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I get asked this question a lot from prospective CEREC owners and new user, the reason is that many of us have seen bad CEREC margins over the years. My answer is that this is no different than good and bad lab crowns. If I prep appropriately and take a good impression, likely the lab or my CEREC will be able to produce a good result. The opposite will be true if I don't.
The reason this site, basic or level 1 training, and level 2 training is so important for all users is that it not only teaches you to use the software, but how to prep, design and bond for success. It really doesn't take any more effort to get a great fitting restoration instead of a bad one, but it does take education.
The Dentist that did the CEREC crown on the left used a similar machine as mine, and took about the same amount of time to make his crown as I did for the one on the right. The difference is that he simply didn't know what the machine needed to give him a great result. If you're new to CEREC or not getting great results, get the education you need from cdocs and the results will be there. Sorry for the commercial, but I really believe strongly in the education available here.
I received a sample of Ivoclar Vivadent's Tetric CAD. This was a case that I thought would be more of an onlay and my mind was dead set on using the block. In my humble opinion this block is perfect for inlays and onlays. The tooth's condition dedicated my prep and with the presence of distal decay that wasn't apparent on the radiograph and with the small buccal breakdown, I changed gears and went with a crownlay prep. In the past, I would typically use IPS e.max HT or MT for these crownlay indications.
Tetric CAD is in the category of hybrid ceramics. It has great edge stability during milling, polishes easily and doesn't have to be fired. With a flexural strength of 272 MPa, it is higher than the other hybrids. I bonded this restoration with Ivoclar Vivadent's Variolink Esthetic DC Warm cement under rubber dam isolation. I have attached a CEREC Materials spreadsheet that I posted earlier this month for those that would like to see the different materials and their properties and indications.
This appointment was less than an hour from start to finish. Polished only. Despite the fact that the value is a bit high occlusally, it still blends beautifully around the margins.
A few months back, I was in the Demystifying Occlusion seminar with Frank Spear and he talked about the prep and pray method for doing posterior crown. It got me thinking about how I used to restore anterior implants via the "Pour up and pray method." My "pour up and pray method" was removing the healing cap, placing the impression coping as fast as possible, squirting impression material into the socket and praying the lab technician could replicate the soft tissue and the emergence profile.
Cerec and its workflow make it so predictable and take all the challenge and guesswork out of anterior implant restoration.
Step 1: scan the day of implant surgery and make a custom healing abutment with enamic.
Step 2: rescan a few months out. used bio reference to copy #9. Fabricated custom incoris zirc abutment (infiltrated) with emax lt c2 for the final crown in extra fine mode.
The last few photos were before cementation yesterday, so it does look a little bit long, but the incisal length is perfect after cementation.
Quick thoughts on the zirconia abutments: 1) mill so smoothly 2) you can also buy them in single packs instead of buying packs of 5
There are situations where the spacing for implant therapy is not ideal one way or the other. With the CEREC-Galileos integration we have the ability to create 2 different plans and decide which one works better.
What do you guys think, 2 or 3?
Late night CERECing thoughts...
It's very humbling to look back on cases when I started using CEREC 12 years ago. I was so happy to take a crown straight out of the mill and put it in the patients mouth. I had no idea what I was looking for when I looked at a tooth, other than if the color was right (which really meant was it close but not perfect). Today, I look at teeth in an entirely different way. I love to see the color patterns, the anatomy, the contouring and the light reflections. I am able to see this now because I posted cases and other doctors were willing to show me how to improve. I was also willing to accept those answers. That is what I love about this forum. We are all here to grow.
So what do I see in a case like this...
Anatomy of a youthful tooth: sharp line angles, prominent central lobe and contouring at the gingival embrasures on the mesial and distal. This is contouring that is done post mill.
Fun color patterns: the white bands at the gingival 1/3, the blue translucency and the white framing along the incisal edge.
Reflections: Do my reflections mirror each other? If so, then my anatomy is similar. If not, I need to re-contour to get them to match.
and the final...
Don't you just love that we have this capability in our office? So.dang.cool.
Ivoclar Vivadent Reprises “Just Cure It!” Bluephase® Style Initiative
Company to donate $100 for each curing light sold to support breast cancer research
In honor of Breast Cancer Awareness month, Ivoclar Vivadent will once again donate $100 for each pink Bluephase® Style LED Curing Light sold during the month of October to Susan G. Koman for breast cancer research. Ivoclar Vivadent employees have also supported the cause by participating in the Susan G. Koman Race for the Cure. This marks the sixth year for Ivoclar Vivadent’s “Just Cure It!” campaign, which was initiated in 2013.
“Each year we are inspired by how well-received this campaign is, and we remain committed to helping to fund the research that is so essential to finding a cure,” emphasized Robert A. Ganley, CEO of Ivoclar Vivadent.
Withits Polywave™ technology, the Bluephase Style provides the broadest spectrum available to efficiently cure all dental materials, and its specially designed light probe easily accesses posterior teeth. The Bluephase® Style can be used cordless or corded, and its slim design and intuitive two-button operation is lightweight, very small, and ideal for any treatment.
According to the National Cancer Institute (NCI), an estimated 266,120 new cases of breast cancer are expected to be diagnosed in the United States in 2018, which underscores the aggressive and deadly nature of the disease. While there is still much to learn about breast cancer, the NCI has reported a steady decline in breast cancer deaths since 1990, which is attributed to advancements in diagnosis and treatment. For more information, contact the National Cancer Institute at the National Institutes of Health at www.cancer.gov/cancertopics/types/breast, or by phone at 1-800-4-cancer.
About Ivoclar Vivadent
Ivoclar Vivadent is a global leader in innovative materials and processes for quality, esthetic dentistry. The company employs over 3200 people and operates in over 120 countries throughout the world. Ivoclar Vivadent is headquartered in Schaan, Liechtenstein. Its North American headquarters is based in Amherst, NY. For more information, call 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada.
For further information, please contact:
Here is a technique that will save you time when provisionalizing implants.
Patient needs tooth #10 extracted and grafted. At the consult appt, I took a scan of just his upper teeth (has an anterior open bite)
I exported the .stl file and put a base/hollowed out with inLab 18 and 3D printed the model
Next, I went to the Omnicam and selected Bridge Mode (veneer #9 Biogeneric and pontic #10 Biocopy) and scanned the 3D printed model in as the Biocopy. Next, using a carbide bur, I went ahead and cut out tooth #10
We then fabricated a maryland bridge out of GC Cerasmart...
All ready for surgery next week!
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When staining and glazing a Celtra Duo crown, I've found that sometimes my assistants have a hard time holding on to them with a locking crown holder, especially on very shallow intaglio crowns. The other worry is that if they spray, they'll get glaze on the intaglio of the crown and often don't get enough glaze around the margins because of this.
I got a tip from a Dentsply Sirona Consumable rep that has worked great. We use silicone ear plugs (you can get them on amazon for around $3) and seat the milled crown on the plug. It's sticky enough that the crown doesn't fall off and it gives you something to hold onto while staining and glazing. The silicone also blocks out the intaglio from glaze getting under the crown. After glazing, you just lift it off with a cotton pliers by the contacts and put in the speedfire. I've been doing this for a few months and my assistants love it.
I know there is a lot of discussion about what materials to use in the anterior zone. I don't think there is necessarily a universal answer but what I've learned over the years is to understand the properties of these materials and their strengths and weaknesses.
In general, I'm trying to use Feldspathic porcelain (VITABLOCS typically for me Mark II or TriLuxe) or Leucite Re-inforced Glass Ceramics (IPS Empress) in the anterior region. I feel like they have more vitality, given the right case, you can just mill polish and cement and get a really nice result. This is a case with VITA TriLuxe 1M2 polish only
I know the go-to block when using e.max in the anterior region is e.max MT. I really like the block and use it quite often as well. My point for this discussion is that a lot of doctors will shy away from e.max HT. There is the big fear of the dreaded "grey" crown or a crown that has "low" value. It is a real concern. I've had it happen to me and if you aren't careful, it can happen quite easily. This was my first case I posted on CEREC doctors and at the time I thought it was quite good. Now I would have approached it differently because of the "low" value of #8,9.
This case I did about a year ago. It's not perfect but it is a vast improvement over what she started with. She is quite happy, but I always evaluate my photos and have other CEREC doctors look at them and give me their feedback. Dr. Tom Monahan and I share cases back and forth, and aren't afraid to pick apart our cases. It makes us better and I would encourage you to do the same.
So I chose HT for this case because I felt like I did see some C-tones in this case. I felt like MT would be too bright or high in value for this and I didn't feel great about using Feldspathic on this case because of limited space on the lingual. So I used A1 HT. I compensated about 2 shades in order to offset the drop in value. I wish I would have taken a pre-op pic with a shade tab but she was closer to A3.
There are a lot of ways to approach these anterior cases, but I felt like e.max HT was the best solution and what I saw for the case in my eyes.