Page 31 - CEREC Q3|2013

quarter 4 | 2013 | cerecdoctors.com | 29
Case #3 with Dr. Daniel Nguyen
A 66-year-old male patient presented
with a previously placed PFMthree-unit
bridge on teeth #6-8 (Fig. 8). The patient
had recurrent decay and an openmargin
on abutment tooth #6, and an esthetic
complaint about the retainer crown on
tooth #8 appearing longer than tooth #9.
Atreatmentplanwasproposedtoreplace
the old bridge with a full-contour IPS
e.max bridge.
The patient’s occlusion was not ideal,
Fig. 8: Preoperative view of patient’s
previously placed PFM three-unit
bridge on teeth #6-8
Fig. 9: To gain more bulk on the connec-
tor without gross over-contouring of
the embrasures, an anatomic connec-
tor design was chosen
Fig. 10: The new bridge blends seamlessly
with the patient’s natural teeth, and
his smile is greatly improved
Case #2 with Dr. Juliani
A91-year-oldmalepatientpresentedwith
a vertical fracture in tooth #9 (Figs. 4-5).
After discussing and weighing all treat-
ment options — including a removable
partial denture, Maryland bridge, tradi-
tional bridge and implant reconstruction
— the patient decided to have the tooth
extracted and a traditional fixed partial
denture (bridge) placed. The tooth was
extracted, and teeth #8 and #10 were
prepared for the fixed partial denture.
After 12 weeks of healing, the patient
returned for his final preparations and
chairside CEREC bridge.
The shade was determined, and both
preparations were finalized for the
IPS e-max bridge restoration. After all
images were captured, the bridge was
designed using the CEREC inLab version
4.02. When designing an anterior or
posterior bridge, careful consideration
must be given to the connectors. Ivoclar
Vivadent recommends a 16-mm-square
connector for both anterior and posterior
bridges, and studies have shown a nearly
100 percent, five-year success rate with
12-mm-square anterior connectors.
After design was completed, the resto-
ration was milled in a CEREC MCXL
milling chamber (stackmill at 21 minutes)
with a 40 mm IPS e.max bridge block
LT shade A3. The restoration was then
stained, glazed and fired in the Programat
oven on cycle P1. After final try-in (Fig. 6),
the restoration was bonded with Multi-
link Next Generation according to manu-
facturing specifications (Fig. 7).
Fig. 4: Preoperative view of the fractured
tooth #9
Fig. 5: Radiograph of the fractured root
Fig. 6: After milling, the IPS e.max bridge
restoration was tried in
Fig. 7: Postoperative view of IPS e.max
bridge restoration
but the old bridge showed very little
wear, so a Biocopy design was used
to duplicate the anatomy of the
bridge. During design, an intersection
connector was chosen first for the new
bridge, buildingupon theBiocopy image.
To gain more bulk on the connector
without gross over-contouring of the
embrasures, an anatomic connector
design was chosen (Fig. 9).
After milling, the HT-A2 IPS e.max
bridge was supported with putty and
crystallized. Characterizations were
then performed using IPS e.max
Shades and Essences. The bridge was
glazed and fired, then finished and
polished with diamond burs. Using
the total-etch technique, the bridge
was then cemented in place with
ScotchBond Universal and translu-
cent Rely-X Veneer Cement. The new
bridge blends seamlessly with the
patient’s natural teeth, and his smile
is greatly improved (Fig. 10).
4 5
6
7
8
9
10