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38 | CERECDOCTORS.COM | QUARTER 2 | 2014
All restorations were then tried on
the physical die model and evaluated
for esthetics, shade, surface texture and
contour (Figs. 17 and 18).
Once approved, the restorations were
then fit intra-orally using try-in paste and
were evaluated for incisal position, arch
form, proportion and symmetry. Once
approved by the patient, all restorations
were debridedwith Ivoclean (Ivoclar) and
etched with 5 percent hydrofluoric acid
(Vita) for 30 seconds before being placed
in an ultrasonic bath for twominutes.
The prepared teeth were cleaned with
flour of pumice (Henry Schein) and Opti-
Bond XTR (Kerr) primer and bonding
adhesive were applied for 20 seconds
each and lightly air-dried after each
application. Meanwhile, OptiBond XTR
bonding adhesive (Kerr) was applied as a
silanating agent on the entaglio surfaces
of the ceramic restorations and lightly
air-dried. Next, translucent NX3 (Kerr)
light-cured adhesive resin cement was
applied to the restorations, and they were
seated over the prepared teeth. Once in
position, the restorationswere tack-cured,
and excess cement was removed before
final light-curing. Occlusal adjustments
were then made, and the bonded ceramic
restorations were refined with intra-oral
ceramic finishing points/disks (Brassler)
andpolishedwithLegabril paste (Cendres
Metaux) on a bristle brush.
After allowing a week for esthetic
evaluation and soft-tissue stabilization,
the patient returned for refined occlusal
adjustments, final photographs and
direct IPS e.max CAD (Ivoclar) crowns
on teeth #19 and #31 (Figs. 19 and 20).
FINAL RESULTS
The patient was ecstatic with her smile
transformation and enthusiastically stated
that her expectations had been exceeded.
Further, she remarked at the esthetic
predictability of the process and appre-
ciated that we only moved forward with
each subsequent step after her requested
Fig. 16: Stain/
glaze effects
Figs. 17-18:
Evaluation of
ceramics
Figs. 19-20:
Final results
| | | E N F I N G E R
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fabrication of the permanent restorations
becomes very predictable. In this age of
increased demand for the blending of
technology with esthetic dentistry, this
level of esthetic and functional restorative
predictability leads to gratification for
both the dentist and the patient.
For questions and more information,
Dr. Enfinger can be reached at
rossdent@msn.com.
alterations were enacted during the
previous phase. Next, we plan to complete
her new smile by placing CBCT-guided
implants in sites #14, #20 and #30 using
the CEREC/XG3D/Galaxis (Sirona) fully-
integrated system, followed by CEREC-
generated implant abutments and crowns.
CONCLUSION
By following the outlined series of steps,
high-end esthetic outcomes and complex
occlusal treatment can be achieved
utilizing CEREC CAD/CAM technology.
It is my opinion that the key to success in
more complex or extensive cases — such
as the one presented in this article — is
in developing very accurate provisional
restorations. Once the prototype tempo-
raries have been tested and approved, only
then are the permanent restorations fabri-
catedbyduplicating the formand function
of the provisionals utilizing the Biocopy
feature. Since all esthetic, phonetic and
functional details aremeticulously refined
in the provisional stage, the design and
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