46
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CERECDOCTORS.COM
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QUARTER 1
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2016
C A S E S T U D Y
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B Y D H AVA L PAT E L , D . D . S .
one of the hardest things to do in dentistry is to match a single tooth to the rest of the teeth.
If it happens
to be an anterior tooth, the difficulty is even greater. Anterior teeth are especially challenging because they have different line
angles, incised edge position, embrasures, shade and texture to consider.
Match Me Up
Accomplishing One of Dentistry’s Most Difficult Tasks
CASE STUDY
A patient came in for an emergency exam with a chief complaint
that he broke his front tooth trying to open a beer bottle (Fig. 1).
On examination, we found that #7 had a class four fracture of
the incised edge leading into the lingual fossa, not involving the
cingulum. The tooth was vital and responded normally to pulp
tests. We discussed different treatment choices for the patient,
and he chose to veneer the tooth.
It was the patient’s expectation that the new restoration match
the contralateral tooth #7 in terms of size, shape, shade position
and characterization.
The tooth was prepped for a veneer, conserving the cingulum,
and a scan was taken with the CEREC Omnicam (Fig. 2). The
CEREC software has a unique design method to match restora-
tions to contralateral teeth called Biogeneric Reference. This
method is utilized when a tooth requires restoration but the
existing shape, size, form and or position is not desirable. The
Biogeneric Reference generates a computer-controlled match
of the contralateral tooth as the restoration design. In this case,
the veneer on #7 was designed using #10 as reference (Fig. 3).
The patient wished to have the slight facial overlap of the lateral
incisor over the central — as can be seenwith #9 and #10. Utilizing
this tool, the final design was completed.
An e.maxHTB1 blockwas chosen tomill the veneer. The veneer
was milled with the MCXL milling unit. After the mill, the sprue
was removed and the veneer was tried in for fit and margin verifi-
cation (Fig. 4).
Once satisfied, some facial re-contouring was done with a fine
diamond bur to create primary and secondary developmental
grooves. This was followed by using porcelain wheels to thin
out the margins and emergence profile. This helps in creating
extremely thin margins that will disappear in the mouth.
The restoration was cleaned, followed by cervical and body
staining to create incisical translucency to match #10 in appear-
ance. The veneer was then put through a firing cycle in the oven
to lock in the stain. After the first firing cycle, glaze was applied
and the veneer was put thorough a second fire. By doing this in
two separate cycles, the stain does not get washed away when the
glaze is applied.
After the second firing cycle, the veneer was tried in for patient
approval and then it was etched, silanated and prepared for
bonding. A selective-etch technique was used along with NX3 and
XTR to bond the veneer.
The final result shows that the new restoration blends in very
nicely with the rest of the teeth, matching in shade, appearance
and texture (Fig. 5). The close-up view shows the staining and
incised translucency that was achieved with the two-cycle firing
method (Fig. 6).
For questions and more information, Dr. Patel can be reached at
The CEREC software has a unique
design method to match restorations
to contralateral teeth called Biogeneric
Reference. This method is utilized
when a tooth requires restoration but
the existing shape, size, form and or
position is not desirable. The Biogeneric
Reference generates a computer-
controlled match of the contralateral
tooth as the restoration design.
