Super Thin e.max Veneer Workflow

[@KlimDDS]

Hands on training schedule can be found at www.cadstar.org/virtual-and-hands-courses

[@AFSMG]

Dear doctor, your videos are impressive. We follow him from Spain. One question: in any video do you explain what colors you use in your makeup to obtain the different colors? For example: for A1, use S2 + etc, etc And so on with all the colors A2, A3, A3.5... Thank you very much. a cordial greeting

[@KlimDDS]

Greeting back to Spain. See the following video content on ceramic base shade selections. This video will review basic principles. All the best. kzbin.info/www/bejne/p5LJl3SelJlqjNk

[@AI_Dentist]

BEST Dental Videos on KZbin. Thank you James

[@KlimDDS]

Thanks

[@jakefatman4876]

What I like about James and his teaching Is that he has heart , soul in teaching👍🇫🇮

[@KlimDDS]

@@jakefatman4876 Thanks, Jake. I really do care and have passion. Glad that is coming through.

[@andrewballard2015]

Very nice Dr Kilm. I was with you at AACD and enjoyed your course so much.

[@ryanlemke8091]

At 16:10 you have an individual die for the processing of that veneer. Did you print that as well or is this "stock footage" of polishing for a different case? Thanks James!

[@KlimDDS]

I do not separate my dies. The margins accessing video clip is from another teaching case. However it is possible to create separate dies with inLab software, I do not do that often.

[@HealthySmilesIMPLANTS]

Greetings from Kathmandu!!! Thank you for sharing… After being Omnicam user for the past 8 years, we are onboarding ourselves to Primescan Primemill and your videos make it so easy to follow. Looking forward to learn a lot from you, and maybe able to welcome you here in Nepal.

[@KlimDDS]

Thanks for sharing

[@dentistfelix]

Really enjoy your videos! Contacted the Miyo seller, sadly 850 isn’t sold in Europe YET. But I am really looking forward to it!

[@gregors.5734]

Funny thing with Miyo: it's manufactured in Europe in Lichtenstein 😅

[@KlimDDS]

I feel the pain. I do know they are at the IDS this week. Are you able to order from the miyo850.com site?

[@dentistfelix]

@@KlimDDS sadly no. But in Juli it will be sold. But when I can, I will purchase it!

[@joeshmo2677]

Hi What’s better lumineer or emax ??

[@eonaloul9098]

Very informative Doc . Can u make video one day about the cementation including shades ,different protocol and all the important aspect related to this subject ! Thanks alot ! Appreciate your efforts

[@silversabre75]

super exciting video as always Dr Klim!!

[@DrMalekAlabdulkader]

Thank u for the informative workflow Can u please guide us to dr fisher article ( regarding stringent )

[@kanupriya9]

Amazing level of understanding and detailing..wow i am thrilled,thank you doc. .. please elaborate shade selection while doing a single veneer as well ,thats the most challenging

[@KlimDDS]

All the best. kzbin.info/www/bejne/p5LJl3SelJlqjNk Reply

[@drbhanson]

Great Video and insight. Welcome to Idaho. Northern Idaho is amazing!

[@KlimDDS]

I love it!

[@theresabond7583]

Dr. Klim, Your videos are phenomenal. You are the most educated and skilled doctor who creates outstanding videos and really cares about your patients. Question: I have emax porcelain veneers on fronts. Looking at 5,6,11, and 12 for additional veneers. It's been suggested to use lithium dislocate but those teeth are darker so I'm concerned that the darkness will not allow for a color match for the darkness may come through with emax monolithic. What would you recommend for the other 4 teeth which are darker, something that has longevity, color match, fracture toughness and flexural strength and can match the existing emax veneers on front? I am 58 Years old. Thank you so very much. I greatly appreciate your expert advice.

[@KlimDDS]

Hi Theresa. You bring up several excellent observations and perspectives and have done your research. Several things to consider are the opacity and thickness of the ceramics to block out a darker tooth. This can be accomplished, but it is also a challenge. The other factor for longevity is preserving as much enamel under the veneers; the enamel surface adds strength to the bonding adhesive interface, and when this happens, one can choose several ceramics, even Empress, which is not as strong as lithium disilicate, will hold up well. So, there are several factors to consider, and it appears from your comments that you are on to understand this. Find an office where you can discuss these issues and then make a choice when you feel there is a fit. All the best.

[@Emilie1Shortiee]

It looks so good I need this for my two front I broke them playing sports and they have a lot of cracks and my one broke in half and the composite doesn’t look good

[@thomasheinrichs161]

Hi James, Tom Heinrichs here. Hope you are well. What is the lip retractor you use?

[@KlimDDS]

optragate from Ivoclar

[@dr.k.5824]

Got some good tips, thank you

[@FrancoisduPlessis-qq7dj]

Best drill bits to use in MXCL for veneers in E-Max ? Using a 12S and a 12S pointed and have some chipping on edges.

[@KlimDDS]

For the MC XL Extra Fine mill, there needs to be four engines, the first bur set is 12 on left and 12S point on the right, and the second bur set is the corresponding EF burs, which have very small refined tips. Then choose Extra Fine mill in the milling screen.

[@FrancoisduPlessis-qq7dj]

@@KlimDDS Thanks for such a speedy reply and some good use full videos.

[@hassaandentalclinic]

Can we do minimum prep veneer on omnicam & mc x as well ?

[@KlimDDS]

Omnicam works well. The MC XL needs four engines, two on each side, to accomplish Extra Fine Mill. The Extra Fine is slower on the MC XL and is slower than the Primemill but works well with the proper bur setup.

[@hassaandentalclinic]

@James Klim DDS Thank u for ur guidance, sir. Stay blessed

[@ramezmahdavi7862]

Amazing work Thank you for sharing.

[@notyourbusiness7896]

thanks for the video TOP G in dentistry!

[@davidshammas7608]

awesome video, do you use a translucent composite to fill in the lingual incisal edge. And also have you ever tried printing provisional veneers on the sprint ray? Lastly, correct me if mim wrong, but you printed out 5 pairs, what was changed between each pair, and do you factor the try ins, into the price?

[@KlimDDS]

Yes, I have the Sprintray and do print provisionals. When I mill mulitple shades (values), I will go for the shade that I suspect will best blend, and then print one shade brighter as another option. Then final blend with tryin paste. And yes, translucent composite on lingual incisal etch. All the best.

[@drtalharafi]

Great and very informative video there. Sir what are your thoughts about 3M RelyX for cementation? and finishing the margins post cementation?

[@KlimDDS]

3M relyX is a nice cement. Having multiple shades is worthwhile for anterior work. Finishing margins after cementation makes it difficult to polish. Lithium disilicate is difficult to finish. I prefer to finish before cementation, so the seams of the veneers are smooth and don't collect biofilms.

[@Lexinmia]

How much does it cost for 10 teeth?

[@kushagravarshney4478]

Great Video Sir, Thanks a lot 👍

[@KlimDDS]

Most welcome

[@rafaloss]

Thanks for your video! Convrfor tge results!

[@KlimDDS]

You're welcome!

[@joeytraer532]

For adding composite on the lingual of the labial edge, why not just cover with the porcelain. It will be too thin? But then the thin layer is composite that is weaker so to me the logic is flawed. Is it too thin to mill then?

[@KlimDDS]

Well, for conservative approaches, I have seen this last for years. It depends on the envelope of function. And by the way, this patient was a dental professional, and she wanted this conservative approach. All the best.

[@joeytraer532]

@@KlimDDS i can see why she wanted to keep the edge now. Kind of like filing an abfraction on MB of a lower first molar with composite instead of reducing the solid buccal cusps by 2mm to incorporate it in an Inlay/Onlay Cerec?

[@aroncarvajal7080]

Hi thank you for your videos, what was the stump shade?

[@KlimDDS]

Ivoclar stump shade ND2, on the lighter side, All the best.

[@ammaraklan5710]

Thank you

[@chiefwaterdog]

When you finished your design, what were restoration parameters before you milled these veneers? Such as cement space and minimal thickness for these “near” prepless veneers.

[@KlimDDS]

Hi Ken. The margin thickness is 50, the spacer is 80, and the minimum thickness is 300. And milled on Primemill Extra Fine Mill. Can be milled well on the MC XL Extra Fine mill as well.

[@rodriguesmarcelo3216]

Hello James! Can you recommend me which cement for a veneer?

[@KlimDDS]

I like Variolink Esthetics by Ivoclar, they have 5 shade options.

[@silversabre75]

what do you think about Vita Enamic which can produce thin margins as well?

[@KlimDDS]

The margin mill of Enamic is excellent, however, surface luster is not stable with wear and tear.

[@brodygoodwine4448]

Really thin on several areas of .1-.3. What issues do you run into with this? Big fan of your videos!

[@KlimDDS]

As long as the ceramic is bonded to enamel, thinness is more about the issue of being able to manage the thinness during manufacturing. The Primemill and MC XL can mills can manage 300 um and 30 um on margins when milling in Extra Fine mill.

[@ryanlemke8091]

@@KlimDDS Great info James! I only have the MC X, but I've had a handful of patients asking recently about no-prep solutions. Any idea what the thinness parameters we can get away with on the MC X are? Please dont tell me I have to buy another mill yet!

[@davidcancelada8986]

Doc, any suggestions with the Omnicam?

[@KlimDDS]

Omincam works well with thin veneers, but you will need the inLab MC XL to mill for extra fine mill mode.

[@nickentros]

Why emax over something like empress for a case like this?

[@KlimDDS]

Good question. I love Empress. I prefer LD with this thin application. I have seen chipping issues with Empress when polishing the margins down to 30 um. What has been your experience with thin Empress veneers?

[@nickentros]

I’m all very new to CAD/CAM, got a primescan AC last summer and have been experimenting with exocad and 3D printed restorations. I want a mill, it’s just a hefty investment

[@KlimDDS]

@@nickentros Yes, I hear you. One step at a time. You have the fundamentals covered. It is interesting to see how printing is working its way into the mix. We are at a good time in dentistry.

[@RG-hf4et]

The lingual incised edge composite will eventually pop off and need to be replaced periodically. Patients don't like having to come back for these composites coming off and repaying for treatment. (Ok, this patient is a dental professional & understands the mechanics, but other patients panic when a similar restoration breaks away.) A permanent veneer is already being placed. My feeling is to wrap it around the lingual & no patchwork because, really when it comes down to it, placing the composite is "patching" that area, imho. Bruxing caused the original wear on the incisal edges & fast forward, most patients will continue to brux even with their best efforts to wear a guard.

[@KlimDDS]

I see your point, but in this case, I see a different angle, and as a prior professional, it was her choice. This patient is in her 70's. These cases are stable when applying a lingual composite bonded to the ceramic and the enamel. I have had this type of work survive well for over a decade. And in her case, she is not an anterior bruxer. Though I usually prep to a solid enamel point, we sometimes need a workaround from the norm, as you mentioned. Having practiced 39 years and observing and applying ceramic treatment options over 4 decades, I do have a perspective to go more conservative. I presented this case at the AACD yearly convention last week. Thanks for your input.

[@KlimDDS]

One more point: patients will not panic when they understand the options and risks; it is about communication and providing care options when they assume the risk. And on the other hand, this case will work for years with the support of the bonded veneer and the improved biomechanical wear facts of the current composites.

[@cmdmd]

"You learn that through experience".... Yup, I ruined many eMax anteriors learning. It was great. LOL After 17 years, I am quite consistent with staining and characterizations.

[@KlimDDS]

Never give up on learning and developing your skills. As an educator, I continue learning, and it has been a forty-year process. Hang out with those on the same journey. I have taught both lab technicians and dentists at a very high level and continue to learn. All the best!

[@cmdmd]

@ "For I was conscious that I knew practically nothing.” Every day is a learning experience.

[@claudemartel1698]

Great video once again, Dr. K. You mentioned virtual wax-up and printed models, even using composites to manually wax the case. But if I want to go 100% virtual , what would be a quick workflow to proceed this way? Cerec SW vs InLab22?

[@KlimDDS]

I recommend adding Exocad software for virtual wax-ups. InLab is not the best for digital wax-ups. All the best.

[@thenecessitarian]

You do your own restorations in house because you enjoy the process? Because A lab can do this while you see multiple patients in the same span of time that is takes you to create these restorations in house. I don't understand the reasoning of in house manufacturing you're paying for the technology you're paying for the extra space to hold the technology and you're spending your time making restorations which cost way less than what you make per case. So the only reason to do a case in house would literally be for the love of the process of doing it in of itself.....

[@KlimDDS]

I appreciate your comments. There are different ways to brand the practice of dentistry and find joy in the journey. Having practiced for four decades, I have tried other models. It is not about always trying to do more dentistry. Since I adopted CAD/CAM into my practice 20 years ago, I have found a love for providing the whole process. It has also branded my practice, and my clients appreciate that their dentist provides the ceramic work. With the current AI software, the workflow is much more proficient. I now coach both dentists and laboratories on the process. The benefits of occlusal accuracy and predictable outcomes have surpassed analog dentistry. The ROI is satisfactory. My overhead has decreased, and I now have a better work-life balance. It all depends on what a clinician wants out of life. The rules have changed with AI, materials, and digital processes. And this will impact the way dentistry is practiced. All the best.

[@thenecessitarian]

I appreciate the insight @@KlimDDS