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What does NTI stand for? and tss?
- Nociceptive Trigeminal Inhibition
- tension suppression system
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What type of impression is needed for NTI?
- Upper and lower VPS impressions and bite registration.
- Accuracy is super important, especially in the anterior
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Why the name NTI?
Nociceptive input to the trigeminal nerve is inhibited by suppressing the intensity of muscle activity.
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What is the NTI used for?
- Protection: Bruxism & Clenching
- Diagnosing: parafunctional muscle activity
- Therapy: Migraines
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What does the lab need to fabricate the NTI appliance?
- Lab slip (Rx) for NTI
- Full arch models or U/L impressions (accuracy important!)
- Maxillary protrusive measurement
- Centric bite record (registration)
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NTI direct vs indirect
- Indirect (chairside) - good for diagnosis and immediate relief
- Direct - Custom fit stronger and lab design for complex cases
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What muscles are affected by clenching? Bruxing?
- Clenching: Temporalis
- Bruxism: Lateral pterygoid
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What does the unique DE design of the NTI provide?
Discluding element provides posterior disclusion in all movements.
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Advantages of NTI:
- Patient comfort/compliance
- Reduce delivery/adjustment time
- Appliance durability
- Reduce intensity of muscle activity
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Crystal Ultra:
Hybrid NanoCeramic!
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What do doctors look for when seating a crown?
- Contacts
- Occlusion
- Margins/tissue
- Shade
- Contour/shape
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Parts of TMJ
- Condyle
- Glenoid fossa
- Articular disc
- Articular eminence
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Parts to shade mapping
- Gingival 3rd
- Body/Middle 3rd
- Occlusal/incisal 3rd
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Anatomical crown vs clinical crown
- Anatomical covered by enamel, clinical visible in the mouth
- (gum tissues cover some enamel, leaving "clinical crown")
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Class I bite:
MB cusp upper 1st molar lines up with buccal groove lower first molar and lower canine 1/2 tooth anterior to upper canine
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Class II bite:
Retrognathic: upper 1st molar MB cusp is anterior to lower 1st molar buccal groove and canines are in line
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Class III bite:
Prognathic: upper 1st molar MB cusp is in line with DB cusp of lower 1st molar and lower canine is a full tooth or more anterior to the upper canine
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Lab process (model to digital):
- Check in/disinfect - case pan assignment
- Scan model
- Crown designed
- Milling
- Stain/glaze
- QC - delivery
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Name 2 ways to manufacture Emax/Pearl Press:
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Working model vs solid model
- Working model has die cut and pinned back for lab process
- Solid model is used to seat crown to do final check on contacts
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What products require a model to be produced?
All C/B layered porcelain and removable appliances
Modeless inlay/onlay
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What are the 3 types of trays used for taking impressions?
- Rigid stock trays
- Full arch custom trays
- Triple trays
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What impression tray should NOT be used for full coverage mouth guards, bite splints or most partials and dentures?
Triple tray - they may not capture enough information or not be accurate enough
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Advantages of triple tray impressions:
- Save chair time; working arch-opposing arch-bite registration all in one
- Less material used
- Patient comfort
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Verotek FCZ:
- 1100 MPa
- Monolithic zirconia
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Verotek Aesthetic:
- 780 MPa
- Monolithic zirconia w/translucency
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Verotek layered:
- High strength sub-structure
- Zirconia sub-structure w/feldspathic porcelain overlay
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PearlPress/(Emax):
- 400 MPa
- Lithium disilicate
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PFM:
- Moderate strength
- Alloy sub-structure w/ feldspathic porcelain
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Indications for FCZ:
- Posterior crowns
- Bridges (unlimited span)
- Implants
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Indications for Aesthetic:
- Ant/Post crowns/Veneers
- Anterior 3 unit bridges
- Implants
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Indications for Layered:
- Ant/Posterior crowns
- Bridges (unlimited span)
- Implants
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Indications for PearlPress/Emax:
- Ant/Post crowns
- Veneers
- Inlay/onlay
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Indications for PFM:
Posterior C/B
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Contraindications for FCZ:
Less than 1.00mm inner occlusal space
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Contraindications for Aesthetic:
- Less than 1.00mm inner occlusal space
- Bridge or splinted over 3 units
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Contraindications for Layered:
- Less than 1.5mm inner occlusal space
- Verotek Pressed: bridges/splinted units w/linear span greater than 40mm
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Contraindications for PearlPress:
- Posterior, 4+ unit bridges or inlay retained bridges
- Deep subgingival prep
- Substantially reduced residual dentition
- Bruxism
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Contraindications for PFM:
Highly aesthetic cases with minimal prep reduction
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Indications for DuraFlex partial:
- Flexible/easy insertion
- Design versatility
- Acrylic allergy
- Metal sensitivity
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Indications for Valplast partial:
- Flexible/easy insertion
- Design versatility
- Acrylic allergy
- Metal sensitivity
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Indications for Framework partial:
- Long and free saddles
- Flat ridge
- Few remaining teeth
- Strong & stable
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Indications for Combo partial:
- Flexibility desired, but strength needed
- Long and free saddles
- Strong and stable
- Flat ridge
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Indications for Acrylic flipper:
Transitional treatment partial
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Contraindications for DuraFlex:
- Need rigid appliance
- Less than 3mm vertical clearance
- Flat ridge
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Contraindications for Valplast:
- Need for rigid appliance
- Less than 5mm vertical clearance
- Flat ridge
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Contraindications for Framework partial:
- Visible/aesthetics
- Metal or acrylic allergies
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Contraindications for Combo partial:
Lack of vertical clearance
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Contraindications for Acrylic flipper:
- Not long term
- Acrylic allergy
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Material composition of DuraFlex:
Thermoplastic
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Material composition of ValPlast:
Nylon Thermoplastic
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Material composition of Framework partial:
Acrylic to cobalt chrome or acrylic to polymer
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Material composition of Combo partial:
Flexible to cobalt chrome
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Material composition of Acrylic flipper:
Acrylic
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What removable appliances can be relined chairside?
Framework and acrylic partials
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What removable appliances can NOT be relined chairside?
- DuraFlex
- Valplast
- Combo partial
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Prep required for FCZ:
- Any margin prep, slight chamfer preferred
- .8 mm axial wall reduction
- 1mm occlusal reduction
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Prep required for Aesthetic:
- Slight chamfer preferred
- 1.2mm axial wall reduction
- 1.25 mm occlusal reduction
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Prep required for Layered:
- Slight chamfer margin
- 1.5mm axial wall reduction
- 1.5mm occlusal reduction
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Prep required for PearPress:
- 1.5mm occlusal & axial wall reduction
- 1mm chamfer margin required
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Prep required for PFM:
- Any margin design with 1-1.5mm reduction for color
- 1.5-2 mm reduction at incisal/occlusal and facial
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4 types of implants:
- Zygomatic
- Subperiosteal - over the ridge, under tissue
- Transosteal - under the ridge, up thru the bone
- Endosteal - into the bone (traditional)
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Risk factors for sleep apnea:
- Gender (males)
- Obesity
- Snoring hx
- Alcohol, sedatives
- Neck circumference
- Narrowed airway
- Smoking
- Medical cond - HTN, Parkinson's, diabetes, CHF
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What are the causes of poor lab outcomes?
- 1 - Bad impressions/scans
- 2 - Poor temporization
- 3 - Lab error
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