50
|
CERECDOCTORS.COM
|
QUARTER 2
|
2015
C A S E S T U D Y
| | |
B Y D A N I E L VA S Q U E Z , D . D . S .
in-office, computer-aided design and manufacturing (CAD/CAM) technologies
are enabling dentists to provide
their patients with advanced treatment options when various restorations are indicated, including inlays, onlays, and crowns,
among others.
1,2
Esthetic Cementation of In-office
CAD/CAM Crowns Adjacent to Direct
Bulk-fill Composite Restorations
Several restorative materials can be used with these systems
(e.g., lithium disilicate, composite, all-ceramic), depending on
the functional and esthetic requirements of the case.
1,2
When the
restoration design capabilities of today’s CAD/CAM software are
combined with scientifically proven materials, restorations that
fit well and demonstrate enhanced marginal integrity can be effi-
ciently and cost-effectively created.
3,4
In particular, the CEREC in-office system enables same-day
preparation, design and delivery of precisely fitting and esthetic,
full-coverage crown restorations.
5,6
The CEREC digital impres-
sion component (CEREC Omnicam) captures detailed and
accurate images, without the need for traditional impression
materials. Additionally, the design software allows clinicians to
review a tooth, preparation and/or restoration design as if they
were viewing conventional models.
6
However, to maximize the benefits of CAD/CAM technologies,
using materials that can withstand the milling process and be
produced to full contour is necessary. Ideally, the material should
enable placement with adhesive bonding or conventional cemen-
tation, and luting materials that provide enhanced cementation
and adhesion for strong and durable bonds should be selected.
Fortunately, a millable lithium disicliate material, IPS e.max
CAD, demonstrates 400 MPa of strength, lifelike optical prop-
erties, and suitability for full-coverage crowns, veneers, inlays/
onlays, and other restorations.
7
Additionally, a combination
of adhesive luting materials is also available and can be used to
simplify predictable CAD/CAM restoration placement.
8-10
For example, predictable and long-lastingbonds between the all-
ceramic material and preparation can be achieved by first chemi-
cally conditioning restoration surfaces using a silanating agent
(Monobond Plus). Then, to enhance efficiency without sacrificing
bond strength, a single-component, light-cured universal adhe-
sive (Adhese Universal) that is compatible with all etching tech-
niques (e.g., self-etch, selective enamel- etch and total-etch) can
be placed in a precise and convenient manner. Finally, to ensure
harmonious shade matching to adjacent natural teeth or direct
composite restorations, a light- and dual-curing adhesive luting
Fig. 1: Preoperative view showing defective amalgam restorations that
had been placed more than 10 years ago
composite (Variolink Esthetic) with color-neutral shades can be
used. This cement’s “Effect” shade system enables seamless shade
matching, yet also facilitates brightening or darkening of the
restoration as needed.
This becomes significantly important when in-office restora-
tions will be placed adjacent to direct, bulk-fill composite restora-
tions and/or over a composite crown build-up. With an esthetic
adhesive luting cement that contains a reactive and patented
Ivocerin light initiator, exceptional shade stability can be realized
in combination with fast and reliable light polymerization.
CASE PRESENTATION
A female patient presented with concerns about old amalgam
restorations that had been placed more than 10 years ago (Fig. 1).
She requested that the unaesthetic amalgams be replaced with
