Page 30 - CEREC Q3|2013

28 | cerecdoctors.com | quarter 3 | 2013
this article demonstrates how
digital scanning technology and IPS e.max
CAD lithium disilicate greatly simplify
what was once a challenging restorative
procedure for dental professionals.
In this case, a 24-year-old male
presented with a maxillary lateral incisor
that fractured during a basketball game.
A treatment plan was developed to restore
the tooth via root canal therapy,
insertingafiberpost, performing
a build-up, and placing a lithium
disilicate crown.
Modern technology not only
allowed all of these services
to be completed in-office —
saving time and laboratory
expenses — but also provided significant
advantages toward enabling a predict-
able esthetic outcome.
Among our “everyday dentistry” duties,
managing the immediate restoration of a
fractured front tooth can typically create
a challenge for most of us. Functionally
and esthetically, there are many details
to consider in planning and carrying out
such a case if it is to turn out well for our
patients. Some of these details involve
selecting an appropriate material that
will survive well overtime; developing
proper form and occlusion; harmonizing
and balancing shapes and line-angleswith
the contralateral side; and achieving the
proper value, chroma, surface texture and
subtle characterizations that will hope-
fully allowour final restoration to blend in
to the adjacent dentition.
Fortunately, the emerging
materials and technology
available today offer us
advantages that can make
Turning “Challenging”
Into “Predictable”
Technological, Material Advances Make Things More Manageable
c a s e s t u d y | | | b y M a r s h a l l H a n s o n , D . D . S .
our intended results more predictable,
and streamline the critical clinical steps
required to successfully complete this
type of case.
This case illustrates theuseof chairside
digital scanning technology, IPS e.max
CAD lithium disilicate, and an in-office
milling and firing process for fabricating
a strong and immediately customized
monolithic anterior restoration.4
Lithium Disilicate
Lithium disilicate is a glass ceramic
composed of 70 percent needle-like
lithium disilicate crystals in a glassy
matrix. This material is highly esthetic
and high-strength, making it a uniquely
versatile restorative option for use in
all areas of the mouth. Lithium disili-
cate features enhanced optical proper-
ties, ensuring a natural appearance, and
strength of 360 MPa throughout, for an
esthetic, monolithic restoration with
superior longevity.5
Case Presentation
The patient presented for a
focused examination regarding
his chief concern of a “broken
front tooth.” He described
receiving a blow to the mouth
by another player’s elbow
during a basketball game a
few days prior. He reported
“moderate sensitivity to air and cold,”
but no extreme pain or tenderness. He
expressed hope that something could be
done to save and restore his tooth.
Diagnosis
Upon clinical and radiographic evalu-
ation, the maxillary left lateral incisor
was found to be horizontally fractured,
with only about one-third of the clinical
crown remaining intact (Figs. 1-2). Fortu-
nately, there was sufficient remaining
tooth structure to create the necessary
preparation for treatment.
From the incisal view, the exposed
pulp chamber was visible. There were
no vertical fractures evident, and the
tooth tested surprisingly non-mobile
(Fig. 3). A localized periodontal exami-
nation revealed moderate gingivitis, with
healthy supporting alveolar bone, and
no “pocketing” beyond 3 mm. The tooth
tested vital and hypersensitive to cold
and air. The restorability of the tooth
Fig. 1: Preoperative view of the patient
Fig. 2: Retracted left lateral view of the
preoperative condition
Fig. 3: Close-up retracted occlusal view
of the preoperative condition
completed crown
1
2 3