Dr. Peter A. Gardell DDS

11/10/2023

Disclaimer- I was asleep at the wheel when ordering my abutment. And yes this Pt does have some other dental needs.
But the a front tooth needs work sometimes the patient wants to get a front tooth. Pt presents with crown in hand ( and a post). Root was fractured- time to think of alternatives. Pt did not want to do the same with the other teeth with issues.
Work up done, Fractured tooth removed and a Straumann 3.3 BLT placed. Maryland bridge milled out of TeticCAD to provisionalize.
Uneventful healing, soft tissue maintained with the Ovate Pontic, Time to uncover and scan for an Atlantis Abutment. Abutment designed , core file received, and when the custom abutment showed up in the office I realized my mistake- I thought I asked for the Gold coating. My normal Anterior solution ips e.Max would have left an esthetic challenge. The LT could have helped block the cold titanium color in the body but it would also deliver an unnatural incisal edge. Lab work could correct but why spend time doing this when there are block with the lab work done for you.
Zircad Prime designed with the help of the Digital Anterior Overlay from the core file fits perfect. It masks the titanium, we contour and texture to " blend" the crown to the neighbors. Ivocolor used to help you fool the observers eye.

09/19/2023

Now over 7years in service. Screw retained Implant crown on a socket shield case. Immediate provisional with TelioCad to maintain papilla, Socket Shield to maintain hard and soft tissue on facial. Definitive restoration with ips e.Max for strength, esthetics and soft tissue response. . Proper planning, proper ex*****on proper result- All what your patients deserve

02/23/2023

Digital workflow is powerful. It has huge benefits when one thinks outside the normal workflows of Analog Dentistry. If you have acceptable initial stability the imaging of the implant at time of surgery can save up to 3 appointments. Saves chair time for you and more importantly many trips to your office for your time stress patient. Intramural imaging+ tibase+ ips e.Max for the win.

02/09/2023

Sometimes it is the little things the can make your day. Received a phone call last week from a colleague from the Cerecdoctors.com community asking if I would see his daughter who is completing her studies in Manhattan. Of course the answer was yes. She was in today and 3 spots were corrected in a single visit. She had been seen 2 other offices that attempted to repair- but only lasted 48 hours. With Cerec, e.Max, TetricCAD and Tetric Prime she is back and better than ever. Long lasting and predictable. Thanks , , , , , ,

01/12/2023

Feb 10 2023 we will be covering topics such as this and much much more. Raise the bar with your implant restorations.

There was a post on the Cdocs.com forum about making adjustments to the model in the software to improve the custom abutment prep. The software is not the smartest when it comes to making a perfect prep for a ceramic restoration when it is splitting a case. By making minor adjustments to the model, or I should say the model alignment you can save yourself some frustration. You do not need to just take what the software gives you. Slight adjustment to the model axis can help. Slight adjustment to the set restoration axis can also help. Combine the 2 and you set yourself up to a strong well fitting restoration that does not hang up on seating. This pictures help show how changes can help the software deliver a better abutment fr your veneer crown

07/19/2022

In the summer time a great way to relax is camping and hiking. A great way to experience the outdoors and appreciate the natural beauty of the world. It is our responsibility to respect where we travel It is important to leave the pristine beauty as we found it, or better yet improve it. As Ralph Waldo Emerson wrote- Leave the world a better place than how we found it.
The same holds true for the work that we do. Take the steps required to improve the patient’s condition. Sometime the steps are complicated and time consuming, sometimes we have the resources to make the improvements simple and straight forward.
Here is a case that demonstrates a straight forward solution that takes less time and leaves the tooth better than the way it presented. While there was not a stick, there was stain that was identified on a recur visit. The Pt was unaware until it was brought to their attention. They stated the tooth was worked on about 6 years ago. “ The tooth doesn’t hurt. Do we need to replace it?” Of course the answer was yes.
6 years is a short usable life and I question the process taken to restore. Pt did not remember having a rubber dam or an isolight used when the previous filling was placed. To me this was a significant factor in how previous work did not reach potential.
For straight forward cases such as this the wheel does not have to be re-invented, a direct resin restoration is perfect. The choice of materials can help you attain you goal of delivering an esthetic restoration efficiently.
For this case preparation completed, selective etch of enamel are the standard. A good restorative system is then selected, in this case Adhese Universal for a predictable bone dispensed with an economical delivery system- Vivapen. Then a bulk flowable that cures in 3 seconds- Powerflow IVA. Then the base capped off with my favorite composite. Tetric Prime “T” shade. It is a chameleon material that makes your work disappear.
A material that fits your patient teeth to a T.
All modeled by hand, done in 2 cures. A extremely efficient appointment with a beautiful result

06/18/2021

Still impressed every time I use the system treatig my patients

04/07/2021

A case that walked in yesterday that reminded me of important points that have been taught by 2 of my dental material mentors one the years. I think these individuals have broken more dental glass than anyone else in the world over their testing careers. Rella Christensen has spoken about the importance of thickness of material, substrate your are placing your restoration on and where you need to place your margin. Dennis Fasbinder has talked about and demonstrated how Cerec Generated onlays last and are a more forgiving restoration.
So here is a broken piece of porcelain, I original placed this restoration 14 years ago and it was made with my Bluecam and my trusty compact mill.
The initial picture demonstrates many of the points Rella has enlightened me on during my career as I attended numerous lectures. Ditching of the margin when using a hard ceramic for a partial coverage restoration in the areas of contact when the patient functions. Now this ditching is limiting but it can create an area where stain can accumulate. Today a check of the patients occlusion pre-op is SOP to make sure I place the margin in a better location. Second point and the reason for the replacement is the fracture. Ceramic needs to be a minimum thickness to be successful. And since the glass ceramic pick up strength from the substrate, below what we bond to is also a major factor. You can see that the fracture occurred on top of where a small core was present. While I thought I had adequate thickness of ceramic, since it was on top of a layer of restorative material I did not. Dentin is king as a substrate for ceramic when bonded to, the resiliency that a core material has can be enough to shorten the life of your restoration. You can see prior to imaging that yes I did a small buildup to fill in the defects, but at the same time changes were made. Final prep allowed for greater thickness of the final material and the final material was. newer generation of resilient ceramic. This can withstand the forces applied and these material also have better marginal performance when used for partial coverage restorations.
Now for what Dennis has added to the decision making tree in my head- Another Onlay
You may ask why another onlay- the last one broke. You may be right if you want to go to a full coverage restoration. In my mind I still think there is plenty of solid tooth structure to work with. This tooth does not need to be decapitated just yet. Afterall the last only was successful for 14 years. With the steps taken to repair the damage:
-Plan the margins in a favorable location
-Increase the thickness of the final restoration but maintain as much of the rock solid dentin as possible
- Get great margins from accurate imaging with Primescan and milling with the reliable mcxl
- Usig a great resilient Ceramic Tetric CAD. Offers great esthetics where the restoration can disappear. Anatomy can be placed without the inclusion of portal weak spots as Rella warns about when enhancing glass ceramic.
Using Cerec and a great material to restore a broken tooth in an efficient manner- The patient winds and the office wins
.
So 1 onlay + another onlay= successful conservative dentistry

03/26/2021

The coronavirus has changed the way dentistry will forever be practiced. Join Dr. Pete Gardell as he discusses techniques for maintaining an efficient and safe environment for his staff and patients.

03/26/2021

Fast, Cheap, or Good . You can pick 2. Every industry has used this saying- it is their perception of reality. We use it in dentistry to answer patient's questions about the cost of dentistry. Since the phrase is used everywhere they can understand.
In reality we have certain limitations when we are doing treatment that is dependent on skill, material and physics.

Direct composites are no different. This is the most widely performed treatment in a general dentist's office so all of these factors are important when it comes to the success of a dental office. Success from a reputation, and financial standpoint is a primary concern with all treatment. When you are dealing with a procedure that is done everyday, all the time- this procedure becomes the lifeblood of the practice.

So you have to choose- Fast- Cheap-Good
or do you?

With direct composites we have strived to be fast- utilizing materials in large increments. But does it cause Stress?

We have used bright lights in short increments- Attempting to shorten the curing. But is the cure complete?

We require the most expensive material in dentistry- Bonding agent (liquid gold). Drops measured in dollars

We require multiple shades and translucencies- to recreate what was lost. But what is the inventory requirement?

We require to place detailed anatomy- to make the restoration disappear. How is the handling of the material.

These are just a few of the concerns that can hinder our ability to attain these 3 goals with our direct composites. Is it possible to be productive, contain costs, and produce an esthetic restoration? My answer is yes and the pictures are the example. Containinng cost by not using "Cheap" materials- but using premium materials in a smart delivery system such as the Adhese Universal Vivapen. Using a Bulk fill fast curing material with the proper light. The Bluephase Powercure works with the chemistry of the PowerFlow to guarantee complete curing in 3 seconds of a 4mm deep layer. Topped of with Tetric Prime "T" shade. A material with great handling and a chameleon effect for superior esthetics.

A bread and butter restoration done in minimal time due to only 2 layers and a fast curing light. Optimum esthetics delivered efficiently and is sure to last a long time.

Quality, Efficiency, and Cost Control

03/12/2021

A patient walks into a dental office....... Sounds like a start to a joke. I guess for the past 12 months we can all use a joke. But seriously what is the reality of a patient coming in with a tooth that lately " doesn't feel right". We run though the normal diagnostic steps and I think we all agree there is some dentistry that lasted a long time, but ithe tooth is in the need for some help. Radiographs show a shadow at the margin, an explorer locates some gaps at the margin ( if you look at the pre-op the gaps where probably there from the insert), and esthetics are on the low end ( IMHO).
So the question is do we think we need to replace, or as with all projects with an old house we renovate.
The digital workflow with Cerec is a significant step to renovation in its own right due to margins that will be spot on- sealing the periphery of the preparation. The materials we select also are a large part of renovating a tooth, bringing the tooth into a new generation and guaranteeing its long esthetic functional life.
You can see in the photos that when we initiate the treatment with a depth cut it reveals some of the existing problems with this restoration. The metal and Porcelain were very thin and the cement gap quit large indicating that the crown never truly fit the preparation. Lab errors model error, impression error- who knows. What I do know is that there shortcomings will not be reproduced when we do it digitally. You receive instant feedback with the Cerec Sytem so if any of theses are found they can be corrected prior to milling. Once the recurrent decay is removed and the prep restored an all ceramic restoration can be fabricated. Ivoclar's Ivocolor system is used to make it unique and pleasing to the eye.
You may ask why a high strength ceramic such as IPS e.Max and not some of the other newer players on the market. My answer is because I like using a material that has worked in my hands for over a decade A material that has been tested more than any other material, has been tested in more testing centers than any other, and has passed these tests with incredible numbers. And a material that has its manufacturer stand behind their product with a guarantee for up to 12 years.
When I renovate I want to make sure the work outlives my career and I leave the tooth to a new builder to take over in a few decades , ,

03/09/2021

Had the pleasure to travel to a beautiful area of the country. Coastal Maine near Acadia National Park. Was there to help a new Cerec user get comfortable with using his new system. While new to Cerec Dr Travis Castleberry has been using digital for years- he was using a different technology but just didn't have the chairside component. Anterior case replacing some old tired bonding on a great fun patient. I think he did an incredible job creating lifelike ips e.Max restorations ( LT D2) characterized with Ivoclar's Ivocolor stain and glaze system.
I have to be honest- I get a little made at seeing what new users are able to do at the start of their Cerec journey due to Peter camera, software, and materials # IVoclar Vivadent # CDocs