3StepAcademy - Dental Revolution STEP Academy | INTENSE – Annecy

The most comprehensive ADDITIVE training consists of 2 INTENSE courses of 3 days each with different hand-on parts and time in between the courses.
The 2 INTENSE courses give the participants the possibility to meet Dr. Vailati twice, while making progress with their own 3STEP cases. These courses are very “intense” and 3 days are the perfect time frame to absorb all new information in a tranquilizing surrounding near the lake of Annecy, France.

Pratical Courses FIRST INTENSE & SECOND INTENSE

SEPTEMBER 09-10-11

INTENSE I

The diagnosis, the data collection and the increase of VDO

September, Monday 09th

Dental wear is a frequently underestimated pathology that nowadays affects an increasing number of individuals.
Teeth are wearing down faster, not only for the excessive presence of the acid in the mouth, but also because of parafunctional habits.

Generally, the affected patients are left untreated until more damage occurs and conventional treatments are more justified (subtractive dentistry based on crowns). Postponing the therapy is not the correct attitude. Non-invasive (ADDITIVE) adhesive restorations should be proposed instead, to protect the remaining dentition from further degradation.

LEARNING OBJECTIVES:

  • Learn the rational behind an ADDITIVE non-invasive approach versus traditional subtractive dentistry.

Before starting any dental treatments, a diagnosis of the origin of the tooth wear should be made. Even though loss of tooth structure is often multifactorial, clinicians should try to identify the cause, to explain patients also how the restored dentition will be ageing in the future.
The participants will learn how to recognising the signs of early tooth wear and be capable to predict the type of evolution if the dentition is left untreated.

LEARNING OBJECTIVES:

  • Learn to identify the signs of dental erosion.
  • 
Know the evolution of untreated mouths affected by dental erosion.
  • Make the differential diagnosis between erosion and parafunctional habits.

In case of severe dental EROSION, the facial aspect of the anterior teeth may also need to be restored. In this case another veneers, made this time in ceramic could be used. The ACE classification is a clinical oriented classification, which considers the maxillary anterior teeth to evaluate the severity of the dental wear related to dental erosion. Instead of trying to precisely quantify the wear due to erosion, this classification proposes to correlate the damage at the level of the anterior maxillary teeth to the possible options of treatment. Patients are grouped in six categories, and for each of them a dental treatment plan is suggested

The classification is based on several parameters, relevant for the selection of the treatment and the assessment of the prognosis, such us the dentin exposure, the preservation of the incisal edges, and the pulp vitality.

LEARNING OBJECTIVES:

  • Classify patients affected by erosion, looking at the damage of their anterior teeth.
  • Propose a treatment based on the ACE classification.
  • Lear how to decide if also facial veneers are indicated in the treatment.

Despite the tendency for adhesive techniques to rather simplify the involved clinical and laboratory procedures, treatment of patients affected by severe dental erosion still remains a challenge.
An innovative approach, called the CLASSIC 3 STEP technique has been developed by Dr. Vailati. The 3 STEP technique is a structured approach to start a full-mouth ADDITIVE rehabilitation with the most predictable result, the minimal tooth preparation, and the highest level of patient’s acceptance.

Fundamental before starting the rehabilitation the communication with the patient and the laboratory technician on the esthetic final outcome. Thanks to a simplified less expensive mock-up, the patient can make an informed decision if he/she is willing to start the more comprehensive rehabilitation.

In this session, the participants will learn how to start developing a full-mouth rehabilitation, starting from two of the three fundamental parameters, the incisal edges and the esthetic occlusal plane..

Learning objectives:

  • Avoid full-mouth waxup
  • Plan an intelligent esthetic outcome for the future rehabilitation

September, Tuesday 10th

Since the main objective of the 3 STEP technique is to avoid the removal of healthy tooth structure, while restoring worn down dentitions, an increase of vertical dimension of occlusion (VDO) is always advocated.
The role of the clinician in determining the new VDO is fundamental. Once the project in wax is clinically validated, the posterior teeth are reconstructed, using transparent silicon keys. These keys are loaded with composite and positioned in the mouth to fabricate posterior restorations (the white bite).

Thanks to the white bite the occlusion of the patient could be verified, before progressing to the final restorations. The white bite becomes a test drive to stabilise the patients and to give back their function.
In this session, details on how deciding the increase of the VDO will be given. Special attention to the communication with the laboratory technician in the fabrication of the wax up of the posterior quadrants will be stressed.

Learning objectives:

  • Learn to understand the clinical validity of a more comprehensive waxup.
  • Determine the increase of VDO for every 3 STEP rehabilitation.
  • The digital wax up will be mentioned, but not discussed in the details, since there are more clinicians who work still in a analogic manner.

Often laboratory technician do not know how to correctly make the transparent keys, leading to clinical complications during the fabrication of the white bite. Errors, such as incorrect occlusion, or interproximal excesses can be reduced if clinicians are able to evaluate the quality of the posterior waxup first and the quality of the transparent keys later. Examples of laboratory and clinical mistakes will be shown during this practical part, where the participants will fabricate a correct transparent key by themselves. Even with both a correct waxup and a transparent key, potential risks of mistakes may still be present during the II clinical step, when the key is used to fabricate the white bite directly in the patient’s mouth. Critical step could be how clinicians handle the transparent key, the quantity of composite loaded, the quality of composite used, the pressure applied on the key etc. These steps will be evaluated, using clinical examples, while participants will use their transparent key and fabricate the white bite themselves.

Learning objectives:

  • Learn to analyse a posterior waxup
  • Learn to fabricate a transparent key
  • Avoid clinical errors, while handling the transparent key

September, Wednesday 11st

During the last day of the course, Dr. Vailati will illustrate the enormous potentials of the 3 STEP technique. This technique was born to treat mostly eroded dentitions; however with time its applications have expanded and today a 3STEP could be applied in every field of Dentistry, from Prosthodontics to Orthodontics. The Additive mind together with the progressive wax become essential in every treatment plan.

Learning objectives:

  • Provide a full picture of the benefit of the 3 STEP approach.
  • Give an idea why the 3STEP is an fantastic tool for clinicians to plan and to test drive patients.

Clinicians are generally not very keen to start treating patients affected by parafunctional habits (e.g bruxism), since they are afraid of the mechanical failure of the restorations delivered. A common attitude is to wait for more damage to occur, to be then obliged to intervene. However, this late intervention is responsible for a further degradation of the original dentition, and a more complicated and expensive therapy. Generally subtractive techniques are then selected and healthy tooth structure removed, leading to further weakening of the dentition. Nowadays, however, these conventional rehabilitations (based on crowns) are very rarely accepted by patients, not only for their biological loss, but also for their important cost.
If dentists are not prepared to treat parafunctional patients, and patients are reluctant to restore their teeth with subtractive techniques, questions on the time of intervention should be raised.
ADDITIVE dentistry can be the alternative to propose to this population of patients, based on an early intervention with the maximum preservation of their tooth structure. In addition this approach allows a test drive to stabilise patients and to see how they react to the new restored dentition.

Learning objectives:

  • Discuss why dentists cannot reconstruct all the different mouths following the same standardised ideas.
  • Place attention on the importance of function (#youcantskipfunction).

A solid initial documentation is fundamental for a correct treatment plan.
To avoid waste of time, clinicians should know what is really necessary when it comes to the data collection during the first visit with the patient.
In this session it will be also explained how to register the patient’s occlusion, the type of impression to take, how to mount the casts etc. In addition a list of essential photos will be described. Very few clinicians understand the fundamental importance of documenting their work with photos. Some of them take pictures only to communicate shade to the technicians, other to show the patient aesthetics. Following the 3 STEP technique, instead, there are several photos crucial to document clinical parameters necessary for the treatment plan.
In this part of the course, the participants will be instructed to take only the necessary pictures and they will be capable by looking at those to identify the critical parameters for the diagnosis and the treatment plan.

Learning objectives:

  • Learn how to collect the initial date for treatment planning of a 3 STEP
  • Learn which are the essential photos to take and which clinical parameters are shown in each picture
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NOVEMBER 07-08-09

INTENSE II

Palatal veneers, function and treatment planning

November, Thursday 07th

Are we really sure to know and understand the patient whom we are going to treat? Often it depends on which type of eyes we are looking at. More attentive to estetic or more aware of the risk of dysfunctional patients? Dr. Vailati would like to start the course with a reminder that rehabilitate patients and not only reconstructing their dentition is the only way to guarantee the long term longevity of the restorations in dysfunctional patients. Only by knowing the initial function, and provide with a better one, a clinician can predict potential problems, avoid them, and guarantee better survival to the restorations.

Learning objectives:

  • Stress the concept that esthetic reconstructions may not be long lasting in patients affected by dysfunction

During the period of time between the INTENSE 1 and the INTENSE 2 courses, the participants will have the time to look at their patients differently, making diagnosis of dental wear, and even treating some of these patients.
A review on the fundamental aspects of the previously explained I and II STEP is essential, since clinicians will have the opportunity to clarify some doubts before progressing with the 3 STEP of the technique.

Learning objectives:

  • Review the main topics of the first and second steps to be ready for the palatal veneers

After the increase of VDO with the white bite, patients present an anterior open bite, which will be restored by means of palatal veneers. Before passing to the next step, it is crucial to evaluate the patient’s posterior support, the new VDO and the occlusal comfort in general with the white bite. Occlusal adjustments are one of the eight steps necessary to prepare the patient for the III STEP, eight steps which are part of the CONTROL visit.

Learning objectives:

  • Learn how to evaluate the occlusion after the white bite
  • Learn how to prepare the teeth for the palatal veneers

Palatal veneers are an outstanding treatment for eroded anterior teeth and worn down dentition in general. However, since it is also an unusual one, clinicians may be not familiar with this type of restorations. In this session, each step on how to deliver them in the patient’s mouth will be explained, stressing the importance of a correct adhesive protocol.

Learning objectives:

  • Learn the adhesive protocol to bond palatal veneers, from the simpler to the more difficult ones (TACOS)

November, Friday 08th

This part of the course deals with the difficulties that clinicians and laboratory technicians may find in planning palatal veneers. Few lab technicians know how to do these uncommon restorations and in Dr. Vailati’s experience more than 80% of what the participants bring to the course should be remake or at least modified before being delivered to the patient.

To help clinicians to evaluate the laboratory work, 10 laboratory parameters should be considered.
The palatal veneers brought by the participants will be photographed and evaluated together with the group to decide if they are clinically acceptable.

Learning objectives:

  • Learn how to evaluate if the palatal veneers are clinical acceptable by looking at them on the cast

Dr. Vailati will take pictures of all the palatal veneers done by the laboratory technicians’ participants. These photos will be shown on the screen and each participant will receive a personalised evaluation based on 10 parameters. The restorations can be great (ready to be delivered), clinical acceptable (some modifications are necessary and done by the clinician) or not acceptable (impossible to be delivered). At the end of this session the participants will receive all these pictures and go back to their technicians to explain the 10 parameters necessary to fabbricate correctly the palatal veneers for a real patient.

Learning objectives:

  • Evaluate participants’ palatal veneers to train their lab technician

After the theoretical session on the ideal shape of a palatal veneer, each participant will modify his/her own palatal veneers, following the guidelines of Dr. Vailati. The reshaping of the restorations will facilitate their bonding and improve their ageing in the patient’s mouth. New pictures of the restorations may be taken and showed to the group to really analyse if the modifications were correctly executed.

Learning objectives:

  • Learn how to improve the participants’ palatal veneers before bonding, by additive and substrative modifications

Bonding palatal veneers could be a stressful clinical situation, not only for the fitting of the restorations, but also for their unusual location in the mouth. In this practical session, the participants will learn on a model how to isolate the operatory field with a rubber dam, and after they will follow the different steps to bond the palatal veneers.

Learning objectives:

  • Learn to isolate the teeth with a rubber dam to bond palatal veneers
  • Execute the different steps of the adhesive protocol for palatal veneers

November, Saturday 09th

Due to a raising awareness about dental wear, several clinicians would like to propose treatments even at the initial stages of this disease. However, when the loss of tooth structure is visible only by an attentive eye and it has not affected the esthetic of the smile, proposing a full-mouth rehabilitation is not easy. Reduction of the cost of the therapy, simplification of the clinical steps, and NON-invasive adhesive techniques may promote patient’s acceptance. With the modified approach of the 3 STEP technique, initial cases of dental wear could be treated, skipping some clinical and laboratory steps, to make the therapy faster and less expensive for the patients. In addition a MODIFIED approach can be used to lower the price of the rehabilitation even in more severe cases of tooth wear. The MODIFIED 3 STEP technique is the most frequent approach of Dr. Vailati nowadays.

Learning objectives:

  • Illustrate the MODIFIED 3STEP
  • Show how to reduce rehabilitation’s fee, but not its quality

The posterior teeth are always the last teeth to be considered by patients due to their minor esthetic value. Instead these teeth are the most important in a full-mouth rehabilitation, since the longevity of the anterior restorations relays always on a solid posterior support. In this optic, treatment planning of the posterior restorations is very complex. In this session, different aspect of how to restore the posterior teeth will be evaluated, looking at the type of existing restorations, patient’s occlusion, money availability etc. New materials like CAD/CAM composite and ceramic restorations will also be described to try to improve the quality of the posterior support and may be to lower the price of the rehabilitation.

Learning objectives:

  • Decide how to restore the posterior teeth to increase the VDO
  • Decide which material use for the final posterior restorations

In this session, cases of dental wear of the participants’ patients will be analysed.
It is recommended to select cases of dental erosion with a less important parafunctional component. Each participant will be asked to select one patient and documented the initial status with maximum15 clinical photos and one video. These pictures will be delivered to dr. Vailati and analysed with the group during this session. The attention will be placed not only on the quality of the documentation, but also on the diagnosis. Advices on the treatment plan will be given. The session will be based on the interaction between dr. Vailati and the participants, especially on the type of dental material selected for the rehabilitations.

Learning objectives:

  • Evaluate the documentation to analyse parafuntional and erosive patients.

In this session, cases of dental wear of the participants’ patients will be analysed.

It is recommended to select cases of dental erosion with a less important parafunctional component. Each participant will be asked to select one patient and documented the initial status with maximum15 clinical photos and one video. These pictures will be delivered to dr. Vailati and analysed with the group during this session. The attention will be placed not only on the quality of the documentation, but also on the diagnosis. Advices on the treatment plan will be given. The session will be based on the interaction between dr. Vailati and the participants, especially on the type of dental material selected for the rehabilitations.

LEARNING OBJECTIVES:

Evaluate the documentation to analyse parafuntional and erosive patients.

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By registering for the entire training course (INTENSE I  & INTENSE II) a reduction of 5% is foreseen in the total enrollment fee.

INTENSE I & INTENSE II
September 09-11 2019 and November 07-09 2019