54
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cerecdoctors.com
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quarter 4
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2012
Loyd Dowd | Tyler, Texas
I used to mill endo crowns with a built-in post
many years ago, but found that they split the root
on bicuspids almost 100 percent of the time. Didn’t have
any molars split though. Interestingly, I did mill a couple
of ceramic copings for an upper overdenture with built-in
posts that are still doing great 10 years later. I just altered
the proposals until I got a smooth, rounded dome and then
milled them. Used to do a lot of overdentures, but found that
many patients wouldn’t consistently put a drop of fluoride
gel in their denture every day to prevent decay so I ended up
removing a lot of roots. I like titanium roots far better and the
lazy patients don’t have to take care of them.
I still put build-ups on the treatment plan but most often
don’t need to do them. The patient thinks I’m wonderful
when I tell them it’s going to cost them $243 less to restore
that tooth.
Bradley Sutton
I think we’re all chomping at the bit to see some
artistry in motion. I’d love to see your preps! I
hope this isn’t coming across as confrontational, but we’re
all interested in what each other is doing on this site for our
patients, and I’d be interested in seeing what everyone thinks
is the standard that they hold themselves to when working.
Again, I am not trying to be a jerk here, and genuinely want
to see where we all stand on this issue.
Alex Botvinnik | Des Plaines, Ill.
In response to Marc Kaufman:
We use inLab set
to inlay/onlay to mill a post/core out of Lava. One
image to get the cavity plus prepped tooth. Once the milled
restoration is delivered, we reimage and design crown, busi-
ness as usual. Very good results so far, the fitment is perfect
in the canals.
FYI, we learned this technique from Armen in Scottsdale,
Ariz., probably Level 3. And you don’t need inLab for this,
but it’s all we use at this point.
Edit: We get about 5 posts from each Lava 14L block.
Marc Kaufman
I did this with chairside, fooling the Biocopy to
make a post using Lava Ultimate works great and
then bonding an e.max crown as a separate item— a trick my
trainer taught me.
Michael Scoles
In response to Bradley Sutton:
Brad, here is one
this morning. In my eyes, the money is on the
margin. Nice, smooth margin and with remotely adequate
retention, you are good to go. It looks like a wider-than-
normal shoulder interproximally; that’s because it had a
big-ass amalgam in it. Instead of placing a build-up to make
it look pretty, I strengthenedmy crown by having a big chunk
of e.max where the GI build-up would have gone. This isn’t
the case you show at your
study club, but I have
margins that margin-
ated without altering,
adequate retention and
good occlusal reduction.
attempt very retentive carpentry preparations, and was
taught to utilize multiple grooves, aka Schiilingberg et
al, bevels, offsets, etc. With the advent of high magnifica-
tion dentistry where the intracoronal tooth structure and
internal anatomy to the exterior surface of the cementum,
enamel or dentin, there are certainly limits to how “smooth”
we can ever get tooth structure. Most would, however, agree
that the smoothest we will ever get probably rests on enamel.
I could be wrong, but I do not recall a study that has shown
that the additional thickness that comes from a liner or base
of any material where restorative margins rest on enamel
with a resin bond increases the longevity of the restora-
tion or decreases the incidence of endodontic involvement
post-restoration.
We are forgetting that we now have the ability to change
the contours of the prepared tooth structure artificially
with the software that can impact the efficiencies of milling
smoothness. Additionally, I think most dental material and
biomedical researchers would indicate the increased success
in bond strength and decrease in tooth sensitivity are more
a factor of chemistry. The past theories of thermal insulation
from thick liners and bases as a requirement for a comfort-
able tooth and successful restorative result when amalgam
was the material of choice went out the window a long time
ago. So, I am left with the desire to have someone show me
the functional necessity of build-ups or liners with bonded
ceramics. That being absent, it seems most build-ups in the
instances being discussedwould not be necessary and should
be discontinued in spite of past habits.
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