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36 | CERECDOCTORS.COM | QUARTER 4 | 2014
| | | H O RW I T Z
Fig. 23: The Multilink A and B primer
mix is applied to the preparation
Fig. 24: The preparation is filled with
Multilink adhesive resin cement
Fig. 25: The cement is tack-cured for
3 to 5 seconds to achieve a “gel” state
for easy clean up
Fig. 26: The bulk of excess cement is
flicked off with an explorer
Fig. 27: An interproximal saw is used to
clear the interproximal flash
Fig. 28: Liquid Strip glycerine is applied,
after which a final cure is performed
to eliminate the air inhibited layer and
achieve a seamless margin.
Fig. 29: View of the IPS e.max CAD
partial coverage restoration
immediately after seating
preparation is filled with Multilink
adhesive resin cement (Fig. 24), and the
cement is tack cured for three to five
seconds to achieve a “gel” state for easy
clean-up (Fig. 25). The bulk of excess
cement is flecked off with an explorer
(Fig. 26, and the flash cleared interproxi-
mally using an interproximal saw (Fig.
27). Liquid Strip glycerine is applied (Fig.
28), after which a final cure is performed
to eliminate the air-inhibited layer and
achieve a seamless margin (Fig. 29).
Or, in cases where there is a failing
amalgam restoration, recurrent decay
and broken disto-buccal cusps, conserva-
tive, CAD/CAMdesigned partial coverage
restorations are appropriate (Fig. 30).
Chairside-fabricated ceramic partial-
coverage restorations inserted using
adhesive technology have been shown
to be able to stabilize weakened cusps.30
The tooth can be conservatively prepared
and lined with glass ionomer (Fig. 31),
after which chairside CAD/CAM tech-
nology can be used to design the restora-
tion (Fig. 32). A lithium disilicate material
(IPS e.maxCAD) can then be selected and
milled to create the partial coverage resto-
ration (Fig. 33), which can be seated using
a selective etch and adhesive technique
23
28
25
27
29
24
26
(Figs. 34-35) to achieve a seamless restor-
ative result (Fig. 36).
CONCLUSION
Partial-coveragerestorationsofferamulti-
tude of benefits for clinicians and patients,
primarily thepreservationof natural tooth
structure. Advances in material science
and technology have provided clinicians
with exceptional options for designing
andplacing restorations that adhere to the
tenets of conservative dentistry. There-
fore, it behooves clinicians to utilize these
techniques and protocols to provide their
patients with a truly minimally invasive
restorative option.
For questions and more information,
Dr. Horwitz can be reached at
hordent@aol.com.
REFERENCES
1 Wolff MS, Allen K, Kaim J. A 100-year journey
from GV Black to minimal surgical intervention.
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quiz 135, 152.
2 Christensen GJ. Bonding to dentin and enamel:
where does it stand in 2005? J Am Dent Assoc.
2005 Sep; 136(9):1299-302.
3 Ritter RG. Conservative tooth-colored restorations for
the 21st century.Dent Today. 1998 Aug;17(8):50-2, 54-5.
4 Blatz MB, Ripps A, Sadan A, Holst S. Adhesive
cementation of chairside CAD/CAM inlays and
onlays. Dent Today. 2006 Jan;25(1):60, 62-5; quiz 65.
5 Liebenberg WH. Partial-coverage posterior ceramic
restorations. Part 1: a return to diligence.
J EsthetRestor Dent. 2001;13(5):296-303.
6 Clelland NL, Ramirez A, Katsube N, Seghi RR.
Influence of bond quality on failure load of leucite-
and lithiadisilicate-based ceramics. J Prosthet Dent.
2007 Jan;97(1):18-24.