Page 16 - CEREC Q1 | 2014

14 | CERECDOCTORS.COM | QUARTER 1 | 2014
CLINICAL CASE
A 41-year-old male presents with a
failing composite restoration. It is
cracked and has stains at the margin.
The failing restoration, seen in Figure 5,
was removed, decay excavated, prepara-
tion was finished. Since the final resto-
ration was to be an inlay, undercuts
were removed prior to the imaging with
the Omnicam. In some instances, a liner
material was used for the small defects
that occur in some preparations.
Margins are identified and inser-
tion axis set for the case, as can be
seen in Figure 6. The design choice
was Biogeneric, allowing for fast and
easy designing. Design was sent to the
MCXL milling chamber, and I attended
to other patients during the quick mill.
For inlays, many times the sprue is on
the interproximal surface, so that was
removed and restoration placed into the
preparation. Occlusion was checked and
adjusted.
Since the material used was Lava
Ultimate, I now took the time to deepen
the grooves and augment the anatomy.
Medium and fine small flames and
round burs in a high-speed handpiece
perform the job very efficiently. The
adjacent teeth are used as a guide to
ensure the restoration fits in with what
is present in the patient. With a ceramic,
Iwouldhave toplace additional anatomy
with stain and glaze; instead, I am able
to do it as it occurs naturally, by
increasing the grooves and ridges. I
don’t have to be an illusionist; I can be a
naturalist, mimicking what was origi-
nally there. The result can be seen in
Figure 7.
To ease in the handling of this small
restoration, I attached a microbrush
to the Lava Ultimate with liquid refer-
ence as seen in Figure 8. This allows
the dentist to control the restoration,
decreasing the chance it will be dropped.
The restoration was air-abraded and
Scotchbond Universal was applied.
Fig. 5: Pre-op photo of failing restorations
Fig. 6: Omnicam screenshot of preparation
Fig. 7: Restoration after anatomy
enhancement
Fig. 8: Restoration after air abrading
Fig. 9: Selective etching of enamel
Fig. 10: Final restoration
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7
8
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Figure 9 shows how the enamel was
selectively etched with phosphoric acid
for 20 seconds, and rinsed and dried.
Scotchbond Universal was scrubbed
into the tooth for 20 seconds and then
air-thinned for 15 seconds until no
movement was seen. Rely-X Ultimate
was then applied into the preparation
and the restoration seated. Excess was
wiped off with a microbrush, then a blue
phase curing light was used to tack-cure
the cement to allow complete cleaning
of cement.
The appropriate steps were taken
to clean off the excess cement, and the
restoration received a final polish. Axis
polishing wheels, Softlex spiral disks,
Robinson brush with Hybrite polishing
paste were used, followed by a rag wheel
to give the restoration a high luster as
seen in Figure 10.
CONCLUSION
To answer the questions asked at the
start: No, we are no longer locked into
using a brittle material that limits the
anatomy we can carve into the restora-
tion. These older materials have served
us very well over the past few years, but
they do require stain and glaze and the
associated oven time.
These newer hybrid materials have
physical properties that allow us to
re-evaluate how we can approach
esthetics. The criticism that they are
un-esthetic because they can’t be
fired (therefore limiting staining and
glazing) really has no grounds. We
can approach the esthetic demands of
the case by selecting the appropriate
shade and translucency, using a prepa-
ration that allows us to gain the effect
desired from the dentin, and enhancing
the anatomy so the light reflects in a
natural way.
For questions or more information,
Dr. Gardell can be reached at
Drpeteg@aol.com.
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