Page 58 - CEREC Q2 | 2014

56 | CERECDOCTORS.COM | QUARTER 2 | 2014
| | | S K R A M S TA D
CASE 1
This patient (Fig. 7) has no existing
restoration and has some esthetic
concerns regarding the size and shape of
his front four teeth. In this scenario, we
can assume that minimal preparation
will have to be done because it’s going to
be more of an “additive” procedure. This
is the easiest case in terms of materials
because we are maintaining the natural
properties of the enamel and dentin.
Since we do not want to block out
these natural properties, a more trans-
lucent material is an advantage. My two
main choices here would likely be feld-
spathic porcelain (Vita) or e.max CAD
HT. Both these blocks can bemilled very
thin and are highly esthetic. Leucite-
based ceramic (Empress) is also very
esthetic, but often you need a little more
thickness to the material for an ideal
result and mill.
Another option would be the e.max
CAD opal 1 or 2 blocks (Fig. 11),
but the worry would be that
the added length on the laterals
would create too much opales-
cence at the incisal edge. These
blocks are more ideal for true
no-prep veneers where only
small spaces need to be closed.
CASE 2
This case (Fig. 8) represents a
more common case than the
first. This patient would like to
improve her smile. She would
require orthodontic intrusion or osseous
crown lengthening but, for now, let us just
concentrate on block selection.
The patient's teeth are lined up very
nicely, have decent angulation, and have
minimal restorative work or caries.
Knowing this, we can plan on minimal
to moderate preparations to correct a
tooth size discrepancy (more within
the golden proportions). Here we have
quite a few options to consider. If func-
tion is a huge concern and strength is
desired, e.max CAD would be a great
option. However, in this case, e.max LT
will not provide enough translucency
for a natural result (without a cutback).
Depending on the preparation,
opting for either e.max HT or e.max
CAD Impulse Value blocks (Fig. 10)
would be a better choice. How I would
decide between the two would depend
on the amount of preparation. The
more preparation, the more the highly
translucent e.max HT will lower the
overall value of the tooth. In that case,
an e.max Value block would be a better
choice. It has more of an “intermediate”
translucency.
If strength is not a huge concern
with the case, you may choose
a multicolor block like the
Vita Trilux/Trilux Forte or
the Empress CAD Multiblock
(Fig. 11). How I would decide
between these two classes
of materials depends on two
things: how much incisal trans-
lucency and opalescence is
required, and how white of a
result does the patient require.
Vita feldspathic material is
a very “warm” ceramic and
does an excellent job matching
natural teeth in the “A” range. It also
does very well when you need a lot of
incisal translucency because of the
large translucent zone in the Trilux
line. If a bleach shade is desired, then
Multiblocks is an excellent and highly
esthetic choice.
Fig. 7: Preoperative condition Case 1
Fig. 8: Preoperative condition Case 2
Fig. 9: Existing PFMRestorations
7
8
9
10
11
Fig. 10: e.max CAD Impulse
Value blocks
Fig. 11: Vita TriLuxe and Empress
CADMultiblock