ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: Pascal Magne Part #4

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two are going to be situations where we start replacing a certain amount of tooth substance in the proximal

or in the incisal or in the buccal.

It's like rebuilding the morphology, the correct morphology of the tooth.

And my favorite cases are this patient with periodontic problems.

This was a patient that was addressed by the periodontist because the patient had an aggressive,

rapid evolutive periodontitis, as you can see with tooth migrations.

and after the periodontist did an excellent work in addressing the periodontal problem, there's no bleeding, there's no pockets anymore,

the supporting tissues are perfectly healthy, but we have a dramatic situation with the aesthetic,

the teeth are intact, they're all vital.

So how can I solve that problem by restorative means only?

It is impossible.

Of course, the first thing, whatever is the restorative solution going to be,

we need to use orthodontics to reestablish homogenous spaces between the teeth.

And that was obtained through a relatively short orthodontic treatment, as you can see here.

Now we have to close the proximal spaces and reduce also the length, which is way too long.

And we are going to study what can be done.

But before, we need to know what restorative means we are going to use.

And I tell you here, you have three options.

Either your name is Michelangelo del Composito,

and then you will apply direct restorations to these teeth and it's going to be a challenge to fit the shade,

marginal adaptation, indenting, beautiful shape, length, etc. The other extreme would be cut crowns,

and I let you imagine on this very small lateral incisor,

the pulp is not going to be very happy with the 360 degree shoulder preparation.

So in this case, really, the bonded porcelain restoration is the best approach,

because it will allow you to use only a facial approach to the problem.

We don't need to prep on the palatal.

That's exactly what we did.

The solution to that was to use a horizontal insertion path for the restoration by keeping the incisal preparation absolutely flat,

but by extending as much as we could in the proximal area

to allow the dental technician to develop inter-dental extensions to compensate for the loss of the papilla.

And this is really the key in these periodontal cases, as well as in other cases.

I don't have time to describe the whole spectrum here.

But remember the frontal insertion,

because in this case we can maintain the wide incisal volume despite a very small cervical width.

So this very triangular shape of the tooth can be maintained.

You don't need to taper the proximal walls.

You can maintain proximal divergence in your preparation by having your restoration inserted through the facial aspect without an oblique angle.

If you are starting to bevel or chamfer the incisal edge like it is here,

then the oblique insertion will force you, in order to seed the restoration,

to taper, to create convergence in the proximal walls.

And this convergence is going to cost you a lot of enamel

and also dentin and it will be a waste of intact tissues.

Instead, choose a frontal insertion.

I must tell you the frontal insertion with a butt incisal margin is a very universal approach to this type of restoration.

And look at this little, very small lateral incisor and imagine the consequences of a full crown preparation on a tooth like that.

and look in there at the right on the right side look the very conservative approach

that we could obtain most of the preparation here is still

in enamel there is a little bit of dentine exposed at the cervical aspect

because it was already exposed before i i start preparing

so i could not regenerate enamel

but i could maintain enamel where it was already present

and this is so precious and you can do that only with this horizontal insertion path.

The incisal edge, as you can see, was prepped absolutely horizontally and flat.

On the palatal side, you see the enamel is intact, absolutely intact.

We didn't need to invade that area.

My brother Michel made a wonderful job of refractory dye technique using

feldspatic porcelain layered

and he developed these little interdental mini wings of porcelain using a more opaque saturated type of porcelain

and you see on this scheme a horizontal cross section through

the proximal space through the extensive interdental preparation he could recreate

the mini wings to compensate for the lack of the papilla

and because we use a more opaque because we use a more saturated porcelain, it is not going to alter the general perception of the tooth.

These teeth will not look bulky despite their extensive interdental surface or extensive interdental development.

Now you have a summary of the case on the left side before the orthodontic treatment, on the middle after the ortho

and on the right hand after placement of the these restoration

it is not a hundred percent aesthetic case many things we

couldn't do the way we would do it in a patient

with an intact periodontium however it is a very nice

and acceptable compromise and on these slides you can appreciate the beautiful work of the porcelain

that is allowed through the full thickness layering using the refractory dye technique.

The platinum foil technique will allow you also a full thickness layering.

We believe in full thickness layering that allows you really to make this type of aesthetic outcome.

Pressable ceramics will not really be able to give this type of result.

Plus they will require more tooth preparation especially at the cervical area to allow the pressing process.

Now you see the final outcome and you note that the proximal space is not 100% closed.

That would not be possible if the preparation is not sub-gingival, which is the case here.

If you want a 100% closure of that space, you need to prep sub-gingivally in order to give the dental

technician the clearance to develop this inter-dental profile at a more apical level.

didn't want to do that here.

It's a six-year follow-up view on this case and you see here the palatal view showing the splint,

the immediate splint that was placed.

Of course the retainer is required straight after preparation,

straight after cementation, otherwise the teeth are going to start moving again despite the contact points that are recreated,

the teeth will start overlapping and moving again if you don't retain them in position.

And the use of a flexible retainer like this one is very nice.

It allows some micro-movement.

This is a twisted wire allowing some micro-movement, so some compliance, but maintaining the teeth in their position.

Again, a beautiful six-year follow-up view,

you see the periodontium and the very nice tight relationship between the gingiva and the teeth or the restorations.

So the next example I want to develop with you is the augmentation of the incisal length and incisal prominence.

And for that, I want to show you the case of this patient with very worn down flat central incisors.

And this is really ideal for the application of bonded porcelain restorations.

This patient is really willing to develop again the incisal prominence.

She's, she had received several generations of composite veneers on her facial surface of the central

that you see a little bit of composite remaining here

that have been polished and repolished and now the teeth have lost completely their prominence

and their length and there has been some incisal wear.

This is a perfect indication

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because the teeth have already lost a major part of their original volume

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and so the restorations are going to be used really as a recovery of enamel,

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of function, of aesthetics, of prominence.

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Basically in one shot you solve all the problems of these teeth and as you had noticed one tooth was non-vital,

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the tooth number nine.

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It was bleached and restored exactly the same way as the other tooth.

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You see the excess cavity that was restored with a composite.

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Sometimes the preparation involves a little bit of the composite in the incisal part,

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but usually we do not recommend overlapping the palatal access cavity with the porcelain.

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You don't need to do that.

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Just prep the tooth as if it was intact and ignore the fact there is a composite on the palatal.

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Ignore the fact sometimes there are composites in the proximal as long as these composites have been replaced before starting the treatment.

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You see now a comparative view at baseline and five years later

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and as you guessed there is very little change in this situation.

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The case is very stable.

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Now there are, a lot of people question the fact

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that we place a certain amount of porcelain on the incisal edge

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and I understand that because originally porcelain veneers were not prepared for incisal coverage for incisal overlap

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and now you will see cases where we have used two

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three four five six seven millimeters of porcelain to restore an incisal edge is that reasonable

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mechanically it is very strong and very sound

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and I will show you mechanical evidence for that

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but I I want to share with you also that there are functional evidence that we are allowed to do that.

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And I want to remind you that the key element in the development of a harmonious occlusion is the incisal guidance.

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And this is not me saying that, as you can see on the screen.

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This is a basic foundation.

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And we also know, and I agree with these authors,

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that the steepness of the incisal guidance is not important for neuromuscular harmony.

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And you know what?

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As long as the treatment is phased,

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and as long as you allow the patient to test in a certain time,

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to give the patient enough time to test the new incisal guidance.

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This is why all the cases I have seen so far, all these cases have been treated in three phases.

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And I didn't say that until now, but I want to make it absolutely clear.

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Phase one, we do an additive wax up on study models.

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And we fabricate the corresponding mock-up, an additive mock-up over the existing unprepared teeth.

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And you see that on the picture.

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This mock-up is finished, glazed to a perfect condition.

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It is used as a provisional for phase 2, which is the evaluation of this new functional aesthetic situation.

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We are going to test also phonetics.

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And the patient will have time to adapt because this mock-up will be bonded to the teeth to the teeth, I will show you.

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And phase three is preparing the teeth according to this final volume upon agreement of the final volume definition.

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And this is the only way we can solve these cases.

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In a real life situation, we don't use digital imaging to have the patient evaluate the aesthetic outcome.

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They need the volumes to be created in their mouth to evaluate that.

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Thank you.

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Shadowing เป็นเทคนิคการเรียนรู้ภาษาที่ได้รับการรับรองทางวิทยาศาสตร์ พัฒนาขึ้นสำหรับการฝึกนักแปลมืออาชีพ วิธีการนี้เรียบง่ายแต่ทรงพลัง: คุณฟังเสียงภาษาอังกฤษจากเจ้าของภาษาและพูดตามทันที — เหมือนเงาที่ตามผู้พูดด้วยช่วงเวลาห่าง 1-2 วินาที การวิจัยแสดงว่าเทคนิคนี้ปรับปรุงความแม่นยำในการออกเสียง ทำนองเสียง จังหวะ การเชื่อมเสียง การฟังเข้าใจ และความคล่องแคล่วในการพูดได้อย่างมีนัยสำคัญ

ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: Pascal Magne Part #4

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