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36 | CERECDOCTORS.COM | QUARTER 2 | 2014
Once proper reduction was confirmed
in all planes, I then completed the final
preparations (Figs. 8 and 9) and final
VPS impressions (Aquasil Ultra Heavy
and XLV, Dentsply-Caulk) were made of
the prepared maxillary and mandibular
teeth. Next, the putty/wash templates
were, once again, loaded with Bis-acryl
material (Structur 3, Voco) and seated
over the prepared teeth to create proto-
type provisional restorations. Last, VPS
impressions (Aquasil Ultra Heavy and
XLV, Dentsply-Caulk) were made of the
provisionals, which the patient wore for
a week while the permanent restora-
tions were being fabricated.
In the lab, the dual-arch final VPS
impressions of both the prepared teeth
and the final temporary prototype resto-
rations were then poured in scannable
die stone (Diamond Die, HiTec Dental
Products) and imaged in CEREC InLab
CAD/CAM software (Sirona).
Since the temporary prototype was
meticulously designed and functionally
tested, I utilized the Biocopy feature
of the software to duplicate the form
and function that was developed in the
provisional stage (Figs. 10 and 11). As
such, I felt very comfortable imaging and
virtually designing both arches simul-
taneously (Figs. 12 and 13). Both sets of
final casts (prepared teeth and provi-
sional) were then articulator-mounted
to positively verify that the occlusion
on the physical models matched exactly
with the results of the virtual buccal bite
software feature. This double-checking
ability added another layer of confidence
that the true occlusal scheme had been
accurately recreated by the software.
With all the necessary information
now in the software, the final smile
design was only slightly altered from the
Biocopy proposal to meet the patient’s
request for squarer, sharper incisal
edges (Figs. 14 and 15). All final resto-
rations were then milled in the MC XL
(Sirona) from low-translucency, shade
| | | E N F I N G E R
Fig. 7: Reduction template
Fig. 8: Final preparations, #4-13
Fig. 9: Final preparations, #21-29
Figs. 10-11: Biocopy overlay
Figs. 12-13: Preps with Biocopied
restorations
Figs. 14-15: Final design
8 9
10 11
12 13
14 15
7
BL1 lithium-disilicate ceramic blocks
(IPS e.max CAD, Ivoclar). Because the
patient desired an artificial “Holly-
wood” smile, the restorations were left
monolithic, with no ceramic cut-back
or layering. Since she wanted minimal
color variation or internal effects, some
minor surface texture was developed
to scatter reflected light and prevent an
inanimate surface. Then, small amounts
of ochre IPS e.max stain (Ivoclar) were
added to the gingival one-third of the
restorations and slight edge effects were
developed by adding blue e.max stain
(Ivoclar) in the incisal one-third prior to
a final glaze (Fig. 16).