INTENSE II – Dr. Francesca Vailati
09.00-11.00 – Advance Diagnosis
Are we really sure to know and understand the patient whom we are going to treat? Often it depends on which type of eyes we are looking at. More attentive to estetic or more aware of the risk of dysfunctional patients? Dr. Vailati would like to start the course with a reminder that rehabilitate patients and not only reconstructing their dentition is the only way to guarantee the long term longevity of the restorations in dysfunctional patients. Only by knowing the initial function, and provide with a better one, a clinician can predict potential problems, avoid them, and guarantee better survival to the restorations.
- Stress the concept that esthetic reconstructions may not be long lasting in patients affected by dysfunction.
- Show clinicians how important is to restore a patient in a comfortable occlusion.
11.00-13.00 – Review of the 3 STEP
During the period of time between the INTENSE 1 and the INTENSE 2 courses, the participants will have the time to look at their patients differently, making diagnosis of dental wear, and even treating some of these patients.
A review on the fundamental aspects of the previously explained I and II STEP is essential, since clinicians will have the opportunity to clarify some doubts before progressing with the 3 STEP of the technique.
- Review the main topics of the first and second steps to be ready for the palatal veneers.
14.00 -15.30 – The CONTROL visit
After the increase of VDO with the white bite, patients present an anterior open bite, which will be restored by means of palatal veneers. Before passing to the next step, it is crucial to evaluate the patient’s posterior support, the new VDO and the occlusal comfort in general with the white bite. Occlusal adjustments are one of the eight steps necessary to prepare the patient for the III STEP, eight steps which are part of the CONTROL visit.
- Learn how to evaluate the occlusion after the white bite.
- Learn how to prepare the teeth for the palatal veneers.
16.00 -18.00 – Palatal veneer bonding (3 step)
Palatal veneers are an outstanding treatment for eroded anterior teeth and worn down dentition in general. However, since it is also an unusual one, clinicians may be not familiar with this type of restorations. In this session, each step on how to deliver them in the patient’s mouth will be explained, stressing the importance of a correct adhesive protocol.
- Learn the adhesive protocol to bond palatal veneers, from the simpler to the more difficult ones (TACOS).
9.00-11.00 – Palatal veneers LAB: analysis on the cast
This part of the course deals with the difficulties that clinicians and laboratory technicians may find in planning palatal veneers. Few lab technicians know how to do these uncommon restorations and in Dr. Vailati’s experience more than 80% of what the participants bring to the course should be remake or at least modified before being delivered to the patient.
To help clinicians to evaluate the laboratory work, 10 laboratory parameters should be considered.
The palatal veneers brought by the participants will be photographed and evaluated together with the group to decide if they are clinically acceptable.
- Learn how to evaluate if the palatal veneers are clinical acceptable by looking at them on the cast.
11.30-13.00 – HANDS ON: Participants’ palatal veneer evaluation
Dr. Vailati will take pictures of all the palatal veneers done by the laboratory technicians’ participants. These photos will be shown on the screen and each participant will receive a personalised evaluation based on 10 parameters. The restorations can be great (ready to be delivered), clinical acceptable (some modifications are necessary and done by the clinician) or not acceptable (impossible to be delivered). At the end of this session the participants will receive all these pictures and go back to their technicians to explain the 10 parameters necessary to fabbricate correctly the palatal veneers for a real patient.
- Evaluate participants’ palatal veneers to train their lab technicians
14.00-15.30 – HANDS ON: Palatal veneers’ modifications before bonding
After the theoretical session on the ideal shape of a palatal veneer, each participant will modify his/her own palatal veneers, following the guidelines of Dr. Vailati. The reshaping of the restorations will facilitate their bonding and improve their ageing in the patient’s mouth. New pictures of the restorations may be taken and showed to the group to really analyse if the modifications were correctly executed.
- Learn how to improve the participants’ palatal veneers before bonding, by additive and substrative modifications.
16.00-18.00 HANDS ON: Palatal veneers bonding
Bonding palatal veneers could be a stressful clinical situation, not only for the fitting of the restorations, but also for their unusual location in the mouth. In this practical session, the participants will learn on a model how to isolate the operatory field with a rubber dam, and after they will follow the different steps to bond the palatal veneers.
- Learn to isolate the teeth with a rubber dam to bond palatal veneers.
- Execute the different steps of the adhesive protocol for palatal veneers.
09.00-11.00 – MODIFIED 3STEP
Due to a raising awareness about dental wear, several clinicians would like to propose treatments even at the initial stages of this disease. However, when the loss of tooth structure is visible only by an attentive eye and it has not affected the esthetic of the smile, proposing a full-mouth rehabilitation is not easy. Reduction of the cost of the therapy, simplification of the clinical steps, and NON-invasive adhesive techniques may promote patient’s acceptance. With the modified approach of the 3 STEP technique, initial cases of dental wear could be treated, skipping some clinical and laboratory steps, to make the therapy faster and less expensive for the patients. In addition a MODIFIED approach can be used to lower the price of the rehabilitation even in more severe cases of tooth wear. The MODIFIED 3 STEP technique is the most frequent approach of Dr. Vailati nowadays.
- Illustrate the MODIFIED 3STEP.
- Show how to reduce rehabilitation’s fee, but not its quality.
11.30 -13.00 – POSTERIOR teeth
The posterior teeth are always the last teeth to be considered by patients due to their minor esthetic value. Instead these teeth are the most important in a full-mouth rehabilitation, since the longevity of the anterior restorations relays always on a solid posterior support. In this optic, treatment planning of the posterior restorations is very complex. In this session, different aspect of how to restore the posterior teeth will be evaluated, looking at the type of existing restorations, patient’s occlusion, money availability etc. New materials like CAD/CAM composite and ceramic restorations will also be described to try to improve the quality of the posterior support and may be to lower the price of the rehabilitation.
- Decide how to restore the posterior teeth to increase the VDO Decide which material use for the final posterior restorations.
14.00 -18.00 – Treatment plan of participants’ cases
In this session, cases of dental wear of the participants’ patients will be analysed.
It is recommended to select cases of dental erosion with a less important parafunctional component. Each participant will be asked to select one patient and documented the initial status with maximum15 clinical photos and one video. These pictures will be delivered to dr. Vailati and analysed with the group during this session. The attention will be placed not only on the quality of the documentation, but also on the diagnosis. Advices on the treatment plan will be given. The session will be based on the interaction between dr. Vailati and the participants, especially on the type of dental material selected for the rehabilitations.
Evaluate the documentation to analyse parafuntional and erosive patients.