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cerecdoctors.com
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quarter 4
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2012
designingmultiple restorations has
gotten easier with the arrival of CEREC
4.0.
The real challenge now is sequencing
the designing, milling, firing and cemen-
tation of multiple units for maximum
efficiency of chair time. This is especially
true when mixing dental materials. The
following case highlights the design of an
e.max crown on the upper-right second
bicuspid, and two Lava Ultimate inlays on
the adjacent first molar and first bicuspid.
With proper sequencing of restorations,
the clinician can leverage the firing times
and cementation to decrease both chair
time and the stress of finishing/polishing
the restorations.
CAD/CAM dentistry allows us to
deliver beautifully functional restora-
tions in one visit with a variety of mate-
rials. When patients need a number of
different procedures utilizing different
materials during a single visit, the chal-
lenge is how to maximize the clinician’s
efficiency. Using the proper protocols, the
clinician is able to shorten the chair time
and decrease the level of stress for both
the patient and the doctor.
The following case will illustrate how
to efficiently combine a crown with two
composite inlays in the same quadrant.
CASE STUDY
The patient is a 59-year-old female
smoker with no other medical condi-
tions of concern. The upper-right quad-
rant had old amalgams, secondary caries
and fractures present (Fig. 1). The case
also presented a common challenge in
that there were no opposing teeth for the
full-coverage restoration (Fig. 2). The
second bicuspid required
full coverage due to the size
of the existing restoration.
E.max (Ivoclar-Vivadent) was
planned for the full-coverage restoration
because of its extra strength. A mesial
occlusal inlay was planned for the first
molar due to interproximal caries and a
mesial occlusal distal inlay was planned
for the first bicuspid due to secondary
caries and a fracture on the mesial. Lava
Ultimate (3M ESPE) was decided upon
for its greater flexural strength and ability
to achieve a high polish.
Anesthesia was administered and the
buccal bite was taken. The Isolite was
then placed and the opposing teeth were
imaged. There are advantages to taking
the buccal bite right after administering
anesthesia: First, the patient is not yet
numb, so they have a better sense of
their “normal” bite; second, the patient’s
mouth has not been open for a prolonged
period, as that could lead to their muscles
being “deprogrammed” and causing an
inaccurate bite record; finally, it shortens
the appointment by giving you something
to do while anesthesia is setting in.
Prior to preparation of the teeth, an
upper Biogeneric Copy folder was added.
There was no eruption of the tooth into
the edentulous space, and capturing
the pre-operative morphology aids in
the design of the Biogeneric individual
crown later.
After anesthesia, the teeth were
prepared for their respective restora-
tions. The first molar was rotated so
that the mesial buccal line angle was
in contact with the second bicuspid. This
meant there was going to be a larger
lingual embrasure and a point contact.
The lingual cusp of the second bicuspid
showed some fractures past the height
1
2
Sequencing of Everyday Restorations for Efficiency
“
I Like Bread and Butter …”
C A S E S T U D Y
| | |
b y d a r i n o ’ b rya n , d . d . s .
Figs. 1 and 2: Pre-operative condition
of the patient’s dentition.
There are advantages
to taking the buccal
bite right after
administering
anesthesia … the patient
is not yet numb, so they
have a better sense of
their “normal” bite …
the mouth has not been
open for a prolonged
period, as that could
lead to muscles being
“
deprogrammed” and
causing an inaccurate
bite record.
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