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o ’ b rya n
is then completed with simultaneous
designing of the restorations (Fig. 6).
The restorations were milled and a
trial fit was done (Figs. 7-8). Adjustments
were made on the composite inlays with
the medium soft flex disc (3M ESPE).
The e.max crown was then glazed
and crystallized. While the crown was
being crystallized, the two inlays were
cemented into place. Note: if you find
that the contacts are a little tight when
you try in an un-crystallized crown, they
can be polished with the fine and super-
fine soft flex discs which will create a
contact that is just right once the resto-
ration is glazed.
The Isolite was again placed in position
to control moisture during the cemen-
tation process. The preparations were
cleaned with Consepsis (Ultradent) for
oneminute toremoveanyresidual powder
and to also disinfect the preparation.
XTR bonding system (Kerr) was applied
per the manufacturer recommenda-
tions and the Lava inlays were cemented
with NX3 cement (Kerr) applied directly
into the preparations with an endo tip.
The cement was allowed to reach its gel
stage and the excess was removed. A final
cure of the material for 30 seconds was
performed (Fig. 9).
Once the restorations were seated, the
proximal margins could be finished and
polished directly since the adjacent tooth
is no longer in the way while the crown
was being crystallized. This was done
with finishing diamonds or carbides
on the gingival margin and soft flex discs
for the proximal margins utilizing only
the medium, fine and super-fine grits.
The occlusion can also be adjusted at
this time.
Once the e.max was done firing
and cooling, it was ready to prepare
for cementation. The object fix putty
(
Ivoclar-Vivadent) residue was removed
from the inside of the restoration with
a Danville micro etcher. The crown was
fitted oncemore to verify the glazewould
7
8
Fig: 7: The restoration’s dry try-in.
Fig. 8: Buccal view of the dry try-in.
Fig: 9: The 3M LAVA Ultimate inlays
cemented while e.max is being
crystallized.
Figs. 10 and 11: Final view of the seated
restorations.
not cause a bind at seating. The resto-
ration was then etched for 20 seconds
with 5 percent HFL acid. The Isolite
was placed and the preparation cleansed
with Consepsis. XTR bonding system
was used per the manufacturer recom-
mendations and the restoration seated
with the NX3 cement placed inside the
crown prior to being handed to the clini-
cian. The cement was allowed to gel and
the excess removed. The contacts were
flossed and a final curing of 30 seconds
was performed. The occlusion was
checked one more time and, after adjust-
ments were made, the restorations were
polished with Diashine fine diamond
paste (Figs. 10-11).
The final result: three restorations
completed with minimal down time due
to piggy-backing the cementation and
finishing time of the composites, coordi-
nated with the firing time of the e.max.
The design also utilizes the preopera-
tive condition to help align the Bioge-
neric Individual proposal with the rest
of the quadrant. Timing and planning
of clinical cases to take into account the
multiple materials and actually utilizing
windows of downtime during a proce-
dure can lead to efficient dentistry,
happy one-appointment patients and a
low-stress doctor and team!
For questions and more information,
Dr. O’Bryan can be reached at
drobryan@onemorereasontosmile.com.