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QUARTER 2 | 2014 | CERECDOCTORS.COM | 41
Of particular concern, it was important to
prepare all proximal surfaces (excepting
the distal of #6) so that the future resto-
rations could be properly designed to
close the interproximal spaces.
The preparations were then scanned
with the CEREC AC Bluecam, being
careful to capture the unprepared
premolars. A PVS impression was also
taken for lab try-in. The wax-up was
again transferred to the mouth to func-
tion as a temporary and to be scanned
using CEREC AC Bluecam to guide our
Biogeneric Copy restoration design.
Key point: I find it best to scan for the
Biocopy at this time, rather than prior
to prepping for larger cases, because
un-prepped surfaces of teeth can cause
the Siltec putty matrix to slightly flex to
allow formore Bisacryl to remain, leaving
you with a slightly increased bulk.
CEREC inLab softwarewas used in this
Fig. 7: The Grid Tool (Ctrl + G) helps
to line things up
Figs. 8-9: Contact made from the lingual
Fig. 10: Contoured restorations
Fig. 11: Stained and glazed restorations
Figs. 12-13: Diastemas closed and
esthetics preserved
Figs. 14-15: Final “after” shots
case to simplify the process, but chairside
software could have been used as well.
Careful attention was paid to maintaining
appropriate proportions in the anterior
(Fig. 7).On larger,moredramaticcases like
these, I find the wax-up to function more
as a guide than an actual, set-in-stone
design. Of greatest import, the wax-up
allows us to visualize the three-dimen-
sional position of the incisal edge and
mesial-distal width of each tooth. From
there, the final closure of the diastemas
was made from the lingual, so as to not
make the teeth appear too large in the
mesial-distal direction (Figs. 8-9). Though
the incisal variation tool can be helpful, I
prefer the FormMinus tool to accentuate
the facial contours.
Once milled (e.max A1 HT), the resto-
rations were seated on a stone model
to refine the contacts and enhance the
contours (Fig. 10). The CEREC courses
at the Spear Campus in Scottsdale, Ariz.,
particularly Level 4 & 5, are very helpful
for learning how to properly contour. My
assistant then completed the stain and
glaze, using minimal stain in the cervical
area to match the adjacent teeth (Fig. 11).
Six days after the preparations, the
final restorations were seated with
Rely-XVeneer (Figs. 12-13), final acclusal
adjustments were made and a tempo-
rary full occlusal guard was fabricated
chairside for nighttime wear.
Ultimately, the patient was elated and
that made us all happy (Figs. 14-15). The
most gratifying aspect of this case, next to
helping a deserving patient, was the cost.
Not only did we have the opportunity
to change someone’s smile (conceivably
her life as well), but by handling this case
in-house,thematerialoverhead(including
retainer, six-unit wax-up, blocks/stains/
glaze, etc.) was less than $1,000.
For questions and more information,
Dr. Grutter can be reached at
bgrutterdds@gmail.com.
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