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QUARTER 4 | 2014 | CERECDOCTORS.COM | 35
Fig. 15: Preoperative view of tooth #3
showing broken down amalgam
restoration with recurrent caries
Fig. 16: View of the initial preparation.
Fig. 17: Close-up view of the preparation
demonstrating the thick band of
enamel available
Fig. 18: The restoration was CAD/CAM
designed and the proposal viewed
with the sprue oriented away from
the mesial contact area
Fig. 19: The IPS e.max CAD partial
restoration was etched with
hydrofluoric acid for 20 seconds
Fig. 20: After try-in in the mouth, the
restoration was cleaned thoroughly
using a cleaning paste (IvoClean)
Fig. 21: The restoration was
silanated for 60 seconds with
Monobond Plus
in the presence of recurrent decay and
cusp involvement (Fig. 1).30 In such cases,
onlay preparations can be performed to
maintain substantial healthy enamel for
use in adhesive bonding (Fig. 2), with
care taken to ensure a thick enamel band.
Onlay restorations can then be digitally
designed (Fig. 3), milled, tried in (Fig. 4)
and then crystallized (Figs. 5-6).
To prepare for adhesive bonding, the
restorations are etched with hydro-
fluoric acid etch for 20 seconds (Fig.
7), after which they are silanated with
Monobond Plus for 60 seconds (Figs.
8-9). To adhesively bond the lithium
disilicate partial coverage restorations,
a universal adhesive cement (e.g., Multi-
link) can be used (Figs. 10-12) to achieve
a naturally esthetic result (Fig. 13) and
enhanced margin integrity (Fig. 14).
Cases with more extensive defects
can also be treated conservatively with
partial coverage restorations, such as
when patients present a failing amalgam
restoration affecting the cusps and
buccal/interproximal walls (Fig. 15).30
Partial-coverage restorations exhib-
ited a reliable treatment for posterior
teeth with large defects.31 The tooth
can be prepared for an overlay by main-
taining a thick band of healthy enamel
(Figs. 16-17).32 Then, a CAD proposal
design can be created of the planned
restoration (Fig. 18).
Once milled, the lithium disilicate
(IPS e.max CAD HT) restoration can
be prepared for adhesive cementation.
First, the restoration is crystallized, after
which it is etched with hydrofluoric acid
for 20 seconds (Fig. 19). After try-in in the
mouth, the restoration is cleaned thor-
oughly using a cleaning paste (IvoClean)
(Fig. 20), then silanated for 60 seconds
withMonobond Plus (Fig. 21).
The A and B primers for Multilink
Automix Universal Adhesive cement are
mixed together (Fig. 22), then applied to
the preparation (Fig. 23). To complete
the adhesive cementation process, the
Fig. 22: The A and B primers for
Multilink Automix Universal Adhesive
cement were mixed together for
application onto the preparation
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