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Advanced Dentistry

Miroslav Stanic
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Description

In this presentation Dr. Stanic will highlight his personal experience in dentistry to present some tips in taking bite record for edentulous patients. This can be applied for fixed or removable dentures.

Objectives:

 1. Demonstrate how to achieve more accurate bite record for edentulous patients

2. Define the neutral zone technique and demonstrate how that treatment modality can improve outcomes by making dentures more stable.

3. Illustrate how to use your dental team more effectively to decrease the patient’s ‘chair time’. 

Presenter

Dr. Stanic was born in Bosnia part of former Yugoslavia. He graduated from Loma Linda School of Dentistry in 1989. Dr. Stanic began private practice in 1993, building his practice from the ground up. Prior to that he worked in a very unique ministry. He was a missionary in Trinidad and Tobago in a center run by the Catholic church. He and his wife, Katarina, serve the local church in various leadership capacities. 

Conference

Recorded

  • October 27, 2017
    2:00 PM
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Now if we come before you and we thank you for. For the gift of there we have your son Jesus there we have forgiveness of our sales there we have peace that this world does understand payscale we are forgiven and there we are you harmony within ourselves and then we can rejoice in you and I pray that you will be present with us because we talk about how we can help patients in our office. To bring them comfortable way to aware of who are dangerous if they lost their teeth we thank you Jesus. So how many of you do dentures. How many of you enjoy it. How many of you have problems now and then. So you. Can go a little bit about my history I. Came to United States when I was eighteen and I graduated from a formal. Law Malinda last year our campus which is now just last year university and I am from the former you come former Yugoslavia now so I have a growing I'm old enough to have two formers. Graduated from law. School of. Accounting though you know each year that is right eighty nine eight or nine years to central. Now that many of you can do that. Care about my work after I graduated. This. Group came from San Francisco came to a million and out of high schools in. California they picked me from there to work in a clinic there they have in Trinidad and Tobago in a. Catholic around school trade school so I was there to train a dental assistants and work on the patients there so Lord blessed me and when I went there they said you know whatever you do just don't talk about your religion. So that the people from San Francisco they told me I saw no problem I want to attend a campus do it outside so we did and my wife worked in the with the church there and helped and I was working with a clinic there and then when I came here how they were complaining how the dentist barely meet their cost. So I prayed and the Lord blessed that I doubled so I spoke even there or God spoke even there even though I didn't talk about religion they saw the difference because you know the double to be had money enough to pay me and still they had money there so I praise God for that but then I came back to the United States and it's worked for a place and Dave did a lots of Dennie Kell or state supported I don't know how it's called in different states so we're there for a year and in the summer so why don't you come to disturb by sailor there's no Denny's that takes a Danny Care and there's cars and office he'll be able to sign right away so or so I prayed and I saw a local or they feel protected open so I'll go a day or so we went there and found an office that ought to garnish just small dark coating was planned and ready I just part to use chairs and I stored it and within a year I had to move it to a bigger place then. So Ross so she it's a lot blessed but in that setting an idea to lots of ventures and I had a lot so for challenges like all of you don't make dangerous you have them so in all of that I was thinking you know what can be done to improve so I'll go a little bit through what's available and then I'll present. What I created to help in making the dangers better so first thing is about bite records. We do know that the U.N. If you make the most aesthetically beautiful dentures here for the bite is incorrect it's worthless. You can have a good suction they can abort them all and you never think that ensure stays in there when date they get dislodged and it's it's it's gone it's most challenging part in doing it because you know. You're working with elderly people and especially if they don't have any teeth you know where do the clothes it's a challenge and all saw its most frequent cause for remakes or doing. A new try so let's look a little bit by trains this is this week notice week last week I went to the lab a local lab that I work and I say let me see any of your bite means that you haven't took a picture so this is what I got it OK the benefits of. Same is that we're all taught how to do it we know it. It's easy. It is Charlie it has challenges working with a patient and their cooperation to get it right. Patients tend to bite into protrudes see so you check them or other will try and they closed the area so you can move good so you deliver the denture and they come weekly there and they say they are falling off when you look and they close and you have over jet. Why they went wrong so then you have you had that experience because now the only one. One is possible rotations and you'll see it on the slide and in the few slides and next hour what I mean by that here you know a bite of a wax or a measly or when a patient closes you one side is higher than the other can you detect it. So I know you think you're OK and then when you get a denture back then one side is higher and then you have to adjust the danger well who will look at it why is there an A with this technique you need to have to take in Precious You need to send it to the lab and make another appointment to bring the patient back so that. You can take those records. OK say there's side. And you see that side say this side is contacting the other side is not but here is bites registration in it so you can see. Right here they're. A bit through the impression but on this side they're probably lifted up to raise you got enough resistance from you but materiel to stop it and to settle in. So that's what the problem with these bites we can see is there you know you can a pretty patient tends to protrude see where you end up with one side higher than the. Going to talk about digital dangers how many of you heard of them or done in the digital age so there's several of them I tried our Dan I tried. Them Teka but I know about all of them a little bit. I read there's about a nine million. Dentures made last year. For your team how many of those were made the digitally. Put your guess one percent so we're on with the digital dangerous we're at the stage when I graduate from dental school and we were with Ceric. Just the beginning but it's coming up and you know everything is going more and more digital especially elapse one digital impressions and scans and Algeria have UN scanners they will scan a whole article either so when you are to clean them you can send you to the lab OK let's talk about but then. I think Loma Linda garden Walter Dean was with them quite a bit. Good acre he was with them OK. This is they have two sets of trace one set of traces to take impression of boredom and the other one is to take the by sea is there so you can see here it's just orientation bite it's not then you functional by authorities so that you can put it on a cast here they have. Prints of the teeth interior sixty feet so you can put that up and. Then a security on their search tree and spacing can see how the teeth will look away and when the when they're set. So you have something like this. You can see a lip line smile and then you can also see the numbers one two three So that's where you. Want to be so then they'll create them that way and. More Yeah it took me about an hour and a half to get all the records because. I know it initially enjoy everything it takes time to get used to do it the harder part is secure this time it and they want to when they scan it they know where to set your teeth then what with. The next step you have to send out to them to their lab the next step is Rex try and if you want if you want to skip you can go to the delivery of the dentures if you always like to try and. Order that and then put in a mouth to like if they were at their you go ahead and send it out. Complete so it takes an obvious hit or two which is it's a big deal and the other thing that they claim is your patient loses the dentures or something you just called Call them up and they next day they set of dentures so you don't need to go through a whole procedure for the patient together records and all that they are kind of costly even though they say they are more affordable than others but yeah it's depends on for how much you can get dangerous in your area. So on a similar principle. Audio that's what we do with a byte array and you take an impression send it to them and then they set the anterior teet. BLOCK And so you take a bite registration with. The benefit of it is obviously you patient can see the Teton line if they miss. Dimension on it I guess you could either take these two or more here so that you can over close and then take the work where you want to have them set it up to a higher line and it would work. That's one way of the way did do it and the. One with the. Overall law and doing dentures from this if you like this would where the teeth are you can go to completion because what else is there I mean this steady they'll make them. To fit a teeth and you'll be fine. But you have to send to them. Relatively new. At least that I'm aware of it and they have a similar system then Teka and they have a trace. And I use the Dan take us to trace where you take their different sizes and you take impression border mold and then sort this in the back and then with this pin you determine a vertical dimension that you want and then utilize gothic arch principle to gether tracing with this would eliminate patients in those terrorists Patricio bite more you have a lot of old rotations you do need to be careful. On the D.S. with the pin the word they're using Got a course tracing it to be careful of patients protrude prognathic there when they go forward the back part can tip down because they will tip tipped up or part and then you're going to end up with open bite when the dangerous come in so just check that in that case. And they use this. Paper indicator that you put on the. Plate and the patient goes protrudes feeling left and right and you read the information I find it easier to just use a clue to spray it so this is one sample OK let me go back over you see the line here. Like that where you here you can see the line you're supposed to cut there off where once you take impression pull it out and then I see you will help get the pink and less so for possibility offer trace touching in the back so that you don't have that interference this that's where I cut myself twice try to cut there so I said I want to do that again they have a tool for work called dimension that you can measure and they have a leap line tool that you can use to measure of where your lip line is. So that's why here on the bottom so you. See how this they pulled the bottom one out is sort of on the top of the day and in this case which is OK so with a digital What is comparing here you know obviously they're going to be biased and they're going or exaggerate I mean I don't know. Does it take five hours for you to make records for the day. I don't think so. It's taking some time in the. Process probably you can add a week or two depending how fast your lab will return stuff to you if you go the other way around because you're now waiting for data by two RAM or racks to do the tracing you go to the record you already do it on a Under through first laser when you take the impressions so all they're saying into is it's I guess they excluded data collection if you do try again and then the delivery you know you have to is there so basically it's to you is it's counting when your starter the process. So these are the come Planet of the day and you can see that it's similar to. Put. Push in the wrong button one of two or so. You do keep those together yes one unit when you're taking the impression. Impression border Walding then you slide this pan in the lower part here and then turn the pan up and down to get your vertical dimension that you need and then spray with a clue to cool clues or surface. There and you get the tracing and then you read the tracing and. Take the record out. Yeah like I said This part I didn't like. That. You know you have to close it I try to follow Death line it's hard and if you don't cut all the way down then you tear it and then you destroy your impression so I don't like that but you know if if you go in cutting and they were to put. So here so yeah I think yeah let's see if we can get it for you here that's a third one like this we have time now that's the last one so. We should be this if you click on that. One point is be OK. So you once again go through your. School which is. Not the last. Here on a. Well we'll see how they are asking you to take a. Trace. Try and we aren't trying. To. After our. Comfort. So the. Area like. Across. A presentation. You'll be able to. Try. OK OK. So. By the secretary that's where the smart So Ari I should say that that's the kit today and I developed to simplify taking the bytes record. Patient so. That's the next on basically watching the areas. Of the care in the a sharpie near them one of face. Compression material might just ational well clued around were in. Some glue. So first thing that to do is take audion Taishan impression and this is where people get most confused when I talk about this kit and I say you're taking pressure in this well how you border more. Here we don't border mold with this this is just to audience so you can put it on your model so your castle in the lab can build So that's what it means. And so this is basically hopper and lower looks like when you do it. And so this is one of the Gotti Koch tracings as you can see pro-choice and a lot of elements and then you go to the area and in I use around birth two or four to make small indentation so when you put back in the patient mouth you have them close in to their spot and then you check for the E.P. rotation on. Just in case you have a bit of the approaches program and then you feel in the material with mites or just station then they're just seal because another one you're never going to get to like they showing a picture they show straight line and they show like I'll be here. Yeah it's not going to happen that way the best way to help patient to get there is to put your finger and say push on my finger and then put on a side push on my finger push on my fingers to kind of guide them and do. Have them do it too often because they're going to be all over the place just not too far away I mean you're going to see more markings see like here and there and they tend to not go all the way back when they go to the left and right but it's kind of hard to mess it all aren't you going to be pretty close in the area so just put your finger say and your team can members can practice with a patient before you come in the chair so they pull. Right there same thing she would guide them down the way and your team members can practice so when you come in there you can do it in two minutes and one. Actually. Even Or even this. Teisho really impression they can do it just put it in play and I'm out in the center so it's you know and he said take it also and they can put to the pain also for work called emotional whatever there would be practice with a patient when you come in and then you verify if you like the vertical dimension or not and I just say that with a pin turning up and down and then where you are doing you know that you like it then you're set to go OK I'm going to show the video did I have on a You Tube me. Doing it do I press or play here or OK. Good or bad or good Roberta reduced anybody to ribs rebutted ribs getting the best You Tube video above. Now you can play a whole week OK once you have impressions then you can practice the motions that I explain and then. You know where to find the word to call dimension and that you like it. And take it out of them out spray with a clue to do it you get the record of the tracing read it in make indentation on a trapper tray put it back in the mouth have patient clothes in that area verify the A.P. rotation that it's not there. At the end with the red just seal and I put little bit more on front and I have them close their lips the heavily ply and then when it's time are committed line take it out say it to the lab you have everything that they need so next week as it would be. West trying to get this set of slides that idea than a patient who has only. Conventional S. and has full set of teeth. On the bottom so this is me taking impression I'm holding in the center so there is no rotations. That's how the pressure looked afterwards and then. Go to the lower and. I did initially when I see that I call with both fingers but then I try to hole in the center so that I don't get a lot of rotations and. That's when his teeth yes you can see a little bit touching the border this is any are you any future oriented impression is on that little millimeter border that I have in there. It's OK because it's just orientations to to to see it and you have. A proper balance on it so you won't give you a high spot when any of them actually have to adjust any dentures since I started using that as far as the bite is concerned for left and right because there they fear just like their feet on a cast. The nearest he is tracing and I'm going with the wrong for. And with a pen here really there didn't have to do me a line on it he has lower teeth and said to Dad but otherwise he would mark there and then have to have a lip support because you know. We're going to be able to that he's existing teeth. I had a few cases where I when I did this and I pulled it out and I look as sure as this is wrong there's no way the patients might like this said it any way to the lab that was let's see and it came back. What the patient was going to buy. Just how it was an article in. So it's really working I like it I'm going to give you one more to the patients Yeah. How many of you know what a neutral zone is. How many of you heard of neutral zone technique. Anyone OK So you know how to do it. Well the hard way is to do with the green and in the beach one and you warm them up so I said well let me try the party. So I roll the party up put it on a. Base plate and I think you'll work even without a base plate to put it on a base plate and then I do have to have a hot water for patient to drink to keep her death. Warm so it would be for me so I tried this. Terry this so these are the forces where the force from the cheek. Neutralize. You pull that out halfway go it will go down you want it you can get pulls it out so of patients they have a. Negative Ridge this is. To take. And it doesn't take that much time and just have to spawn off each. Catalyst and mix them together. The reason why I think they don't have a picture here. When I turn it over and I looked at it. Body. Also took the impression of the tray where I was called the ridge where I was missing the trail probably more so you don't need to wait for the lab to make. The tray try to I'm sure it would work and. We're told the. Line would be taken and just put. An adventure will stay and you'll be amazed. Forces because they're neutral because not into this logic if you wily Dorsey that space will push it out if you go too far the cheek when they open mouth they will pop out yes. Basically tray that you can but I think it will work without just putting it down to help them swallow give them a you know a couple. While this is setting up. A few times while this is setting in their forces. Will go out cheek will go in they will form thank. Stays on top and you try to ensure that I did I put half way and let it go to the actual stayed up just pushed. Sometimes when you said those. They might not be on the ridge they'll be outside but because they're stable patients do function I learned from Dr my son I don't know how many a few hurdled listen to the Thomas. You know. I use it in the cases where I had trouble thanks for staying in a negative Ridge resort to this. And other questions. Yes. Thank you. Cast. And they cut it down to where the do or close all surface would be and what they can do they can use other type of a party and just feel that in so they just set teeth in the space or they can have sand and have plaster feel it in and put the teeth in there. Yes. You know don't separate record this is just what it said to take. Care This is just to take the. TRANSLATOR to your article in there and then you have already a record from using a B.R.T. or whatever other technique you use and then dates place then they do this. Wherever you permission you gave them and then they trained and out to death point. Position on the take. To you could. Also hear. All the way down just leave me the teat and there he would. Need your body pressure put in a. Patient go to swallow his sword and the cheek would form and you can get those areas and then just cut in the teeth and ginger when you have that you can create can cavities so it will hold it especially if your kid. And although they slow with more can cave it tends to hold dislodging the danger. Things that I look for when the patients. Are coming off I look for. Dislodging it. And then I look if it's convex. And try to make the area more cunt case so that he she can see it in their holding. Room he's safe there dislodging when they. Would be. Open wide and you're fine just too long. A bite will be if when they close and it's so close and you show you. So they're. Kicking it out of the suction coming. Out of question. You. Can put it is just like you are. And. To it basically I have a few samples here but what I do I take the pain out custody of the. Have the panhandle. One take up take upper and lower so you can see. Give the pain a stool. Like this because what killed him actually is high down my seat on a cast so I just take that out when I say it to the lab so then they have and if anything is interfering they can just cut it out yeah thanks. That's holding them yeah right so they won't come apart this this one hold it is just. To determine the vertical dimension. OK Yes. Life. I think of then Teka. Would probably be the easiest less excess to tear. But then again to be careful of separating cutting. Yourself. With all of them I guess. This this part putting the teeth was what was cumbersome for me and it was. Problems in my hands. 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