Page 38 - CEREC Q3|2013

36 | cerecdoctors.com | quarter 4 | 2013
with a Microbrush. The temporary
materialwas allowed togel, and thenwas
removed to prevent locking it into place.
The temporary matrix with the acrylic
in a flexible state was then replaced on
the teeth and made sure to seat all the
way. Temporary acrylic contracts as it
sets; therefore, if the temporaries are left
off the teeth too long, then the material
can contract to the point where it won’t
seat. The flip side to this is if you leave
the material on the teeth too long it can
get locked into place as the material will
contract into undercuts.
After the temporary material has
hardened, it is adjusted with a combi-
nation of finishing burs and soft-flex
discs. After it has been adjusted and the
margins refined, it is tried in the mouth
again. Any areas around the margin that
are deficient are then added too; this is
done by sandblasting the internal aspect
and applying bonding agent to the inta-
glio surface of the temporaries. Flow-
able composite is then placed around
the margins of the teeth that correspond
to the temporaries with short margins.
The temporary is then seated and the
composite cured. It is vital to make
sure you do not have undercuts in the
preparations in these areas, otherwise
the temporary can crack upon trying to
remove it. After the composite is cured,
the temporaries are removed and the
margins refined again. They are then
cemented into place with TempBond
Clear (Fig. 12). The occlusion is only
adjusted a minor amount at this point,
since the maxillary will be prepared in
the next few days.
The patient returns a few days later
for the maxillary teeth to be prepared.
The same process for preparation was
done. For this set of temporaries, an indi-
rect method was used. After preparation
an alginate impression was taken and
poured up in Mach 2 silicone (Fig. 13).
The model was then lubricated to make
sure nothing adhered to the prepara-
tions. The matrix with the composite
facings was filled with temporary mate-
rial and seated on the model (Fig. 14).
Once it had reached a gel state, it was
removed to ensure no binding. It was
then taken on and off the model to make
sure it had draw (Fig. 15). The tempo-
raries were then trimmed andmade sure
to fit passively on the model (Fig. 16).
Once the maxillary and mandibular
teeth were prepared and temporized,
the occlusion was equilibrated. The
patient was then seen back at the one-
week mark to evaluate the occlusion
(Fig. 17). The different shades of tempo-
rary material were for the patient to
evaluate which shade she wanted to go
with. She went with the lighter shade on
the maxillary.
Now that the occlusion was dialed in,
we can start the final restorations in the
posterior. The patient requested to not
be in the chair for too long a time period
in one sitting, so we broke the posterior
teeth into quadrants. We scheduled the
patient every Monday afternoon for
four weeks at three hours per appoint-
ment. The quadrants were broken down
further by doing two teeth at a time in a
modified Sarmen technique. The molars
were imaged, and then the temporaries
| | | o ’ b rya n
12
13
14
15
16
17
Fig. 12: Mandibular provisionals
Fig. 13: Mach 2 maxillary model
Fig. 14: Maxillary shell
Fig. 15: Maxillary shell off model
Fig. 16: Refined maxillary shell
Fig. 17: Maxillary provisionals