dental software to do this.

In my practice, one of the biggest benefits of CEREC is the ‘free time’ it has created to do comprehensive examinations on my hygiene patients. I am now not in a hurry when doing ‘checks’ and have the time to sit down and solidify the relationship and do a better job of diagnosing. Remember, you can’t treat what you don’t diagnose. By empowering your dental assistant to help make this ‘free time’ happen you too can reap these benefits.

In this course, tailored specifically for CEREC dental assistants, each attendee will learn the skills and knowledge to immediately produce highly aesthetic posterior CEREC restorations. Specifically, this course will outline in great detail and with hands-on experience:

1. How to quickly create and accentuate occlusal anatomy
2. How to efficiently polish CEREC restorations
3. How to artistically stain & glaze CEREC restorations
4. How to prepare and treat CEREC restorations for bonding

One of the great things about course from Dr. Agarwal is his no-nonsense approach to dental efficiencies. He understands the concept of minimizing inventory and creating techniques that achieve the desired result without creating complexities. Your assistant will leave knowing exactly what materials are needed to implement this Monday morning in your practice.

If you’ve seen beautiful restorations and wanted to achieve those same results or if you’re not happy with the final results of your CEREC restorations, then you owe it your patients and your practice to send your dental assistant to this course.

*** THIS COURSE DOES NOT TEACH CEREC DESIGN ***

In this seminar, tailored for dental assistants, each attendee will learn the

A trained dental assistant can greatly enhance the efficiency of the CEREC visit while at the same time improving quality.

Len walked into my office in August 2006 after responding to one of my advertising pieces. He wanted to improve his appearance and was unhappy with his smile. I didn’t learn until recently, while talking with his wife of 30 years, how disabling his smile was. Before I had even looked in his mouth he said “Doc, I don’t expect miracles and no idea what it takes or how much it costs”. The first thought that popped into my head was “what the hell could be growing in there and why am i wasting my time – he probably can’t afford this.” But having been taught the lesson of never judging a book by it’s cover, I went through the entire consultation just as I do on everyone.

Melinda (my treatment coordinator) and I gathered as much “fit” and “life” issues we could from Len and then took a few photos of his mouth to share with him. What I found was a case of tetracycline and malocclusion. The prescription was easy – orthodontics and porcelain! The difficulty comes in letting the patient know and not get discouraged by the time and money involved. This is very important in cases like this, because the real goal isn’t accomplished until the very end.

The final plan looked something like this…..

Phase 1 – Invisalign to straighten teeth – 12 months $5,000

Phase 2 – Upper 8 Anterior Porcelain – 6 weeks $9,600

Phase 3 – Lower 6 Anterior Porcelain – 6 weeks $7,200

Phase 4 – Upper Posterior – TBD (implant vs bridge)

Phase 5 – Lower Posterior – TBD (implant vs bridge)

Looking back, I really had to fight myself to resist on skipping the ortho and just prepping down the teeth. I am convinced now that Invisalign was not the best choice in cases like this as it ended up taking 18 months with 2 corrections and didn’t get the teeth where I really wanted them. We gave up and decided that prepping the canines a bit more wasn’t terrible. I should have gone with traditional brackets and wire ortho ala STO.

In the end, the patient wanted whiter and whiter teeth. At the beginning it was “one consistent color and i’d be happy” to “can we make the finals whiter”. That’s why I am glad I work out the color and shape with the temps.

Photos at Consultation

Photos after Orthodontics with Invisalign

Photos after Porcelain Veneers

In this seminar, tailored for dental hygienists, each attendee will learn the importance of digital photography, the uses of digital photography, and how to take digital photos. More importantly, the hygienist will leave with the skills to integrate photography into their daily routine at the highest level.

If you are looking for your hygiene department to go beyond ‘just cleanings’ and become a more integral part of the restorative practice – THIS SEMINAR IS A MUST ATTEND!

2009 Dates

Thanks to popular shows like Extreme Makeover and The Swan direct to consumer marketing on LUMINEERS, today’s aesthetically minded patients are demanding and seeking cosmetic dentistry to improve their appearance. The ability to provide this type of rewarding dentistry is no longer an option – it is a must!

This unique seminar has been developed to review and demonstrate (on an actual patient) every aspect of creating beautiful smiles. You will leave with the knowledge of the latest techniques in smile design, preparation, temporization, rapid cementation, case planning, lab communication, and digital photography. Come spend two days with Dr. Tarun Agarwal and learn the skills as he walks you through from start to finish on actual patients.

Are you less than satisfied with the results of your smile makeovers?
Would you like to perform more smile makeovers?
Are smile makeovers not as predictable as you would like?
Do they take too much clinical time?
Are you following the ”prep and pray” philosophy?
Confused by all the talk about “NO PREP”?

THEN THIS SEMINAR IS FOR YOU!

There are three ways to learn – hearing it, seeing it, and doing it. The OTS stands for Over the Shoulder. The OTS class allows you to learn by hearing it through lectures and by seeing it done in real time. I don’t show videos… I actually do it in real time! That means if I encounter any trouble I can’t hide from it and you get to learn exactly how I handle that situation. Simply hearing it isn’t enough… so I give you the opportunity to watch a highly skilled dentist at his craft.

What Makes This Seminar Unique?

This seminar is a combination of all the education Dr. Agarwal has participated in over the past decade. Dr. Agarwal readily admits that he didn’t invent cosmetic dentistry nor are the techniques he teaches unique to him. T-Bone brings to you the clinical techniques and ‘gems’ he has learned over the past decade that have actually worked in practice and made a positive impact on the clinical results and practice profitability. In other words, this seminar is 100% based on techniques and philosophies that Dr. Agarwal uses in his practice and not some concepts that are not tested to work in the real world. Remember that he is a full time practicing dentist.

You will learn every single aspect of how to do and treat smile makeover cases. From single teeth to 20 units. From A to Z and everything in between. You will have the opportunity to ask questions, bring your own cases for review, and see the lectures put to action. More importantly all information is practical, no nonsense information that you can use starting Monday morning on all your patients.

All dentists can benefit from the techniques and philosophy of this course. Dr. Agarwal is an actual full time practicing dentists. He has a ”real” practice and treats regular patients. He doesn’t have a niche practice that only does smile makeovers all day long. Because of this, he is able to help you incorporate these cases into your practice practically. He has done it and so can you! It is the goal to give you the skills and confidence to enhance your results and do more cases, but to do it within the realm of your everyday practice.

There is no denying that the best way to learn these skills is from ”live” patient experience – where you work on your own patient. Unfortunatly, most dentists don”t have the desire to make the investment in these types of courses (costs range from $4000 – $8000 for tuition alone – not including travel, lab fees, equipment); dentists aren”t comfortable dedicating the time (usually 5-8 days) for these types of courses; and/or dentists aren”t comfortable working in front of many of their peers… this course takes away all those barriers and still allows you to see a case being done. You will get the same clinical education!

Tarun is down to earth person who take great pride in being approachable and is always there to answer any question you may have.

Have you been to a lecture where you ask a quesion and the lecturer ”guru” blows it off or laughs at you?
Have you ever wanted to ask a question but were intimidated by the speaker?
have you ever had a speaker stay late with you and answer all your questions?
Have you aksed a question and have the speaker say ”buy the video or attend our next seminar”?

Well Tarun is a different breed of dentist. His motivation is to help you be a better dentist and help you start enjoying dentistry the way they do! He is approachable, kind, sincere, and most importantly he is a regular Joe.

At a recent visit to Glidewell Dental Lab in Newport Beach, CA, I was privelaged to walk through the lab and get a better understanding of their inner workings. First, I must admit that Glidewell is committed to excellence and consistency. They literally have every piece of technology and if they don’t have it – they invent it! Well in walking through the lab and talking with the team leaders I was quickly made aware of the single biggest problem for the laboratory – what dentists send them.

First issue is the impression itself. You would be amazed at what I saw. Impressions with no visible margins, impressions for final restorations in dried alginate, impressions that weren’t full polymerized, and the list goes on and on. The other issue revolved around the preparation itself. The biggest problem was under-reduction. As dentists we always jokingly say that ceramists ‘always want more room’, but it goes beyond that. It goes to the point that we typically don’t give the laboratory enough reduction for the minimum requirements for the material. This leads to restorations that are weak due to inadequate thickness and unaesthetic and/or bulky because lack of room to build in beauty.

In an effort to ensure proper reduction for the chosen material, I found that I dramatically increased my efficiency at the same time. By following a connect the dots approach and using burs that are designed to achieve adequate reduction, I was able to make preparations ‘assembly line’ like in procedure.

Let’s take a look at a preparation for a typical all-ceramic posterior crown – whether zirconia, procera, or empress. The manufacturer recommends 2.0mm of occlusal reduction and a minimum of 1.0mm of axial reduction.

The first key is to use a occlusal depth reduction bur to ensure occlusal reduction. Here a 2.0mm depth bur was used.

The interproximal should be reduced to open contacts.

Now the occlusal depth cuts are connected to achieve full occusal reduction. Notice how interproximal has been reduced.

Using the same 856-016 diamond facial and lingual depth cuts are placed to half the depth of the bur. This will give about 1.0mm axial reduction.

The depth cuts are connected and the margin is refined with a fine diamond. Finally retraction cord is placed to allow for an excellent impression.

While it may seem elementary to spend time discussing such a simple procedure or reviewing areas to make it better. It is natural to feel that we are fast enough and good enough already, but this technique is simple and only requires 3 burs.

1. Meisenger 2.0mm Occlusal Router
2. 856-016 coarse diamond
3. 856-018 fine diamond

Having a particular setup and sequence allows your auxillary to be prepared for you and have all the tools out in advance. Aditionally it will reduce your inventory and allow you to cut down on time spent using multiple different burs. Finally, by using a fine diamond to smooth your preparation will give extra detail and send a message to the laboratory that you require excellence. And most importantly, the use of burs that are designed to give appropriate reduction for materials will ensure a restoration that meets guidelines for maximum strength and aesthetics.

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Most generalists are typically hesitant to enter into surgical placement of dental implants. While there is no such thing as ‘easy’ implant placement, there are certain cases that are ideal for placement by the hesitant general dentist. Replacement of upper and lower premolars are such sites. They typically present with ideal bone quality and generally free from the vital structures, such as maxillary sinus and inferior alveolar nerve, that are the cause of hesitation for general dentists. By starting with these ‘easier’ cases the dentist can then slowly move into the next level of implant treatment to replace lower molars.

This case study demonstrates the replacement of a lower molar with a dental implant. This particular case was done without the use of flap. However, please note that the use of a flap is critical for ensuring success and cases without flaps should tried once a level of competence is achieved.

Pre-Operative photo shows edentulous site #19. There is plenty distance between #18 and #20 and the only hurdle is the slight boney defect on buccal of implant site.

Pilot drill is used to make initial osteotomy. The pilot allows for evaluation of angulation for ideal restoration in future.

Here a nobel ‘dummy’ abutment was placed in the pilot osteotomy to evaluate the location of abutment to ensure ideal placement.

The full osteotomy is commenced with initial drill to final implant depth.

The second osteotomy drill was then used to further expand osteotomy

Final osteotomy drill was taken to appropriate depth to complete the osteotomy.

The implant being carried to osteotomy site. Implant Direct Screwplant 4.7mm X 8mm

Implant being ‘tapped’ into place. Implant gains initial stability by self-threading into slightly undersized osteotomy.

Implant abutment being removed from implant to allow for placement of cover screw healing abutment.

Single stage surgery being completed by placement of healing collar.

Final implant placement with healing abutment in place.

Final implant placement with healing abutment from occlusal view. Note placement in mesio-distal and bucco-lingual directions.

Implant placement will become a large part of dentistry – whether for replacement of single teeth, multiple teeth, fixed edentulous restorations, or as aid in implant reinforced removable prosthetics. The key is for the general dentist to become capable and confident in the restoration of such cases. Even more important will become the ability to surgically place the implants. It starts with ’simple’ cases and then can progress to more complex cases.