July 1, 2010
by Graeme Milicich, BDS
One of the major challenges in placing indirect aesthetic restorations is handling and controlling the restoration during preparation for bonding, loading with bonding material, and accurate placement of the restoration. A new product from Triodent, developers of the V3 Ring system for managing contact points, has been released to make the placement of indirect restorations a simple, stress-free procedure. One of the many stressors in dentistry is handling small objects like inlays, onlays and veneers, with the risk of dropping a restoration, or accidentally orienting it the wrong way around. With the increasing adoption of all-ceramic restorations and associated bonding protocols, including the use of hydrofluoric acid and silane, accurate and safe handling of the restorations can reduce the time and stress involved in bonding procedures and consequently increase productivity.
An investigation of the many techniques currently used by dentists reveals most have short comings. Most of the adhesive devices are seriously challenged by the presence of silane during the pre-bonding phase and can lead to uncontrolled separation of the carrying device, most often at the most inappropriate moment. Devices like the wax-tipped Sticky-stic and the adhesive-tipped Optrastix are seriously challenged by silane and can release at the most inopportune moment. During the preparation of the restoration for bonding, a small object has to be handled while applying hydrofluoric acid and then silane, with the restoration having to be placed in an ultrasonic cleaner after HF etching.
Several products have come to market trying to deal with these issues. None have been completely successful in achieving the goals of reliable adhesion, ease of placement and the ability to passively release the restoration, and pick it up again during preparation for bonding, and then be able to passively release the restoration again once it has been located on the tooth. Some products work adequately with veneers but don’t work with irregularly shaped inlays, onlays and crowns. The new Griptab system (Fig 1-3) has universal application to all restoration types including gold, reliable adhesion to the restoration, ease of pick-up and release, and easy and clean removal after placing the restoration.
Prior to the patient’s arrival, a staff member attaches a GRIPTAB to each restoration. The appropriate sized tab is selected and twisted off the rack with a pair of Pin Tweezers. A small amount of adhesive is applied to the tab and is located onto the desired surface of the restoration and released. (Fig 4) The adhesive is then light cured for 20-40 sec, depending on light intensity. (Fig 5) The restoration can now be picked up and released as often as is desired during etching and silanation. (Fig 6) The tab will not release when the restoration is placed in an ultrasonic cleaner.
Following preparation cleanup (Fig 7) the crown can be tried-in to check fit prior to bonding preparation. (Fig 8) The restoration is then loaded with the desired adhesive by the assistant and handed to the dentist. The restoration is then placed on the tooth with no risk of incorrect orientation or accidentally dropping the restoration during transfer from assistant to dentist or when placing it onto the tooth. (Fig 9) The pin tweezers are then passively released from the Griptab with no risk of accidentally displacing the restoration (Fig 10). With all other placement techniques, apart from using fingers, the dentist is faced with a handle stuck onto the restoration that has to be removed to allow for removal of excess cement. At this point, there is a serious risk of accidentally displacing the restoration, with the concurrent risk of air entrapment under the restoration or on a margin. Clean-up can then proceed with the Griptab still in place and once the restoration has been bonded, the Griptab can be simply removed by sliding a thin metal blade under the adhesive, with no risk of damaging the restoration or any residue being left on the surface. (Fig 10)
The Griptab system facilitates stress-free adhesive cementation of multiple restorations (Fig 12) where time is of the essence and the risk of dropping or mis-positioning a crown can have significant consequences with adhesive beginning to polymerize before the mishap has been corrected. By attaching a pair of pin tweezers to each restoration, they can then all be etched and silanated at the same time by holding all the tweezers in one hand, (Fig 13) and then loaded with adhesive by the assistant and handed to the dentist in the prescribed order, with no risk of dropping the crown or having it handed to the dentist in the incorrect orientation. (Fig 14) The increase in cementation efficiency and reduction in potential problems is an eye opener once the extended use of the system has been grasped. (Fig 15,16)
The cementation of veneers and multiple is also fraught with handling challenges. It is challenging to handle thin veneers during shade-matching, try-in and final cementation. With the Griptab, there is no risk of accidentally dropping the veneers or getting in a mess with cement or try-in paste all over the dentist’s fingers. The assistant has total control of the veneers during etching and silanation and final loading of the chosen adhesive. The development of a veneer system tray has further reduced the risk of accidentally trying to apply a veneer to the wrong tooth by allowing the mounted veneers to be sequentially located on the delivery tray. There are clear disposable overlays to minimise post treatment cleanup. (Fig 17)
The Griptabs are attached parallel to and near the incisal edge of the veneers, (Fig 18) prior to the cementation appointment and can be left in place until the completion of cementation and will facilitate cementation during all phases of the procedure. The veneers are retained in individual pin tweezers and placed in the appropriate position on the veneer system tray. By locating the Griptab near the incisal edge, they do not interfere with try-in cement shade selection. (Fig 19) Once the correct shade of cement has been selected, it is very easy to pick up all the veneers off the teeth and wipe out the try-in paste without the risk of dropping the veneers. If they need to be ultrasoncially cleaned to remove all traces of try-in paste, the Griptabs will remain attached and the veneers can be picked up again with the pin tweezers. Following loading of the chosen shade of resin cement, the veneer can be accurately placed on the tooth with no messy fingers and no risk of accidentally displacing the veneer when the pin tweezers are disengaged. The veneers can be light tacked into position with the Griptab still in place and then removed prior to final cleanup and polymerization of the cement.
The advent of the Griptab system has revolutionized and simplified the placement of modern adhesively bonded restorations by providing secure grip in the presence of silane and simple and predictable passive pick up and release of the restoration as many times as is required during the procedure. They are very useful in managing any small object that has to be introduced into the mouth. Their applications are only limited by the dentist’s imagination. OH
Dr. Milicich lives in Hamilton, New Zealand. He lectures internationally in the fields of minimal intervention, caries risk assessment and management, minimal intervention restorative techniques and on the physics, and clinical applications of hard-soft tissue lasers.
He is a Fellow, Diplomate and founding board member of the World Congress of Minimally Invasive Dentistry (WCMID). He is also a Fellow, Master and board member of the World Clinical Laser Institute, and is a founding Board
member and honorary lifetime member of the NZ Institute of Minimal Intervention Dentistry. He is also a trainer and educator for the E4D CAD/CAM system. E-mail: firstname.lastname@example.org Website: www.advancedental-ltd.com
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