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Howard Chasolen Education Events

TIRED OF HAVING TO DO REPAIRATIVE PROCEDURES AROUND IMPLANTS….

TIRED OF HAVING TO CORRECT BIOLOGY AFTER THE RESTORATIVE FACT???

I CAN AND WILL SOLVE THIS FOR YOU AND YOUR TEAM

I always say, “never diagnosed, never treated.” It is critical to master the diagnosis of clinical conditions that mandate or at least lead us to a perio-restorative treatment protocol. Without a clear diagnostic map, we will miss so many opportunities to help our patients become healthier, benefit from meticulous esthetic and biologic restorative dentistry and maintain it for years. In this section you will learn:
 
1. Why implants are not always the best option and what can happen when implant treatment goes wrong.
2. WHY AND WHEN do I need to use this protocol. The specific clinical conditions that indicate a perio / restorative treatment protocol.
3. Understand that marginal teeth, when treated appropriately, can be saved predictably over a long period of time.
4. Realize that the proper treatment intervention at the correct time used with early perio / restorative issues can save teeth for a lifetime.
5. Review the relevant literature on the topic of perio / restorative treatment and gain an understanding of the long -term results.

Many of us have become so excited with new and exciting technologies. But, we have lost the ability to actually save a tooth with a simple restorative protocol. Teeth with old restorations or early furcations being planned for extraction in favor of titanium. I will show you exactly how to save teeth by

1. FIXING THE FOUNDATION (PERIO). This includes biologic width, furcations, developmental grooves and lack of attached tissue.
2. FIXING THE HOUSE (RESTORATIVE). Defective restorations, caries removal, cores, provisionals and definitive restorations.
 
In order to do so, we must understand the subgingival condition, place a core and provisional first, correct the periodontal condition surgically, allow proper healing and restore meticulously. I will show you every step in detail

A core is the foundation for all restorative dentistry. It serves as the esthetic and biologic template for the restorative process. And a core MUST be performed prior to any periodontal correction, or the perio restorative interface may not be established correctly. A step-by-step detailing of how to remove old dentistry, be certain all old restorative material and caries are removed and the placement of an adhesive core and surgical provisional will be covered. Emphasis will be placed on the exact protocol, materials and instrumentation used to produce predictable and perfect results. Without a core, effective perio-restorative treatment is not possible.
 
By the same standard, a provisional restoration is not just a placeholder. It is a blueprint to a successful biologic, aesthetic and functional restoration. A complete review of different techniques and materials will be presented. Provisional restorations are necessary for 360 degree access for successful periodontal correction and biologic shaping. The rationale, steps and protocols will be detailed for fabricating and facilitating easy removal of provisionals by the periodontist.
 
1. Learn how to remove old restorations, old restorative materials and accomplish complete caries removal.
2. Learn why a core buildup is the most foundational aspect of crown and bridge restorative dentistry.
3. Master a cookbook process of the entire adhesive core build-up process.
4. Learn the current state of the art and science in adhesive practices and philosophy.
5. Learn how to perform a perfect core even in a subgingival environment.
6. Understand how to refine the core buildup using the exact burs, instruments and finish lines to facilitate periodontal correction if necessary.
7. Learn the available materials and techniques to make provisional restorations you can be proud of.
8. Make provisional restorations that support aesthetics, occlusion and biology.
9. A review of direct and indirect techniques as well as an in depth discussion of PMMA vs, Bis-acryl materials.
10. Finishing, polishing and cementing protocols are discussed in an easy to repeat fashion.
11. The process- how to get the patient ready for the periodontist. From a clinical, support materials and understanding perspective.

For outstanding perio/restorative outcomes, a healthy subgingival environment is essential. This means eliminating subgingival furcations, root concavities, divots, abfractions and defects. While patient hygiene certainly plays a role, achieving long term success depends on idealizing and correcting this environment with biologic shaping and soft tissue grafts. In this section, I will cover the basic principles of surgical correction. As I am not a periodontist, I do not perform these procedures myself, but have had the great fortune of benefiting from working with Dr. Danny Melker and sharing clinical images of all of our cases. Truly, you can not have a real appreciation of the benefits of this surgical correction without visualizing the subgingival environment directly through flap reflection. In this section, I will cover:

1. The principles of furcation management with BIOLOGIC SHAPING

Incorporation of soft tissue grafts to ensure the long term success of your restorative work and minimize further periodontal and restorative breakdown.

3. Why root concavities can destroy a beautiful case by harboring calculus and how to correct this problem.

After surgical correction, a specific provisional management protocol is required. There are exacting biologic reasons for performing the provisional reline at the 4 week postoperative mark. This timing allows for initial tissue healing while also providing the necessary space for continued coronal migration and maturation of the attachment. This is crucial for long-term success. If you don’t nail this visit with meticulous attention to detail, the outcome will certainly be compromised. In this section you will learn:

1. Who does what… the role of the periodontist and restorative dentist through the first 4 weeks of post surgical care.
2. The management protocols for the first 4 weeks following periodontal corrective surgery.
3. The concepts and rationale for relining provisional restorations at the 4 week post op visit.
4. How and why we do not place the provisional margin at the tissue level.
5. Detail the exact technique provisional margin placement with respect to the tissue.
6. Detail the finishing and cementing protocols for the reline visit.

Now that such great effort has been made to get to the final restorative stage, it cannot be handled haphazardly. We want to prepare meticulously defined finish lines, capture perfect impressions or digital scans while managing the tissue with ultimate respect, detail well directed instructions and prescriptions to our laboratory, select not only the correct restorative material but design it with the most beautiful contour, deliver it a healthy dry environment with the best selected luting agent protocols. We are almost home with this great process; it’s time to get to the finish line with perfection. In this section I will detail:

1. Bur selection, margin design and margin position.
2. Impression versus intraoral scan…does it make a difference?
3. Soft tissue management and the retraction conundrum. How do we capture the margin in the most respectful way?
4. Restorative materials and their application. Do we even think about PFM or full gold anymore? I will discuss the current all ceramic material selection criteria and their application to our perio / restorative patients.
5. Restorative contours…there are very specific rules for restorative design. Especially so on periodontally treated patients. Don’t blow the case by ignoring these principles.
6. A protocol for delivering every case so there is ZERO anxiety about this critical final phase of treatment.
7. Cement selection- let’s simplify our menu of items to increase predictability.

Occlusion is one of the most confusing and controversial topics in dentistry. Until recently, when digital workflows became the rage, occlusion was considered one of the most important components of restorative dentistry. However, there was and still is so much misinformation about occlusal philosophies and the effect the occlusion has on supporting structures. To complicate things, much research over the last 15 years has debunked many of our original occlusal doctrines and dogma. We have shifted much of our attention to parafunction and its potential destruction of supporting structures including joints, muscles, ligaments, cartilage, teeth, periodontium and restorations. We design an occlusion to survive the parafunction.
This could not be more important in the periodontally compromised patient, where loss of supporting structure is a major confounding factor in the progression of breakdown. In this portion of the program I will cover:

1. The basic concepts of occlusal philosophy.
2. Occlusal goals for healthy supporting structures and function.
3. Do inappropriate occlusal schemes initiate parafunction?
4. The concept of primary and secondary occlusal trauma.
5. The effect of parafunction on healthy versus periodontally involved dentitions.
6. Splinting- a debated but critical topic to review.
7. Occlusal considerations in the ortho/perio/parafunctional 

In this section, I will present cases from my clinical practice. Most of the cases will be detailed from diagnosis to delivery reviewing every step of care. In most cases, this will include all of the surgical care as well. Many of the cases presented will be extremely challenging and illustrate all of the concepts presented so far, in a proof of concept fashion showing long term follow up results.
 
It is rare to see cases presented from diagnosis to delivery these days. It is even more rare to have the opportunity to see the long term follow up and objectively look at what worked and what did not. I will review and comment on my thoughts about what was done right and what could have been done differently in all of the cases.
 
If you can apply the concepts presented and stitch those concepts, philosophies and protocols into the case presentations, you will have a truly unique look and understanding of some of the most complex perio / restorative treatments imaginable. This will allow you to apply this material to your own patients immediately and achieve outstanding results on most every perio/restorative scenario you come across.

I counsel all of my patients that a great outcome is a shared responsibility. If they allow us to provide the recommended treatment, if we provide it it the highest level of care AND they continue to take responsibility for long term care through both professional care and personal care, great long term outcomes can be expected. This is easier said than done.
 
It amazes me how many people will invest great amounts of time, inconvenience and money into something and neglect to care for it shortly thereafter. We cannot follow our patient home, however we can certainly give them tools, resources, support and accountability parameters to help them continue to stay healthy.
 
I will share my 30 plus years of experience, protocols and recommendations for a well designed continuing care program.