Page 36 - CEREC Q3 | 2014

34 | CERECDOCTORS.COM | QUARTER 3 | 2014
as clinicians, we are continually
looking for efficiency and predictability
when offering the highest quality of
dentistry we are currently capable of to
our patients. Bringing today’s advance-
ments in materials and technology,
chairside has increased our ability to
achieve and attain such. The following
case shares a sequence of steps and tech-
niques — a workflow in an everyday-
dentistry scenario — that demonstrates
how efficient and predictable achieving
our desired results can be while utilizing
current technology and materials.
HISTORY AND DIAGNOSIS
A41-year-oldmale presented for a limited
exam with his chief concern being what
he believed was a “chipped tooth” on
the upper left. He reported having some
lingering discomfort to cold. Upon clin-
ical and radiographic examination, gross
decay was identified on the mesial of the
upper left first bicuspid (Fig. 1). Acold test
and other diagnostic tests confirmed that
the deep decay had developed into irre-
versible pulpitis.
Treatment options were discussed
and plans were arranged for root canal
therapy, build-up and an indirect
ceramic restoration for tooth #12 to be
completed in the same visit.
TREATMENT SEQUENCE
step #1: A pre-treatment intra-oral
photograph was taken (Fig. 1).
step #2: The bite was checked pre-
operatively with occlusal
marking paper to identify
and remove deflective con-
tacts with opposing teeth.
Efficient and Predictable
Quality Dentistry
AWorkflow in an Everyday Dentistry Scenario
CASE STUDY ||| BY MARSHALL HANSON, D.D.S. , A.A.A.C.D.
step #9: Final tooth preparation
was accomplished, suitable for an indi-
rect CEREC inlay restoration. The
mesial proximal contact surface of the
adjacent tooth was also polished with a
medium sanding disk on a slow-speed
hand-piece (Fig. 4).
step #10: A final scan of the prep-
aration was done using the CEREC
Bluecam. Removing the retraction cord
after powdering makes the margin
extremely clear to identify (Fig. 5).
step #11: The inlay was digitally
designed and sent to mill (Fig. 6).
step #12: While the restoration was
being milled, the tooth was endodonti-
cally accessed, and root canal therapy
was initiated (Fig. #7).
step #13: At a step where the canals
were soaking with disinfectant, the
milled e.max inlay was tried in. The
proximal contact was idealized with a
single-sided blue-handled sanding strip.
(With some fair finger pressure, the strip
should barely be able to sweep through
the contact area without binding, but
not so easily that it feels passive.) This
tool can be flipped to adjust adjacent
surfaces. This technique will remove
interfering proximal contact in the
correct area in an efficient way leaving
a broad, flat contact, ideal for flossing
when designed correctly (Figs. 8-10).
step #14: After the fit and occlusion
of the restoration was confirmed (and I
personally love the predictability of fit
when it comes to these type of CAD/
CAMrestorations!) itwas polished (Figs.
11-12), cleaned, and stained and glazed
for the oven. Colors Sunset, Mahogany
step #3: Local anesthetic was
administered.
step #4: A pre-scan with the
CEREC Bluecam was done to corre-
late the bite and anatomy with the final
restoration’s digital design. All anatomy
of the preoperative tooth was copied,
except the cavity
step #5: Decay was then excavated
from the tooth with an effort made to
preserve intact enamel (Fig. 2)
step #6: Removal of all decay
around the perimeter of the pulp
chamber was confirmed with the aid of
caries-indicating dye.
step #7: Once the decay was
removed and the remaininghealthy tooth
structure could be visualized, determina-
tion of the appropriate design and mate-
rial for the restoration could then be
made. A traditional crown preparation
for the restoration of this toothwould not
be my first choice. With so much of the
internal dentin now removed, preparing
the tooth circumferentially for a crown
would leave very little clinical tooth
structure remaining. Further, it could
predispose the tooth to early failure of
the restoration and possibly the subse-
quent loss of the tooth. Therefore, judg-
ment was made to preserve all remaining
enamel, and replace the lost dentin with
glass ionomer. A monolithic e.max inlay
would then provide the enamel replace-
ment and final tooth restoration. An
Isolite was used for isolation.
step #8: The cavity was then
cleansed, conditioned and prepared for
glass ionomer using Fuji 9 as the build-
up material (Fig. 3).