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44 | CERECDOCTORS.COM | QUARTER 1 | 2014
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retraction cords were removed, and
a full-arch PVS impression (Kerr)
was made of the maxilla to fabricate a
working model for the laboratory tech-
nician and to allow for marginal cross-
verification of the milled restorations.
The full-arch maxillary Omnicam
scan, along with the Biocopy scan of the
chairside provisional, were then used
to design milled CADpro Temps. These
proprietary temporary restorations
provided by Jurim Dental Studio are
ideal for long-term provisionalization.
They are made using an industrially
produced PMMA of incredible strength
and esthetic, and can be milled — in this
case with Sirona’s inLab MC XL milling
unit. With the margins marked on each
tooth preparation by the operator,
Jurim Dental Studio’s CAD/CAM team
was able to use the Biocopy scan to aid
in the design of the CADpro Temps to
ensure they best mimicked the desired
esthetics and occlusion worked out in
the patient’s chairside provisionals.
The superior-fitting individual CADpro
Temps were then milled and finished by
Jurim Dental Studio, and inserted using
TelioCS cement (Ivoclar) (Fig. 7).
While fabrication of CADpro Temps
may seemlike an added treatment step, it
has some tremendous benefits. First off,
the delivery of each individual CADpro
Temps unit allows for verification that
the margin marking on each tooth in the
Omnicam scan is accurate (Fig. 8). If any
inadequacies are identified, the correc-
tions to the margin marking can be
made prior to milling of the final resto-
rations. The occlusion and esthetics of
the digital design of each restoration
can also be evaluated, and any neces-
sary adjustments can be made prior to
the final milling. Lastly, delivery of the
well-fitting, milled provisional CADpro
Temps allowed for the gingival health to
improve tremendously prior to delivery
of the final restorations, ensuring ideal
conditions for insertion of the final case
(Fig. 9), not to mention certainly less
stress during the delivery appointment.
The patient wore her milled provi-
sionals for several weeks, verifying their
accuracy of the duplicated occlusion.
After confirmation that she was func-
tioning with complete comfort and that
she achieved emotional closure with the
esthetics of her CADpro Temps smile,
the remaining treatment of milling
and delivering the final units was both
predictable and easy. The maxilla was
restored first. The design of the CADpro
Temps in Sirona’s 4.0-level inLab soft-
ware allowed for the change of mate-
rial to IPS e.maxCAD (Ivoclar). Prior
to milling, any minor marginal changes
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Fig. 7: CADpro Temps smile
Fig. 8: Margin marking evaluation with
CADpro Temps
Fig. 9: Improved tissue health following
provisionalization with CADpro Temps
Fig. 10: Maxillary final IPS e.max CAD
restorations cutback and fired
Fig. 11: Maxillary final IPS e.max CAD
restorations with anterior
characterization
were made to the case, and the final
design was updated. Virtual cutbacks
of the anterior facial esthetic zone were
added to allow the skilled laboratory
technician to artistically overlay IPS
e.max Ceramic veneering porcelain
(Ivoclar) to customize the cosmetics of
her smile (Figs. 10-11).
Try-in of the final units with a
disclosing medium (GC Fitchecker)
revealed excellent marginal fit and
seal, and the patient was very pleased
with the esthetics. With the patient’s
consent, the maxillary units were
cleaned for 20 seconds using Ivoclean
(Ivoclar), then silanated with Mono-
bond (Ivoclar) and delivered using
Multilink (Ivoclar) as per the manufac-
turer’s instruction. All excess cement
was meticulously removed, and any
necessary occlusal adjustments to
ensure an anterior guidance scheme
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