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cerecdoctors.com
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2013
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o ’ b rya n
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At the lab, the technician was able
to upload my Biocopy images to have a
working model of what the final product
needed to look like (Fig. 19). This
Biocopy was able to be placed over the
preparations and made transparent to
visualize the relationship of the prepa-
rations to the final restorations (Fig.
20). To aid in the design process, the
smile design feature was utilized. This
allows the clinician or the lab to import
a patient’s photo into the CEREC soft-
ware. The photo allows the clinician or
the lab to visualize how the final restora-
tions will look in relation to the lip and
the inter-pupillary line (Fig. 21). After
the shape was finalized, the incisal vari-
ation tool was used to create a uniform
cut back on the restorations (Fig. 22).
The restorations were then milled out
of B1 LT e.max. The cut-back area was
then fine tuned and characterized with
incisal ceramic. The restorations were
polished to give the desired luster and
finish.
The patient then returned for the
insert of the final restorations. The
patient was anesthetized and the tempo-
raries were removed. The preparations
were cleaned with Consepsis and the
restorations tried in. Fit of the restora-
tions was excellent. On the maxillary
centrals, the patient was not 100%happy
with the angulation after adjusting, so
we replaced the temporaries and sent
those back to the lab with photos to
show what the patient wanted changed.
The lowers she was happy with, so we
cemented the lower six anterior teeth
with XTR/NX3.
After a phone consultation with the
technician, we were able to make the
changes and the restorations were sent
back for evaluation and final placement.
The patient was again anesthetized
and the temporaries were removed.
The preparations were cleaned with
Consepsis and the restorations tried in.
I then left the patient to evaluate the
restorations for a good 15-20 minutes
to make sure she was happy with the
esthetics. After we got the OK, I then
bonded them into place with XTR/NX3
(Fig. 23).
By utilizing the smile design software
and long-term temporaries, it is very
predictable to have a good esthetic and
functional result. The amount of inci-
sors showing and the relationship to the
lower lip is very esthetic (Fig. 24). There
were also no phonetic changes due to
the therapy.
conclusion
A partnership with a good lab is neces-
sary for cases that you don’t want to do
yourself. This case not only needed the
esthetics of cut back and layering, but
Fig. 21: Cut-backs
Fig. 22: CEREC smile design
Fig. 23: Final restorations
Fig. 24: Final smile
also the patient did not want to have a
long appointment. As clinicians and
business owners, we have to weigh the
time it takes to do a procedure against
what else we could do in that time
frame. In the time it would take me to do
a 12-unit case and do the cut back and
layering, I can produce more dentistry
than the lab fee associated with it. Also,
the cut back and layering of a trained
ceramist is going to be much nicer than
most clinicians are going to be able to do.
For these kinds of cases, a combination
of chairside and lab-fabricated restora-
tions make for an easier workflow and
more predictable result.
For questions and more information,
Dr. O’Bryan can be reached at
