CEREC doctors.com - Q1 2017 - page 68

66 | CERECDOCTORS.COM | QUARTER 1 | 2017
| | | D I S C U S S I O N F O R U M
• Did the RCT first (was extremely fast and easy).
• Sandblasted the tooth structure thoroughly to clean off any
debris and get a fresh surface for bonding.
• Etched to tooth fragment that fell out and applied/cured
adhesive.
• Etched the tooth in the mouth and applied/cured adhesive.
• Bonded the tooth back into the mouth. The fit was really
perfect; just like a puzzle piece.
• Biocopied the tooth in the software.
• Prepped tooth for a full-coverage crown (more on that later).
• Designed and milled with VITATriLuxe 3M2.
Now, even with the 3M2 block, the tooth was really quite
lighter than his other teeth. So, I was going to have a bit of
work to do to get a match. Here’s that the step-by-step:
• Contoured the restoration to sharpen the line angles and
also sharpen the wear facets and incisal anatomy that he
naturally had. The milling process tends to round things off
a bit and we needed more definition.
• After contouring, I polished surface very slightly with
green and blue (very light) Meisinger Twist Polisher.
• Isolated the area with cotton rolls and held the crown in
firmly with my finger on the lingual surface.
• I am going to stain and glaze this in the mouth directly. My
assistant holds the staining well, and I have one brush with
a fairly thin tip that I use for intraoral staining and glazing.
• Apply a very thin layer of glaze just to the facial surface.
• Apply sunset to the cervical and work it into the mid facial
area (this took the most time).
• Apply a little A3.5 shading and work it all the way to the
incisal edge.
• Apply white in multiple areas — and very finely worked it
in so it wasn’t super perceptible — especially on the incisal
edge (vertically to break up translucency).
• Apply a little more glaze in areas where I wanted to dull out
color (i.e., it was too intense).
• Gentlymoved the restoration off the tooth and grabbed it on
the mesial and distal with a cotton pliers; assistant applied
putty to the inside and we transferred to pin and fired.
• After firing, we polished the lingual and interproximal with
all the Twist polishers and the facial surface with the pink
and yellow Twist polisher.
• Finally: bonded it into place!
Hope that helps.
Looking back on what I would have done differently, I may
have just tried NOT doing a full-coverage crown on this case.
Possibly just bonding old tooth back in and layering composite
to match. I have had luck with that before, and it would have
been more conservative and less expensive for the patient. If
it didn’t work, I could have come back and done this.
DAMEN PATEL
Mike you are my idol!
CHRISTOPHER JORDAN
Beautiful case, Mike. I agree, once the original
tooth was bonded back together, I may have just
given it a bit of composite on the facial and sent him home.
I’m not sure howmuch strength you gain by prepping for full
coverage here.
JON SKARE
Wow Mike! Can you make some videos on how
you do these?
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