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After a handful of beautiful anterior results with master Technician, Yuki Momma, RDT, I began to ask myself: for what can or should I take credit? The answer: two-way trust. There is an age-old dogma pertaining to the dentist/technician relationship, which perhaps today can be modified or challenged with the emergence of new materials. 

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Fig 1. Initial presentation 

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Fig 2. Provisionalization with gingivectomy 

Traditionally, before picking up the hand-piece, the dentist has envisioned the final restoration material, contours, and shade. Accordingly, we implement our plan to achieve adequate prep reduction and take photos of tooth/stump shade as our vital link to the technician. The key here is that while we’re open to suggestions, we prescribe the material deliberately and pray the technician can turn our pre-op vision into a reality.

Even when metal-ceramics were the full coverage gold standard in the esthetic zone, skilled techs could achieve almost anything with ample facial reduction. Today, materials such as E.max Prime allow us to achieve the same (if not better) results with significantly less tooth reduction. Regardless, I can trust Yuki to match a single central with impressive facial layering in almost any circumstance. Below, I outline one case as an example and provide a general check-list for a two-way trust relationship.

Practitioner/Technician Shared Responsibility
with E.max Prime in the Esthetic Zone

 

Dentist

Technician

Photos

Detailed, clean
photographic
documentation

Defining required documentation

Tooth Preparation

Adequate facial and incisal reduction

- Substructure design

- Mastery in ceramic layering

Anatomy

Firm establishment of provisional contours,
midline, and incisal edge position

Appreciation for anatomy
of adjacent teeth and provisional translation

Soft tissue management

- Well-fitting provisional and cervical contouring

- Atraumatic tooth preparation

- Well-fitting margins

- Avoidance of cervical over-contouring

Shade-matching

- Strong understanding of patient expectations

- Custom shade tab

- Custom shade tab

- Mastery in ceramic layering

 
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Fig 3. Final tooth preparation and gingival health

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Fig 4. Ceramic layering

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Fig 5. Definitive restoration

 


SteinDr. Stein received his D.M.D. from the University of Pennsylvania School of Dental Medicine in Philadelphia, PA where he graduated with honors in clinical dentistry.  Completing his three-year Advanced Graduate training in Prosthodontics and a Masters in Medical Sciences (M.M.Sc.) at the Harvard School of Dental Medicine in Boston, MA he was also deeply involved in clinical research.  Today, he is a full-time private practitioner in Boston specializing in Prosthodontics.  While Dr. Stein enjoys all facets of his specialty, he has found increasing enjoyment and prowess in restoring teeth in the esthetic zone. He strives to stay up-to-date in the latest advances in the digital technology workflow and its implementation for optimal patient experience, lab communication, and treatment outcome.

 

IMG_1984Yuki Momma, RDT graduated from Yukioka Dental Technician School in Japan. Followed by his graduation, he started his career at Dental Lab Obal in 1998. In 2000, he joined to Miyamoto Dental Clinic where he could directly have feedbacks on each restorations he made. While working at the clinic, he challenged himself by studying at Osaka Ceramic Training Center. Upon his completion at the training center, he moved to Boston and started working as a Master Ceramist at Gnathos Dental Studio in Weston, Massachusetts. He built his skillset as a ceramist for 7 years and, in 2017, started Ceramic Artisan Dental Lab. Since he started his own laboratory, he has been more active about publishing articles and giving lectures. His articles are on DTG Magazine issue sixteenth and on Labline Spring 2018, as well as his presence at the lecture at DTG Symposium 2018 and his first hands-on course in September, 2018 in Boston. Lab Day Chicago 2019 will be his first lecture in 2019. Along with the lecture, he also plans a couple of hands-on courses in several locations in 2019.