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2013
Case #4 with Dr. Darin O’Bryan
A teenaged female patient presented
with a missing lateral incisor (Fig.
11). The patient will undergo implant
therapy when she is done developing,
but wanted a better option than a plastic
flipper to get her through the next two
to three years while she is waiting for
completion of her skeletal growth.
Several options were considered, and
the treatment plan chosen was to make
off-label use of the IPS e.max bridge.
A single-unit design with an inter-
proximal wing connector was fabri-
cated. Incisal characterizations were
imparted using Ceram Incisal, and
the restoration was glazed, fired, and
finished and polished with diamond
burs. The bridge was bonded in place,
and for a high-school student, this was
a much better esthetic option (Fig. 12).
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J u l i a n i
Case #5 with
Dr. Gregory Bennett
A male patient presented with a
broken Maryland bridge (Figs. 13-14).
The patient also did not like the
color mismatch of the old restora-
tion or the short height of its gingival
zenith. The patient was not a candi-
date for implants, so after weighing
the options, a treatment plan was
proposed for off-label use of the IPS
e.max bridge material to create a
replacement Maryland bridge.
The Omnicam 4.05 was used to
obtain intraoral images of the old resto-
ration, but the CAD software offered
strange proposals. To get a better
image, an impression was taken of the
old bridge, and the patient was sent
home for the day with a temporary.
Using a stone model made from the
impression, the desired pontic shape
and size were created by scraping
some of the stone away. Extraoral
imaging was completed, and the soft-
ware created an excellent proposal.
The restoration was milled with
CEREC InLab.
At the second appointment, the
bridge was already crystallized, which
allowed time for custom character-
ization. The restoration was glazed,
fired, and finished and polished with
diamond burs, and cemented in place.
The patient was very pleased with the
results (Figs. 15-16), especially after
enduring multiple opaque and short,
PFM-type restorations.
Fig. 11: Preoperative view of a missing
lateral incisor
Fig. 12: Postoperative view demonstrat-
ing the esthetic, off-label use of the IPS
e.max bridge block restoration.
Figs. 13-14: Preoperative views of
a broken Maryland bridge, color
mismatch of the old restoration and
short height of its gingival zenith.
Figs. 15-16: Postoperative view with
enhanced esthetics of the off-label
IPS e.max bridge block restoration
Conclusion
These cases are great examples of
traditional and innovative uses of the
IPS e.max CAD system, and the new
bridge blocks in particular. In the age of
minimally invasive and highly esthetic
dentistry, it is our responsibility to
deliver to our patients not only strong
but beautiful restorations that promote
oral health. IPS e.max and CEREC allow
us to do this not only effectively, but
quickly. This means that we can do what
we love to do and help our patients in
profitable and efficient ways.
For questions and more information,
Dr. Juliani can be reached at
References
1 ChristensenGJ. The Confusing array of tooth-colored
crowns. J AmDent Assoc 2003;139(9):1253-5.
2 Small B. The use of cast gold restorations: scientific basis
and clinical technique. Dent Today 2000;19(11):42-9.
3 Cattaneo S, CastroMA, Castro JM, et al. Misfit profile of
dental bridges. Acta Odontol Latinoam2012;25(1):53-8.
4 Della Bona A, Kelly RJ. The clinical success of all-
ceramic restorations. J AmDent Assoc 2008;139
(Suppl 4):8S-13S.
5 McLarenEA. CAD/CAMdental technology:
a perspective on its evolution and status. Compendium
2011;32(4):2-6.
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