quarter 4
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2012
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cerecdoctors.com
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55
Gary Templeman | Corvallis, Ore.
In response to Michael Scoles:
I am with you that
this is a tooth [for which] I would not have done
a build-up. Pure adhesive bonding just to get the prep pret-
tier has no *clinical* benefit, as the bond will be no stronger
than the bond of the ceramic to the tooth will be. In addi-
tion, ceramics are good insulators (think space-shuttle tiles)
so the concept of a separate layer for thermal protection is
no longer a consideration. As an aside, Bertolotti said, when
bonded, even deep amalgams did not need a thermal insu-
lating layer. A build-up when doing gold saves on the lab fee
and, if the build-up is mechanically retained in addition to
the bond, will add to the retention and resistance form. The
ceramic restorations generally do not need traditional reten-
tion and resistance form, so why make an effort to add it?
If a crown like this debonds, it is just as likely to bring the
build-up with it.
Edit: From what I recall from Christensen, he also did
not consider filling in a few “pot holes” as a build-up, only
when a substantial amount of missing tooth was replaced
by the core.
In response to Michael Scoles:
Thin, thick, wide,
narrow, short, tall … it’s whatever fits whatever
criteria needed toprovide the best dental healthcare possible.
Granted, not all situations are similar. That’s why I always
leave options to give the best results possible. I guess I’m
saying, I try not to do cookie-cutter dentistry. Each patient,
each case, is taken individually, build-ups or no build-ups.
Loyd Dowd
I feel that a resin build-up has more potential
to flex and debond, whereas porcelain is stiffer
and less likely to debond. With today’s bond strengths and a
couple of millimeters of ferule, I seldom ever have anything
debond.
Ray Kessler | Charlotte, N.C.
A couple of thoughts: I rarely do build-ups under
e.max or zirconia and let the resin cement fill
in the holes. With feldspar ceramic, I try to get a nicely
smoothed and even surface to give it support and strength.
Thomas Kauffman
With no disrespect intended, all of the comments
and attitudes and philosophy to explain treatment
on this thread boil down to no more than, “I do this because it
makes sense tome.” That is either a reflection of our collective
lack of knowledge or a reflection of the fact that our current
basis for guiding our choices is not adequate.
John Pappas | Phoenix
In response to S. Michael Roussel:
Frank Spear still
recommends build-ups for the same reason. [He]
lectures that porcelain does well in compression and not so
well with shear forces, so build-up to support porcelain.
Charles LoGiudice | Geneseo, Ill.
IMO, when there is tooth structure under our porce-
lain, it is supported. I have had one restoration that
had some unsupported porcelain fracture away since I’ve been
doingCEREC. Itwas anEmpressCADcrown thatwas proposed
with a bulbous area on the DL cusp that I failed to reduce (as
the software has improved, this happens a lot less frequently
than it used to). The patient didn’t want the crown replaced, so
I smoothed it off and polished it. It is still in the patient’s mouth.
I don’t care if someone else thinks my preps look sh---y. I want
my margins/shoulders to be as smooth and flowing as I can get
them, and I round off all the sharp edges and corners. If I place a
build-up or liner, I feel I am reducing the amount of surface area
I can bond to. When I heard Gordon say that we should place
build-ups sowe have a known, consistent thickness of ceramic in
our restorations to make them easier to cut off. I see less plaque
adhering to my CEREC restorations than I do to metal or PFM
restorations, and I feel this contributes to less recurrent decay
problems I amseeing aroundmyCEREC restorations.
Thomas Kauffman
The reality is that there is a lot of empiric decision
making out there regarding treatment, and some-
times it lacks the critical thinking appropriate for the current
materials and techniques we are using. Just asking questions;
how ’bout some answers. It seems that e.max has significantly
changed the playing field, and not sure the same rules apply, or
if anyone really knows. I cannot recall ever splitting a crown
and trying to remove it and having the tooth fracture as some
have reported with e.max and resin cement.
Brent R. Browning