How I Address Filling the Access Hole of a Screw-Retained Implant Crown 

April 17, 2024 Lee Ann Brady DMD

By Lee Ann Brady, DMD 

For addressing the access hole of a screw-retained implant crown, my preferred method involves applying Teflon tape over the hole followed by temporary filling material, such as Telio Inlay from Ivoclar Vivadent. 

I emphasize to patients the importance of maintaining accessibility to the screw for potential adjustments without jeopardizing the integrity of the ceramic crown. Hence, immediately after seating the crown, I ensure no adjustments are needed before doing the filling. 

Patients are scheduled for a final post-op appointment with the surgeon after the restoration is in place. If there are no issues requiring crown removal, the Teflon tape and Telio Inlay may remain indefinitely, monitored during hygiene recall appointments. As long as the temporary filling remains intact, replacement is unnecessary. 

In cases where the Telio Inlay dislodges but the Teflon tape remains intact, I inform the patient of our plan to reapply the temporary filling. However, if repeated dislodgment occurs, leading to inconvenience, we consider transitioning to a permanent filling. In such instances, fresh Teflon tape is applied, and the access hole is filled with composite that precisely matches the crown’s color. 

Even if years pass and the Telio Inlay needs replacement, I opt for a temporary filling for ease of identification if removal is necessary. Only if frequent filling replacements prove bothersome do I consider switching to a permanent filling because I prioritize easy retrievability of the screw. 

Related Course

E1: Aesthetic & Functional Treatment Planning

DATE: December 11 2025 @ 8:00 am - December 14 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 39

Dentist Tuition: $ 6800

Single Occupancy with Ensuite Private Bath (Per Night): $ 345

Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

Learn More>

About Author

User Image
Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Dental Care While Wearing an Essix Retainer 

April 15, 2024 Lee Ann Brady

By Lee Ann Brady, DMD 

One of the most common ways that we temporize a patient who is having maxillary anterior implant dentistry is with an Essix retainer. Some patients will wear it 24 hours a day and others for less. Hopefully they are taking it out to rinse, brush, and floss, but the reality is they are wearing a removable device that covers all of the tooth surfaces for a lot of hours every day, and we’re increasing their risk of caries, decalcification, and gingivitis. 

In addition to discussing the normal oral hygiene to be done at home, in our practice, we typically dispense a product like Clinpro 5000 from 3M or MI Paste from GC America. These are high calcium and fluoride products that provide fluoride treatments inside the Essex retainer. 

  • If a patient is sleeping in the Essix, the instructions are to brush and floss the teeth and then use a toothbrush to spread a little bit of Clinpro or MI Paste on the inside of the retainer before going to sleep. 
  •  If they are not wearing the Essix during sleep, the instructions are the same but to wear the Essix for up to an hour every evening before removing it to go to sleep. 

If the patient’s caries risk is high, I prefer using 10% carbamide peroxide gel instead of Clinpro or MI Paste. This is the active ingredient we us in perio trays to help prevent gingivitis. This is also the means by which patients can whiten their teeth while wearing an Essix retainer. 

To prevent damage to the Essix, instruct patients to rinse it with cold water and, when not wearing it, to store it in the provided container.  

Related Course

Worn Dentition: Direct & Indirect Adhesive Management Through a Non-Invasive Approach

DATE: October 24 2025 @ 8:00 am - October 25 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 15

Dentist Tuition : $ 2595

Single Occupancy with Ensuite Private Bath (per night): $ 345

Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

Learn More>

About Author

User Image
Lee Ann Brady

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Are Your Temporaries a Practice Builder or Simply Temporary? 

April 10, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

Many dentists believe that provisional restorations don’t really matter. After all, they are not really a stand-in for the final restoration. I would respectfully disagree. I am a proponent of creating functional, durable, and highly esthetic provisional restorations, every time. They have the potential to impact your dental practice a lot more than you might think. Whether you print them, form them, or free-hand them, a GREAT temporary is a great billboard for your practice. 

  1. Make the provisional as Esthetic as the final restoration.

I contend that the more your provisionals look like what you are hoping for when you seat the final restorations, the more people will talk about them, AND you. 

I was able to build a referral restorative practice by creating provisionals that made patients want to come to my practice and specialists want to send people. For much of our career, almost the entire team of the oral surgery office we worked with, and many of the team members from the other specialty practices we worked with, were our patients in Pemberville, Ohio. 

Front teeth or back teeth, when you make them look like teeth, people will like it and they will show and tell other people. “This is just the temporary?!” was not an uncommon question or exclamation from our patients.  

  1. A GREAT guide makes a GREAT provisional restoration.

Your wax-up** cast/model serves as your vision, as your preparation guide fabrication device, and as your provisional former. When the preparation is appropriately reduced for the material selected, the temporary can mimic the restoration. 

** The wax-up might be created with wax then duplicated with impression material and stone to create a cast, or it might be scanned to be duplicated with resin and printed or milled to create a model. 

  1. 3. Use that provisional to highlight the talents of your team members.

You might LOVE to make those provisionals, but if your assistant is equally excited when it comes to recreating nature for the patient to appreciate, then it could be an opportunity for patients to see that your assistant does much more than set-up, clean up, and hand you an instrument. My dental partner, Cheryl, (who is also my wife) and I actively sought out things that could help our patients experience our team as much more than our helpers. 

As we all know, dental assistants are an integral and vital part of what the practice is and are a powerful force in how and why patients ask for dentistry. Assistants who fabricate provisionals have an opportunity to be seen differently, and we were always looking for ways to create partnership with them in our treatment. 

  1. 4. Take pictures of them.

Photographs of the temporary will make it easier for the lab to design the outcome. They will be able to see what you are thinking, able to visualize what you want, AND maybe even more importantly, see what you do not want. With anterior provisionals, I have frequently noted to my ceramist, “Please put the incisal edge in exactly this position vertically and horizontally in the face, then use your artistry to create the tooth that belongs in the face you see in the photographs of the patient before, prepared, and temporized.” 

There were many times when the technician was able to see and create effects that I might have not recognized as being “just the thing that would make these teeth extraordinary.” And don’t forget to show the patient the photograph. 

  1. 5. Love the material you make the temporary with.

The better the provisional material is at holding tooth position and functional contact, the less adjustment we’re going to have, so using a high-quality material is important. There are a lot of them out there. I like bis-acryl materials that polymerize with a hard surface, have little or no oxygen inhibited layer, and can be polished easily. The polish is more about feeling smooth than about the shine. Ask you patients how their provisional tooth “feels” when you are done, so they sing your praises. 

  1. 6. Use high-quality core material.

When you use a good core material the prep will be smoother, making it easier to fabricate nice provisionals. Ideal prep form goes a long way toward better provisionals. 

  1. ASK your patient to tell people.

As noted above, when you can elicit an emotional response about the awesomeness of your provisional, ask the patient to tell other people, “….and this is just the TEMPORARY!” 

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

User Image
Gary DeWood, DDS

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Using Glycerin with Resin-Based Temporary Dental Cements 

April 1, 2024 Kelley Brummett DMD

Kelley Brummett, DMD 

Resin-based temporary cements are wonderful due to their translucency and their ease of cleanup after light curing. My favorite is TempoCem from DMG.  

To prevent resin-based temporary cement from bonding to the newly placed composite, some dentists apply Vaseline on the prep before placing the provisional. 

Instead of Vaseline, I use glycerin. We keep glycerin in a little syringe in the room, and we put just a smidge in a little dapping dish so I can coat the top of the prep with it. Since beginning to use glycerin, I have not had difficulty retrieving bonded provisionals. 

If your provisionals come off, just get a new and stronger temporary cement. No! I am just kidding! If the provisional comes loose, it is often because you do not have enough space, so excursive interferences are high. When this happens, I engage with the patient in checking their occlusion, and continue to work out the determinants of their occlusion.  

Figuring these things out while the patient is in a provisional that is retrievable due to the ease of the temporary cement used, helps me continue to make progress on their occlusion before moving forward with the final restoration.  

It is not a failure of cement; it is a growth opportunity for discovery and patient engagement! 

Related Course

Worn Dentition: Direct & Indirect Adhesive Management Through a Non-Invasive Approach

DATE: October 24 2025 @ 8:00 am - October 25 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 15

Dentist Tuition : $ 2595

Single Occupancy with Ensuite Private Bath (per night): $ 345

Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

Learn More>

About Author

User Image
Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

The Effect of Rubber Dam Isolation on Bond Strength to Enamel 

March 13, 2024 Christopher Mazzola, DDS

Christopher Mazzola, DDS 

This is an example of a clinical study that can help us in our everyday practice of dentistry. Although the findings do not surprise us, keeping the findings in mind will guide us in decisions we make when performing treatments our patients are counting on to be long lasting. 

Dr. Markus Blatz is co-founder and past President of the International Academy for Adhesive Dentistry (IAAD) and Chairman of the Department of Preventive and Restorative Sciences and Assistant Dean for Digital Innovation and Professional Development at the University of Pennsylvania School of Dental Medicine in Philadelphia. He and a research team from the University of Coimbra, in Portugal, studied the effect of rubber dam isolation on bond strength to enamel. Their goal was to test two hypotheses. 

Hypothesis 1: Rubber dam isolation improves sheer bond strength independent of the adhesive system used. 

Hypothesis 2: A highly filled 3-step etch and rinse adhesive will provide higher bond strength values than an isopropyl-based universal adhesive. 

For their tests, they used OptiBond FL from Kerr for the 3-step etch and rinse adhesive and Prime & Bond Universal Adhesive for the isopropyl-based universal adhesive. 

The mesial, distal, lingual, and vestibular enamel surfaces of thirty human third molars were prepared (total n = 120 surfaces). A custom splint was made to fit a volunteer’s maxilla, holding the specimens in place in the oral cavity. Four composite resin cylinders were bonded to each tooth with one of two bonding agents (OptiBond FL and Prime & Bond) with or without rubber dam isolation. Shear bond strength was tested in a universal testing machine and failure modes were assessed. 

Both hypotheses were supported by the results reported in the Journal of Esthetic and Restorative Dentistry in November of 2022. 

  • With the rubber dam in place, both of the adhesives performed better than without the rubber dam in place, resulting in approximately twice as much shear bond strength with the rubber dam. 
  • The 3-step OptiBond FL system resulted in a more resilient bond than the Prime & Bond Universal adhesive. The OptiBond FL group with rubber dam presented the highest mean bond strength values. Fracture modes for specimens bonded without rubber dam isolation were adhesive and cohesive within enamel, while rubber dam experimental groups revealed only cohesive fractures. 

For the benefit of our patients, we shouldn’t cut corners that will impact the longevity of a restoration. My thoughts are that whenever we have basic pure enamel bonding it should be under a rubber dam, using a total etch, 3-step adhesive system. But considering dentin likes to be moist, we may need to make other clinical judgments.  

Related Course

Worn Dentition: Direct & Indirect Adhesive Management Through a Non-Invasive Approach

DATE: October 24 2025 @ 8:00 am - October 25 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 15

Dentist Tuition : $ 2595

Single Occupancy with Ensuite Private Bath (per night): $ 345

Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

Learn More>

About Author

Default Avatar
Christopher Mazzola, DDS

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

The Pre-Clinical Interview – Part 2 

March 11, 2024 Laura Harkin

Laura Harkin, DMD, MAGD 

Let’s delve deeper into the preclinical interview! 

It’s helpful to understand a patient’s perception of their overall health and oral health, as well as what type of restorative dentistry they’re hoping to have and why they feel the way they currently do.  

Sometimes, an integral family member has influenced the timing of care. For instance, you may hear, “My grandchildren are making fun of my teeth” or “My wife asked me to get my teeth fixed.” From this response, I know that I will need to be sure my patient personally desires treatment before rendering it. I’m also anxious to understand what type of restorative dentistry a patient is considering. For example, are they open to removable prosthetics, fixed crown and bridgework, or implantology? 

Recently a new patient came to my office with an emergency. Tooth #5 presented with the buccal wall broken to the gumline and a moderate-sized, retained, amalgam filling. He immediately said, “I do not want bridgework.” I listened quietly until he elaborated by saying, “When I had this front tooth replaced by my other dentist, I had to take it in and out, and I just found that so irritating.”  

I finally understood that he was referring to a flipper but calling it bridgework. So, it’s important to listen and ask questions when someone seems close-minded about having a certain modality of treatment. Delve deeper into the conversation because it may simply be confusion surrounding dental terminology. 

For the grandparents who ask for a better smile, I’d like to understand their thoughts on the scope of treatment and their expectations. Are they looking for a white, straight, Hollywood smile or a more natural appearance with a little bit of play in the lateral incisors? Are they mainly concerned about stains, gaps, or a missing tooth? Are there other problems they’re aware of such as tooth sensitivity, inflamed gums, or the need for a crown? This input is very important as we continue conversation with co-discovery throughout the clinical exam, diagnostic records, and treatment planning phase. 

Learn to count on your chairside for pertinent information. 

I’m fortunate to always have my assistant, Cindy, beside me for preclinical conversations, comprehensive examinations, and restorative procedures. Sometimes, Cindy interprets a patient’s statement or component of conversation differently than me. She may hear a message that I missed or read body language of which I wasn’t aware. Sometimes, auxiliary conversations between patient and assistant take place after I’ve left the room to complete a hygiene check.  

At the end of the day or in the morning huddle, we always take time to discuss interactions with our patients. Together as a team, we’re more efficient at acquiring accurate information so that we may approach the road to health most effectively for each individual. 

Determine if trust is present. 

As I’m getting to know a patient and before I choose to begin restorative treatment, I seek to understand if trust is present in our doctor/patient relationship. New patients often share past dental experiences, and, unfortunately, some have lost trust in dentistry itself. This may be warranted due to improper care, but it may also be due to a lack of understanding or unclarified expectations regarding a given procedure or material choice.  

It’s not unusual, particularly when a patient is considering a large scope of treatment, to serve as a second or third opinion. Building trust and waiting to be asked for our skills are key necessities before moving forward in irreversible therapy.  

The comprehensive examination, periodontal therapy, splint therapy, and gathering of records are all appointments during which opportunities exist to get to know our patients. True trust often takes time to establish, but the reward reaped is frequently one of empathy, friendship, and the ability to do our best work. 

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

Default Avatar
Laura Harkin

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

A Tip for Matching the Color of Cement Between an Implant Abutment and Crown

March 8, 2024 Lee Ann Brady

Trying to match the color of the cement between the abutment and the dental implant crown in the anterior can be very frustrating. Here’s a trick that works well for me. 

A while back I was struggling to match the color of the cement between the abutment and an anterior implant crown. I always try-in the abutment and the crown and try to confirm the shade before they are put together. We do this because the laboratory can’t redo the shade once they’ve bonded the crown and the abutment for screw retention without trying to separate the cement, which is difficult. 

Over the years, it was a challenge to replicate the opacity of the cement used to connect the titanium abutment and ceramic crown. I’ve tried using some of the opaquest try-in paste on the market. 

In the case I referred to above, we thought we had it. My lab cemented it together and I put it in. I could see the opacity of the cement through the restoration. So, we had to take it apart and try again. My laboratory technician shared with me a trick that he had learned from one of his other dentist clients. And that was to simply go to CVS, Costco, or Target and buy good old fashioned liquid white out.  

Now, I put a very tiny amount of whiteout on a micro brush and paint it on the inside of the labial surface of the crown on the intaglio surface. Then, I use a bit of translucent try-in paste to seat the crown. 

The whiteout works well because it is basically titanium dioxide and water with preservatives—the same white compound that is in super white sunscreens. In my opinion, it is relatively safe to use, and I can see what the implant will look like when the pieces are cemented together. 

Related Course

Worn Dentition: Direct & Indirect Adhesive Management Through a Non-Invasive Approach

DATE: October 24 2025 @ 8:00 am - October 25 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 15

Dentist Tuition : $ 2595

Single Occupancy with Ensuite Private Bath (per night): $ 345

Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

Learn More>

About Author

User Image
Lee Ann Brady

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

How Ivoclean Works 

March 1, 2024 Lee Ann Brady

How Ivoclean Works 

Lee Ann Brady, DMD 

Saliva on the inside of restoration surfaces greatly reduces the bond strength between the porcelain and the cement but during the intraoral try-in process, it is inevitable that there will be saliva contamination. 

Most dentists I know use Ivoclean from Ivoclar to clean their indirect restorations after try-in. It is an incredible material for removing saliva and other contaminants that the restoration is exposed to during the intraoral try-in process.  

We trust Ivoclean to fully remove resin or traditional cements, as well as saliva and red blood cells to produce a super pristine surface.  

Did you ever wonder how Ivoclean works to get rid of saliva and all the other debris that gets on the inside of a ceramic restoration or metal base?  

Intraoral contaminants contain lots of phosphates. Ivoclean contains suspended zirconia particles that have an affinity for phosphates. The zirconia particles pull towards them the phosphate-laden particles, so when you rinse off the Ivoclean, the intraoral debris is rinsed away leaving a clean surface. 

Note: We don’t want to expose zirconia restorations to something that contains phosphates or includes phosphoric on the label because there is a strong attraction at an elemental level between zirconia and phosphate particles. To neutralize the ionic bond between saliva phosphates and zirconia, we need an alkaline solution such as potassium hydroxide (KOH). This is the active ingredient in products such as ZirClean from BISCO. 

Related Course

Worn Dentition: Direct & Indirect Adhesive Management Through a Non-Invasive Approach

DATE: October 24 2025 @ 8:00 am - October 25 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 15

Dentist Tuition : $ 2595

Single Occupancy with Ensuite Private Bath (per night): $ 345

Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

Learn More>

About Author

User Image
Lee Ann Brady

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

A History of the Pankey-Mann-Schuyler Method

February 19, 2024 Bill Davis

A History of the Pankey-Mann-Schuyler Method 

By Bill Davis 

During his three-month summer course at Northwestern University in 1931, L.D. Pankey was introduced to the principles of occlusion. This was a new term for him and many of his dentist colleagues. The students were assigned an article by Clyde Schuyler and published in the 1926 New York Dental Journal. Dr. Schuyler was a promenade prosthodontist from New York City. The article talked about the basic principles of occlusal function, its dysfunction (malocclusion), and the basic requirements for restoring occlusal harmony. 

1931: Dr. Clyde Schuyler Prompts Considerable Thinking 

At first, L.D. did not understand what Dr. Schuyler had written. He was not alone because most of his classmates had the same problem. L.D. eventually made personal contact with Dr. Schuyler and, after a series of conversations, understood Schuyler’s work.  

Schuyler told L.D., “Those in the field of dental reconstruction must have and cultivate the creative mind of the artist and the accuracy of the engineer.”  

That was easy for Schuyler to say, but he did not explain to L.D. how to approach and visualize a dental reconstruction. Before L.D. met Dr. Schuyler, he had restored posterior occlusion using a Munson articulator and a chew-in technique. The Schuyler article pointed out the importance of anterior teeth guidance. This made L.D. start thinking about approaching occlusion in a more logical step-by-step manner. 

1947: Dr. Arvin Mann Looks Up Dr. L.D. Pankey 

In 1947, Arvin W. Mann moved to Ft. Lauderdale from Birmingham, Alabama. Dr. Mann had graduated from Western Reserve and moved to Alabama to do nutritional research at the University of Alabama before he moved to Florida. L.D. also had an interest in nutrition. His first published article in the Florida State Dental Journal was related to the connection between carbohydrates and dental decay. 

While in Alabama, Arvin became interested in occlusal rehabilitation and the relationship between periodontal disease and restorative dentistry. A periodontal faculty member told Arvin, “When you get to Florida and want to do a restorative work where you won’t have to do all this grinding to correct occlusal restorations, look up Dr. L. D. Pankey in Coral Gables.” 

As soon as Arvin got to Florida, he went to Coral Gables to meet L.D. They became fast friends because they realized they had the same goal of helping their patients keep their teeth for their lifetime. Over the next ten years, they worked together to develop a predictable diagnostic and treatment method for restoring patients’ teeth to health, comfort, function, and esthetics that would fit into the Philosophy of doing their best to help patients keep their teeth. 

1947: Drs. Mann and Pankey Begin Collaborating on Cases 

Arvin began bringing a set of mounted diagnostic casts and an intraoral series of radiographs to L.D.’s office. Arvin and L.D. would review the case together and develop an optimum treatment plan. L.D. would then present the case to Arvin using Arvin as the patient. This was a way to demonstrate to Arvin how to use the Philosophy, get to know the patient, explain what needed to be done, and educate patients to accept the treatment plan.  

Arvin would practice the presentation on L.D. He would then return to his office and explain the treatment plan to his patient. When the dentistry was finished, Arvin would have another appointment to “resell” the case to the patient and make them a missionary for his practice. Within a short time, Arvin had a busy and successful practice. Arvin eventually helped four young dentists from outside his office like L.D. had helped him.  

Mann and Pankey Replace the Munson Articulator with the P-M Articulator 

They used L.D.’s Munson articulators when they started working together on their new restorative method. But soon, they found Munson articulators had limitations for their 3-dimensional approach, including a functionally generated path. Along with an engineer from the Ney Gold company, they designed their own — the P-M instrument and face-bow.  

Arvin became excited about their restorative technique and wanted to share this information with the profession at a Chicago Mid-Winter Dental Meeting. L.D. felt that it would be best to work with a small select group of dentists interested in occlusion and comprehensive restorative dentistry. By now, L.D. had been teaching the Philosophy for a few years.  

L.D. and Arvin selected eleven dentists from various geographical locations around the country who had taken the Philosophy course at least three times and were already using a conventional method to do restorative dentistry. They asked them to try the new P-M technique and articulator for a year. At the end of the year, the group got together in Dallas. The reports from the eleven dentists at the meeting were positive and gratifying. L.D. and Arvin then started the Occlusal Rehabilitation Seminars to teach other dentists the P-M technique and how to use their articulator and face bow.  

1959: The P-M Method Is Presented to the AARD 

In 1959, they presented the P-M therapeutic method to the American Academy of Restorative Dentistry at the Chicago Mid-Winter. They were then asked to write up two articles describing their new process showing the use of the P-M articulator for publication in the 1960 Journal of Prosthodontic Dentistry 

1960: The Occlusal Rehabilitation Seminars Begin 

Arvin and L.D. wrote the Pankey-Mann Manual for the Occlusal Rehabilitation Seminars and started teaching the restorative technique to other interested dentists. The seminar schedule was coordinated by L.D.’s long-time secretary, Rose Quick.  

One of the most significant difficulties in teaching the P-M technique was the inability of dentists to understand occlusion. At that time, no dental school in the United States taught occlusion. L.D. and Arvin realized it was essential to have Dr. Clyde Schuyler present his work on occlusion at their seminars. Also, they did not want Clyde to go to his grave without the profession appreciating his contribution to dentistry.  

L.D. asked Clyde if he would help them teach occlusion. Clyde was reluctant because he anticipated much opposition to this new method and articulator. Also, he didn’t want to upset his friends and colleagues who had authored books or conducted clinics with him about occlusion. 

Eventually, Clyde agreed, and from that point forward, the P-M technique became the Pankey-Mann-Schuyler Technique for Oral Rehabilitation. 

 

 

Related Course

Creating Financial Freedom

DATE: March 6 2025 @ 8:00 am - March 8 2025 @ 2:00 pm

Location: The Pankey Institute

CE HOURS: 16

Dentist Tuition: $ 2795

Single Occupancy with Ensuite Private Bath (per night): $ 345

Achieving Financial Freedom is Within Your Reach!   Would you like to have less fear, confusion and/or frustration around any aspect of working with money in your life, work, or when…

Learn More>

About Author

User Image
Bill Davis

William J. Davis DDS, MS is practicing dentist and a Professor at the University of Toledo in the College Of Medicine. He has been directing a hospital based General Practice Residency for past 40 years. Formal education at Marquette, Sloan Kettering Michigan, the Pankey Institute and Northwestern. In 1987 he co-authored a book with Dr. L.D. Pankey, “A Philosophy of the Practice of Dentistry”. Bill has been married to his wife, Pamela, for 50 years. They have three adult sons and four grandchildren. When not practicing dentistry he teaches flying.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Restorative Notes on Bonding to Sclerotic Dentin and Removing All-Ceramic Crowns

February 7, 2024 Lee Ann Brady

Restorative Notes on Bonding to Sclerotic Dentin and Removing All-Ceramic Crowns 

By Lee Ann Brady, DMD 

Bonding to Sclerotic Dentin 

Bonding to sclerotic dentin is difficult, if not close to impossible. If the lion’s share of the tooth’s surface is sclerotic, you may not have the longevity that you’re hoping for. I’m specifically thinking of some lower anterior restorative cases I’ve seen over the years, where the veneers just haven’t held up and we’ve had to go to full coverage. 

I don’t trust some of the self-etching adhesives to result in a strong bond on sclerotic dentin, even the newer ones in the eighth generation. Fortunately, one thing we don’t need to worry about is sensitivity because the dental tubules are closed. Since I’m not worried about sensitivity, I can apply the same techniques I would with enamel with the intent of improving the probability of a strong bond. I can do a light prep, get rid of the sclerotic surface, and etch it with phosphoric acid for 25 or 30 seconds. Alternatively, I can use 30- to 50-micron aluminum oxide in an abrasion unit.  

Removing All-Ceramic Crowns 

Removing dental crowns can be a delicate and time-consuming procedure. In a world of so many different materials, it’s helpful to have an idea of which bur to use and how long removing the crown could take. One of the biggest challenges is determining whether a crown is a lithium disilicate or zirconia restoration. The radiograph and visual inspection will give us clues but afterwards, we must go through a process to understand what may be involved. 

Our First Clue: Zirconia looks like metal on a radiograph, and lithium disilicate looks radiolucent like natural tooth structure.   

Our Second Clue: If the crown is partial coverage, it’s much more likely to be bonded and I plan to prep down the entire restoration.  

Lithium disilicate restorations are often easier to cut through or section but they could be bonded and impossible to remove in pieces. Even if we can cut four pieces, we may have extensive prepping to do.  

On the other hand, zirconia can be harder to cut through, especially the 3y or 4y variety. But at least once you get to the cement layer, you can normally break it into pieces and remove them instead of having to extensively prep the entire tooth.  

If the restoration is full coverage, I can easily remove it in sections. In this case, I attempt to make my cuts all the way from buccal to lingual across the occlusal surface without bothering to stop. At this stage, I can pick up a crown remover and apply some general pressure to crack it off. If the crown is not budging at all, I assume it is bonded to the tooth, and the next thing I do is pick up a big flat-top diamond to do my occlusal reduction as if I were prepping a natural tooth. Once all the occlusal is off the glass, the pieces on the buccal, lingual, and interproximal fall off. 

 

Related Course

Worn Dentition: Direct & Indirect Adhesive Management Through a Non-Invasive Approach

DATE: October 24 2025 @ 8:00 am - October 25 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 15

Dentist Tuition : $ 2595

Single Occupancy with Ensuite Private Bath (per night): $ 345

Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

Learn More>

About Author

User Image
Lee Ann Brady

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR