Dear Dr. Bill:
I rarely use Sirona Connect because I don’t feel like I get a good restoration fit, especially with bridges. I usually just take a traditional polyvinyl siloxane impression for bridge impressions. Have you experienced this problem before, and if not, any tips on what I can do to improve the fit?
Dear Dr. Ben,
Sirona Connect, like the chairside software, is extremely accurate and immune to distortion since it references digital points of data. As the comedian Flip Wilson from the 1970’s used to say, “What you see is what you get!” This describes Sirona Connect perfectly because “What you scan is what you get!”.
It has been estimated that only 20% of dentists who mill chairside use Sirona Connect. My question is WHY? We routinely fabricate excellent fitting restorations chairside so why should Sirona Connect be different?
Sirona Connect is a great investment for you and the patient as far as the product it can deliver if you spend the time and effort to learn the technique and give necessary pre-op information to your lab.
Communicate with your lab if you are having issues with your final bridge fits, occlusion, or contours/contacts. This lab contact may be an opportunity for you to receive constructive pointers to help you deliver a better product. This may include your lab suggesting they have difficulty reading your preparation margins, with insufficient occlusal reduction, or buccal bite issues. Don’t take their advice personally but accept their input as benefitting you, but more importantly the patient. Check your ego at the door and try to learn to not only improve yourself but the patient! Remember the patient? Yes, there should be a level playing field amongst the patient-lab-doctor. Dentists are ‘control freaks” and we don’t like others telling us what to do. Accept guidance from others to improve quality patient care. Don’t forget when you were introduced to Cerec Chairside you accepted advice from mentors/trainers and spent much time and effort to learn design and material selection to give your patient the best restoration possible chairside. This should be no different when planning a large bridge case with a lab technician where an implant(s) is not an option.
Pointers for Seating Bridges Using Sirona Connect
- Watch for labs that don’t use the specific instructions on how to handle Zirconia bridge blocks, especially furnace and cooling times. This could be a major issue causing ill-fitting restorations.
- If the lab pours your PVS impression, then scans the trimmed model and fabricates the bridge virtually, there is a built-in potential error for distortion that might affect fit.
- Make sure the bridge margins are fully seated and closed and the proximal contact tightness is ideal before adjusting the occlusion or belly of a pontic.
- On small multiple unit cases, the main reason for seating adjustments is hyper-eruption and proximal tooth movement due to temporization. On large cases I recommend pre-op study models, wax-ups, occlusal bite impressions, or photographs with a shade guide to minimize seating adjustments and staining.
- One of the biggest reasons Sirona Connect bridges “don’t fit” is because the margins/proximal contacts/belly of pontics/and temporary material left on abutments are improperly adjusted! Remember, potential tooth movement is possible from the proximal and opposing teeth when a temporary (even a great fitting temporary) is placed on the tooth/bridge while waiting on the final restoration. Remember to adjust in sequential order: Marginal fità Proximal contactsà This is an area that dental assistants may need a refresher in because if it’s not followed may result in unnecessary adjustment of proximal contact areas or occlusion. This may lead to light or no interproximal contacts or occlusion.
- Sirona Connect is an adjunct to Chairside milling. This represents the “perfect marriage” of technologies to achieve quality dentistry. Same day restorations should not be the goal of patient care but quality restorations that benefit the patient, whether that’s Chairside Milling or Sirona Connect. Don’t feel defeated as a dentist because you can’t mill everything. Depending on your practice philosophy, some say a healthy dental practice will mill about 80-85% of units and send 15-20% through Sirona Connect. This will vary but my point is to do what’s best for the patient and your skill level!
Other Reasons to Use Sirona Connect
- Excellent choice for bridges and other multi-unit cases instead of PVS impressions.
- End of the day or emergency crown where milling would keep staff after work.
- Lack of restoration block shade or supply.
- Problems with milling unit or wireless connection to the milling unit.
- Cases involving a difficult shade, occlusal pattern, or crown shape
Don’t short change your patient or yourself by not using this incredible Sirona Connect technology to give your patient a fantastic result!
(The comments and suggestions from Dr. Bill are not to be construed as professional medical advice or treatment but are to be used as Dr. Bill’s thoughts and opinions. Your comments are encouraged and valued.)