Getting acquainted with Insta-Ortho

We have a patient who has rotated centrals overlapping the laterals, there is under-lapping of the laterals into the canines and the crowding in the canines caused rotation and overlapping into the laterals. The dentist would most likely advise the patient that for conservation of tooth structure, the patient should consider orthodontics for a prolonged period of time to rotate back the central into the correct position while spacing out the crowding. This, of course, is the short analysis of the case.

Orthodontics would require a lengthy period of time before progress and results would show. Realistically, if you or I had a choice between this long process of treatments before we saw results or an alternative way to have the results instantly, we would most likely choose the latter as the treatment plan.

Danny Materdomini, MDT, has being teaching the Insta-Ortho technique to dentists for years in his seminars and hands-on seminars on a duplicate study model.

The method that Materdomini teaches requires augmentation and preparation of the teeth for veneers. It provides the patient with instant results, fewer visits and less patience necessary to see results and more likely than not, the dentist will gain case acceptance.

We will discover some of the main points of Materdomini’s presentation on Insta-Ortho with a study case provided to him by Dr Steven Donia.

The key to success for an extreme case like this is planning. The dentist will need to plan what tools are going to be needed to gain case acceptance as well as communication tools between the dentist, the patient, and the dental lab. What materials are going to be needed to start and finish the case? What are the restoration choices for the case for the best possible outcome in aesthetics?

A wax-up is highly recommended from your dental lab to be used for three purposes; use it as a communication tool to show what changes will be made to the patient’s teeth, use it as case acceptance tool, and lastly for a putty stent for temporaries. You will also need a good smile guide to completely understand from the beginning what your patient wants in the smile makeover transformation.

We highly recommend the Lorin Library Smile Style Guide by Dr Lorin Berland and Dr David Traub. The smile guide will also be essential to communicate to your dental lab what the final restoration will need to look like. Once the patient has accepted the case treatment, the dentist will use the Golden Proportion to establish the width and length of the teeth.

Materdomini explains that the dentist will need some physical tools to get the job done correctly. A good veneer preparation kit is important; da Vinci or Nixon Porcelain Veneer Preparation Kit is by far one of the best and complete kits out on market. Renamel Nano by Cosmedent is a great light cured hybrid composite material that will be needed to complete the augmentation. Two discs are needed; an ultra-thin double sided diamond disc and a single sided diamond disc by Brassler to augment and open proximal contacts.

Materdomini instructs that the dentist will create a starting point at the midline. Using a marker and a pair of dividers the dentist will mark the teeth before starting any preparation or doing any augmentations (Fig. 2).

Then beginning with the double sided ultra-thin diamond disc the dentist will establish a midline between the centrals (Fig. 3). After the midline is established, the dentist will start to open the contacts where the over-lap and under-lap appears. The dentist will then open the distal contacts of the centrals, open the mesial and distal contacts of the laterals, and then open the mesial and distal contacts of the incisors with a single sided diamond disc (Fig. 4).

Materdomini clarifies to dentists that they must finish all augmentation of the teeth before using the hybrid composite to re-establish the contact points of the teeth to create a balanced arch form of the upper anterior. Apply the hybrid composite to the lingual mesial and distal areas where the contacts were opened up and cure all composite at the same time (Fig. 5). The next step is to use the football shaped diamond to create a symmetrical lingual surface before starting the veneer prep. Prep the teeth as the dentist would for veneers (Fig. 6a and 6b).

Once the veneer prep is done and the final impression is taken, we go back to the wax-up to create a putty stent for the temporaries. The dental lab will be given the smile design which the patient chooses from the smile guide and from there the dental lab will create the veneers.

Materdomini opts for the Noritake Feldpathic Porcelain because it still offers the best results when it comes to polychromic effect as well as aesthetics. He uses the foil technique over the refractory method for veneers because it is a better method for creating a better marginal fit as well as overall fit. He has been successful with this practice for more than 27 years.

We can see that the final outcome of the case and the aesthetics are beautiful (Fig. 7). The translation from the wax-up and smile guide is on point. We have a new balanced upper arch form (Fig. 8). The widths and heights match the overall look of the patient (Fig. 9).

Conclusion

Insta-Ortho provides an alternative dental treatment for the patient. The patient does not have to wait for results as they would with orthodontics.

Orthodontics is still the standard as a treatment plan as it is conservative when it comes to tooth structure but most patients just do not want to wait months or even years to see results. Some orthodontic cases will still require prepping for veneers later on. Insta-Ortho provides a new treatment plan that will also generate new revenue for dentist and give patients instant results that they seek. Communicating and planning with patients and dental lab for a case like this is always the key to success.

Danny Materdomini explains in more detail of how to use the Golden Proportion to assess the correct aesthetic, how to augment using the discs and veneer kit, and how to create a balance arch using the hybrid composite for veneer preparation in his seminars currently offered at da Vinci Dental Studios, West Hills, CA, USA, and da Vinci Institute, Beverly Hills, CA, USA.

About the author

Daniel Materdomini received his ceramic training and degree in New York City in 1960. For 30 years, he has been the owner of da Vinci Dental Studios, located in West Hills, Calif. Materdomini has been producing the highest quality esthetic porcelain veneers for more than 27 years. In 1993, he was awarded Honorary Membership in the American Society for Dental Aesthetics. He received a lifetime achievement award from the American Academy of Cosmetic Dentistry in year 2000 and is the only recipient of this prestigious award. He has lectured to doctors and ceramists nationally on every phase of the veneering process and has trained hundreds of ceramists in the fabrications of porcelain veneers using the foil technique. Materdomini has co-produced and directed three videos on porcelain veneers with Dr Robert Nixon of Beverly Hills, Calif. He is the co-developer of Ceramic II G veneer porcelain for Johnson & Johnson; and he is presently involved in the development of new materials, techniques, instruments and procedures relating to the dental lab industry. Materdomini developed the Vita da Vinci Veneer Porcelain and the da Vinci Veneer Bonding System in collaboration with Cosmodent. da Vinci Veneers were featured on ABC’s “Extreme Makeover” and FOX’s “The Swan.” He has written numerous articles on porcelain veneers for numerous major dental publications.