Showing posts with label Dental Prostheses.. Show all posts
Showing posts with label Dental Prostheses.. Show all posts

Tuesday, 11 February 2014

Workshop on Whole mouth rehabilitation - Register for free info section on28th Feb 2014 (9:00 am to 11:00 am)


Faculty – Dr. Vasanth S

Venue: Dentcare Dental Lab Pvt. Ltd., Muvattupuzha, Kerala, India.

CR based Comprehensive Dentistry

Lecture and Hands on: Participants are encouraged to start at least one case in their clinics, after the first module. Learning while doing helps to understand concepts faster. It also allows earning while learning! Try to do as many cases as possible. Pre-module and between modules notes and photo series of all hands on procedures makes the program a 4-month course and not just a 7-day hands on.

Module I

Occlusion in every day dentistry

The reality and logic of CR

Patient examination and records
Occlusal bite splint
Anterior deprogrammer
Recording face bow, CR & Protrusive
Know your Articulator
Condyle guidance and anterior guidance
Articulation of casts to patient records


Date: 28th Feb, 1st and 2nd March 2014
Day 1 and 2 ………… 9am to 5pm 
Day 3 … …………………..8am to 4pm

Module II

Occlusal concepts

Lower incisal level, upper incisal level,

Centric contacts
Posterior occlusion
Curve of Wilson, curve of spee
Treatment planning on articulated casts
Whole mouth rehabilitation


Date: 5th and 6th April 2014
Day 1 ………………… 9am to 5pm 
Day 2 … …………………..8am to 4pm

Module III

Vertical dimension

Equilibration

Custom incisal guide table
Clinic – lab communication
The art of provisionalisation
Basic ideas of smile design

Date: 3rd and 4th May 2014 

Day 1 ………………… 9am to 5pm

Day 2 … …………………..8am to 4pm

Highlights of the program:

Participants will plan treatment, step by step, two real patient case articulated models in each module.

Three real case studies will be presented in each module, showing from diagnosis to finish, with all intermediary steps.

For further details please contact:
Ms. Ida Rachel S M (Program Secretary)
Visit : http://dentcareindia.blogspot.in/2014/02/whole-mouth-rehabilitation-quick-guide.html
Register for free info section on Feb 28th 2014 (9:00 am to 11:00 am)

Whole mouth rehabilitation – A quick guide By Dr. Vasanth


I understand a lot of dentists want to take up whole mouth rehabilitation, but do not know how, and others who are doing it already but want to improve their work.
This article is for their benefit. It is about whole mouth rehabilitation, how it should be approached, and how to achieve predictable success.

There are various definitions of what whole mouth rehabilitation is.

My personal definition is as follows:

Any procedure that involves the whole stomatognathic system and not teeth alone, that brings harmony to its various components, namely TMJ, muscles and teeth, should be called whole mouth rehabilitation. It has to be a centric relation based approach, where teeth surfaces are modified with equilibration, or fillings or crowns, and missing teeth replaced with bridges or implants or cast partial dentures, so that teeth can achieve maximum intercuspation with the joints seated in centric relation. The occlusal scheme should be anterior guidance, or in rare cases group function.

So according to me whole mouth rehab does not necessarily mean 14 or 28 crown and bridges. Just equilibration, or 28 crowns, or anything in between can be called whole mouth rehabilitation if it satisfies the above said criteria.

Now let us go through the step by step process of whole mouth rehabilation.

Examination –data collection

The whole process starts with a complete examination – what is called a COMPREHENSIVE EXAMINATION. Examination should cover the TMJ, the muscles of mastication and other head and neck muscles, teeth and periodontium.

A good set of die stone models, face bow record, centric relation record and a protrusive bite record should be made.

A discussion appointment, after a week, is scheduled where the diagnosis and treatment plan will be presented with a diagnostic mock up.

Treatment planning

Treatment planning should be done on mounted casts in a semi-adjustable articulator with face bow and CR record. Incorporating all treatment goals, a wax up is made, which I call “A treatment blue-print”. Cut and move teeth requiring orthodontic treatment, grind teeth requiring equilibration, build up with wax teeth requiring filling and crown and bridge, or teeth to be restored with implant or cast partial.

Treatment execution

The basic essential treatment like periodontal / endodontic management and extractions should be completed first. All crown & bridges should then be done, but with only provisional. Occlusion is tested in the mouth. Finally when you and the patient are completely satisfied, final impressions and final ceramic crowns should be cemented and equilibration done.

Let me explain the various aspects of whole mouth rehabilitation


    1.     Clinic set up and Doctor’s skill

1. Doctor’s skill. 
2. Good lab support. 
3. Four or six handed dentistry.
4. Good impression technique. 
5. Semi-adjustable articulator.
6. Provisionalisation.

      1. Doctor’s skill

A dentist must hone up his skill in various fields of dentistry, through self study and various continuing education courses. At the end of the article, I will outline the hands on programs that I conduct at Chennai and at Dentcare lab, Muvattupuzha. These are tailor-made for whole mouth rehab aspirants. You definitely need extra skill beyond dental school training to successfully tackle full mouth rehab cases.

2. Good lab support

You cannot undertake whole mouth rehab cases unless you have a good dental laboratory support. Both the lab and the dentist must be in good rapport, and must work with the common goal of delivering EXCELLENCE.
  
3. Four or Six - handed dentistry

Any dentist who wants to go beyond just “extraction, acrylic dentures and amalgam filling practice” must realize that the first step in that direction is working with assistance.

Two handed dentistry is no longer acceptable. Minimum is four handed dentistry (dentist and one assistant). Ideal will be six handed dentistry (dentist and two assistants).


4. Good impression technique

In the last ten years that I have been conducting workshops and hands on programs, I realized that taking impression is the most neglected procedure in most clinics. My discussion with dental labs also confirmed that. Getting an excellent (good is not enough!) impression is a basic requirement for whole mouth rehabilitation cases. 


5. Semi-adjustable articulator

Possession and knowledge of handling a semi-adjustable articulator, is another mandatory requirement for doing any meaningful diagnosis or treatment plan.


 6. Provisionalisation

All crowns and bridges planned on the casts should be tested with acrylic provisional in the patient’s mouth before committing on permanent ceramic. A provisional should resemble the final in shape and shade. So making a good provisional, is one more skill needed in whole mouth rehab cases.


2. Diagnosis and treatment planning

If building a house requires a plan and a detailed blue-print before we start, how can you start building occlusion without a pre-plan – what we can call as treatment blue-print or treatment wax up?

The following aspects are important in planning treatment:

1. Centric relation 
2. Face bow transfer 
3. Occlusal scheme
4. Treatment wax up 
5. Clinical photographs 
6. Patient education

1. Centric relation
Centric relation is the key for predictable success. Dentists must develop a good understanding about the temporo-mandibular joint and its relationship to teeth and muscle harmony. Recording centric relation is a very learnable skill that every dentist should master.



     2. Face bow transfer 
It is a simple 3- minute procedure, which transfers patient’s hinge axis relationship to the articulator. It is a mandatory procedure, without which the articulation will not represent patient’s occlusion.

3.Occlusal scheme
 To me, the only acceptable occlusal scheme is Anterior guidance. In rare cases, group function occlusion will become necessary. 

4.     Treatment wax up 

Treatment wax up is like a preview of the final treatment. It convinces the dentist that his treatment plan will work. It allows the patient to visualize the treatment outcome. Patients will be more convinced to accept your treatment plan.

     
     5.Clinical photographs 

Clinical photography is an important component in whole mouth rehabilitation. Right from convincing patients for treatment acceptance to showing off your excellent work to the patient and others, good photo records go a long way to make your practice different.

    6.Patient education 

A patient who understands the nature of his problems, and who understands the effort you have put to plan an ideal treatment plan for him, will appreciate your work and pay with gratitude, and will also refer patients. Your reputation as a “Different Dentist” will be a great practice builder.

           3. Execution of treatment

1. Periodontics 
2. Surgery 
3. Endodontics 
4. Restorative 
5. Orthodontics
6. Crown & Bridge 
7. Implant 
8. Cast partials 
9. Equilibration

 1. Periodontics 2. Surgery 3. Endodontics 4. Restorative 

Periodontal management, surgical procedures, endodontics and caries management are normally carried out first. These are baseline treatment protocols that form the starting point for any serious whole mouth planning.

Plaque control, improving patient’s hygiene management and caries control have to be in place for any long term success.

     5. Orthodontics

It is unfortunate that orthodontic treatment has never been projected as a strong tool in whole mouth rehab armamentarium. Also since the average dentists’ (other than orthodontists) knowledge on orthodontics is very limited it is natural that they will not be in a position to incorporate it in their treatment plan. Some basic orthodontic training, especially in straight wire, is essential for any dentist who wants to do whole mouth rehab cases.

     6. Crown & Bridge

In most whole mouth rehab cases, crown & bridge play a great role. Extra training in crown preparation and impression taking is essential. Developing this skill will decide your success in managing whole mouth rehab cases.

           7.Implant

Implants are another way of replacing missing teeth like crown and bridge. Where ever possible it is the best way to replace missing teeth, because it avoids unnecessary preparation of abutment teeth, and also preserves bone in the edentulous areas. But good implant training is mandatory. Unless the implants are placed in the exact planned three-dimensional location, restoration according to prosthetic plan might not be possible.

     8. Cast partials 

It is unfortunate that cast partials are hardly used as routine treatment. If implant option is not possible due to financial or other reasons, cast partial becomes a good option. But unfortunately undergraduate dental training hardly stresses on cast partials. Most dentists require cast partial training. Even if you do not do full mouth rehabs, learning to do cast partial dentures is a great help to normal practice.

 9.  Equilibration

Equilibration is reductive reshaping of occlusal and incisal surfaces to achieve occlusal goals. This is an essential skill every dentist must develop.

Added benefits of this centric relation based approach

I have been following this centric relation based approach to whole mouth rehab for about 5 years now – I call it comprehensive CR based dentistry. It is based on the Pankey – Dawson philosophy. As centric relation based dentistry restores harmony between TMJ, muscle and teeth, it helps us to tackle TMD and myo-facial pain.

As your client base will include patients with migraine, intractable headache, vertigo, neck and shoulder pain, your practice will become exclusive. You will elevate yourself into a physician of the stomatognathic system.

Whole mouth rehabilitation is not an "anybody can do it procedure". But at the same time, if a dentist takes time and effort to implement the main requirements I have listed above, success will be predictable.





Monday, 21 October 2013

The Journey from Famine to Feast - John Kuriakose ( Founder & Manageing Director- Dentcare Dental Lab Pvt. Ltd.)


Starting from nothingness, a young boy from a remote village in Kerala was lifted up to a supreme position in dental technology, simply because of his faith and commitment to God - “who lifteth up the meek and raiseth up the poor”. John Kuriakose, Founder and Managing Director of Dentcare Dental Lab Pvt. Ltd; started the lab in 1988 in a small room attached to a dental clinic in Muvattupuzha. It is now a 50,000 sq. ft. world class Dental laboratory; with 1700 skilled technicians, 10 million satisfied patients and more than 10,000 benefited dentists.

John Kuriakose comes from a very poor family, his father and mother being ‘daily wages’ workers in nearby houses. It was very difficult for them to make both ends meet, so that from childhood itself John had faced the bitterness of poverty. Many a day John and his two brothers, Baby and Saju would wait eagerly for their mother to return in the evening, to feed on the “given away collected food” she would bring for them in an earthen bowl.

Adding to their miseries, John’s father and grandfather were mentally abnormal, frequently becoming violent. This mental disease appeared to be hereditary, that his mother was worried about it haunting her children too. Life became so miserable that she attempted suicide thrice. John and his brothers were victims of an inferiority complex in their school days, and they were an object of ridicule in the school and society. They were called “sons of mad Kuriakon” (Bhranthan Kuriakon). John’s desperation and disappointment darkened his life - and his future seemed blank without any hope. In 1983, John completed his SSLC and was forced to work as a rubber tapper to support his family.

One day, John’s mother got a chance to attend a prayer meeting of Christian Revival Fellowship led by Prof. M.Y. Yohannan. The man, who had invited her, gave her the bus fare to attend the meeting and she went with a cloth borrowed from neighborhood. Fortunately, Jesus Christ touched her life in that prayer meeting and she came back with a peaceful heart. The drastic change in the life of John’s mother inspired the whole family to attend these prayer meetings regularly in spite of serious objections from the church.

Slowly happiness and peace crept into the family. This was a turning point in John’s life – the beginning of a journey from famine to feast, from nothingness to fullness, from bitterness to blessedness and from tears to triumph.

At that time, John was working as a rubber tapper. Determination and enthusiasm filled his mind and he wished to have a decent job, with a salary of at least Rs. 250 per month. But John himself was aware that, a person with only pass mark in SSLC cannot even dream a job. But one word from Prof. Yohannan’s message remained deep rooted in his mind- “If one leads a sinless holy life before Jesus Christ, God will fulfill the ambitions in his life.” ‘‘Humility and fear for the Lord, lead a man to riches, honour and long life”. John took this as the gospel of his life, and he assumed the job of an attender in a nearby dental clinic, with a monthly salary of Rs.250. He was earnest and faithful in his job. During the six years spent at the clinic, he was exposed to the complexity of artificial dental prosthesis and learned the tricks of the trade.

Almost every other day John used to watch his doctor struggling and sweating to seat ill- fitting crowns and bridges. Standing at the chair side as an assistant, John silently began to think of fabricating crowns and bridges with precision and perfection. Therein began a sparkling new chapter in his life.

Excellence is never an accident. It is always the result of high intention, sincere effort, intelligent direction and skillful execution. John worked hard day and night with determination and perseverance, and within a short span of time, a small dental lab with staff strength of ten has grown up to a 50,000 sq. ft. State of the art Dental lab having staff strength of 1700.

At every given opportunity John is glad to proclaim his testimony.  He shares his past with anybody without any reservation to inspire and motivate them. He says it was divine intervention that bought about a change for the better in his life. He knows very well that, what he is now today is only because of the grace of God.

He continues by saying; “I started my career as an attender in a dental clinic. Considering my sincerity in the job, Dr. Reji Mathew, owner of the clinic, promoted me as his assistant, which was an opportunity for me to learn more about dentistry. I noticed dentists struggling with ill-fitting crowns and bridges. Gradually, I thought of setting up a lab, which could provide quality products to dentists. I worked hard day and night doing part time jobs to save money and could set up a lab in a small room at Muvattupuzha, a town in Kerala, South India in 1988.” John completed the dental technician course from Balaji Dental College, Chennai and devoted his time to the growth of the lab, and the results motivated him to grow even further. His brothers Baby and Saju came forward to support him. He was very keen on providing quality services to the clients. A few dentists encouraged this venture.

To go hand in hand with progress, John started to attend seminars and sessions around the world to learn more about the dental scenario and trends. He says: “I started travelling around the world to keep pace with changing trends in technology. I was totally consumed by the passion to set up a lab in India with global standards. I have received training from countries such as US, Germany, Japan, Switzerland, Italy, Sweden, Austria, Denmark etc. This exposure has given me a deep understanding of technology of major dental companies like VITA, Ivoclar Vivadent, Shofu, Bego, Degudent, Nobel Biocare, 3M ESPE, Dentaurum, EOS, Renfert etc.

During the last 25 years, John has attended over 200 training sessions and participated in a number of National and International dental conferences including International Dental Show in Cologne, Germany. He has been honoured with many national and state level awards. John’s family, include his wife, Mrs. Jessy John, who is the Executive director and Chief quality controller of Dentcare, and the young buds, Joshua, Joel, Job and Jonathan, who have added strength to all his initiatives.

Dentcare Group
Synonymous with superior quality, executive product range, best-in-class technology and state-of-the-art manufacturing process, Dentcare Group of dental laboratories is the largest of its kind in India and could be one among the largest few in the region. The company is ISO 9001:2008 certified and 13485:2003 certified and has CE marking: 1293. The company will soon be getting FDA and ISO 14001:2004 (Environmental). The 50,000-square-feet laboratory carries out all manufacturing processes related to the dental prosthesis. An exclusive export unit of 75,000 sq. ft. will be added this year.
The company has over 10,000 customers, which include those in dental colleges, dental hospitals and clinics. He says: “We have an efficient workforce consisting of skilled dental technicians. All services are supervised by highly qualified chief technicians who have been trained under master technicians from countries such as Germany, Switzerland, Japan, US, Italy and Sweden. We have employed renowned master technicians from Europe to bring a global perspective. We have also involved specialists among dentists to oversee and ensure quality.”

Products and Services
The products include crowns, bridges, dentures, implants, veneers, inlays, onlays etc. The lab offers the best choice in CAD/CAM metal-free prosthesis in India like Lava 3M ESPE(Germany), Cercon Degudant(Germany), Procera Nobel Biocare (Sweden), and IPS e-max Ivoclar Vivadent (Switzerland). In 2011 the company introduced DMLS(Direct Metal Laser Sintered)PFM, EOS (Germany).

The lab has separate divisions for titanium-cast partial, telescopic crowns, Implant supported dentures (Cement Retained Custom Implant Abutment, Screw Retained Crown/Bridge, Hybrid Wrap Around Bridge, Overdenture  Bar and Clip, Custom Bar and Clip) and Precision attachments. Complete Dentures, chrome cobalt cast dentures and Removable Partial Dentures are from renowned brands like BPS (Switzerland), valplast, Bredent (Germany) etc.

The lab uses raw materials from Germany, which supplies the bestquality materials in the world. “As far as Dentcare is concerned, we would never use any material which is harmful to the patient. We would never compromise on quality to beat competition. This makes Dentcare different from others”, insists John.

Dentcare uses modern equipments that are mainly imported from Europe, US and Japan. The registration department uses computer generated job cards and bar-coding system to ensure complete traceability. All departments are computerized and scanning of each work is done at every stage.

“Technology is changing at digital pace and we are very particular about upgrading technology on a continuous basis. We are one among the best to introduce the latest technology like model scanners, model printers etc. Now a long cherished dream of John; “A Research and Development Division” is being set up.

Global Opportunity
“Within 10 years, China and India are expected to be the top economies globally. There will be stiff competition between the two countries in almost all fields. China has large-scale production facilities, but a skilled and educated workforce gives an edge to India.” says John.

John says that a major chunk of Indian population is affected with various dental diseases. The accessibility of rural patients to the clinic is very low, but things will soon change within the next 10 to 15 years.

Customer satisfaction
The guiding light of Dentcare is the management policy which is being followed. According to John. “We never compromise on quality. Our aim is to provide best-quality service to our customers. Our strong faith in God and firm commitment to the safety of our patients who use our products are our greatest strength. Our employees are our valuable asset and they consider this lab as their second home and so we call the Dentcare as ‘Dentcare Family’.

In an interview John exposed his views: “If someone enters this field with the sole aim of making money at the shortest possible time, I must say he is misguided. This field requires a lot of patience, commitment and sacrifice. In the long run, one can survive in this field only by ensuring quality consistently and continuously.  Every year many labs are getting closed.”

John’s immediate priority is to build an export exclusive unit to cater to the needs of dentists in any part of the world. The infrastructure development for this is going on and expected to be completed by 2014. “We want to retain the position of technological superiority. In the long run we will try to emerge as one of the largest and the best labs in the international arena. I still have a dream unfulfilled. It is to set up an international training centre for dentists and technicians and to set up a research and development division to give innovative dental technology to dental fraternity. I am working towards that goal and I believe it will be materialised with the help of my Lord Jesus Christ.”  John shares his dream.