Cerec Doctors

Blog Author: Ross Enfinger

07 Aug 2017

Posted by Ross Enfinger on August 7th, 2017 at 12:38 pm
View Comments (8)


Great work per usual Ross. Curious if you used 4.5 for shade match...
31 Jul 2017

Posted by Ross Enfinger on July 31st, 2017 at 10:55 am
View Comments (8)


Totally awesome!

Why does it look like the temps have articulating paper marks while still in the block?
19 Jun 2017

Posted by Ross Enfinger on June 19th, 2017 at 04:15 pm
View Comments (13)


The following patient was dissatisfied with her previous cosmetic result delivered elsewhere, so we literally went back to the digital drawing board to re-design her smile. One of the most impactful concepts we teach at Spear Education is understanding that a smile usually consists of more than just a couple restorations. We use templates and mock-ups to demonstrate to the patient the potential solutions to his/her concerns, to help him/her understand what is possible, to set realistic expectations of the outcome, and, of course, to guide our Cerec design.

embedded image

embedded image

embedded image

embedded image

embedded image

04 Apr 2017

Posted by Ross Enfinger on April 4th, 2017 at 04:47 pm
View Comments (34)


If you've ever done a denture conversion to an implant-supported, screw-retained provisional prosthesis after the implant surgery, you know how messy and time-consuming it can be. So I was thinking: If we are capable of very accurate implant placement, then we should know exactly where our implants are going to be placed. And if we know that, then we should also know precisely where the prosthesis should attach, right? So what's stopping us from having a pre-made, implant-supported prosthesis instead of having to convert a windowed surgical denture? Well, as it turns out, the answer to that question is that nothing is stopping us except a little ingenuity and effort.

For the last few weeks, I've been working on an All-on-xxxx solution within the Sirona system. I must give a deserving shout-out to my lab partner on the following case, Brad Diver of Champion Ceramics Studio, for doing all the InLab design work and milling of the interim prosthesis. I also want to thank Jay Black from Winter Springs Dental Lab for all of his guidance through this process and for helping us create some clever work-arounds. Lastly, thank you to all my surgical mentors who encouraged me to take on my first All-on-xxxx surgery.

embedded image

embedded image

embedded image

embedded image

embedded image

embedded image

embedded image

embedded image

embedded image

embedded image

08 Feb 2017

Posted by Ross Enfinger on February 8th, 2017 at 07:54 pm
View Comments (26)


This case was one of the most challenging esthetic and structural situations I've ever been faced with. We knew going into this case that it was going to fall far short of ideal because of the poor position surrounding the existing implant #9. It was an old Calcitek implant that was placed far too deep and much too far buccally. We made the easy decision to bury the implant in favor of a FPD #8-9-10 and have the periodontist perform hard and soft tissue grafting to gain as much bulk as possible in the ovate pontic #9 site. Here's what he was able to accomplish:

embedded image

embedded image

 

As you can see, even after extensive grafting there was still a considerable vertical defect remaining. So I made a mid-crestal incision and used pressure from the ovate pontic to push the tissue as far facially as I could. We were still quite deficient, so I then injected Juvederm hyaluronic acid filler into the papillae and facial tissue to shape it around the provisional bridge contours. Next, I had to deal with the very dark stump (ND9 prep shade) on endo-treated #8, so internal bleaching was performed using sodium perborate. This took the stump shade from ND9 to ND3, making the difficult block-out much more manageable...

embedded image

 

The next challenge was to match the very translucent enamel on her natural teeth with the e.max LT bridge block. To attempt to accomplish this, I milled an LT BL2 block and layered lavender stains first, followed by some brown chroma, and finished with a white-wash to match her striated enamel. After several layers of stain/glaze characterization, we ended up with approximately B1 as a final ceramic shade. It's not perfect, but here are the before and after shots:

embedded image

embedded image

 

After struggling with every aspect of this restoration, the biggest take-home message I learned was: once the soft tissue becomes deficient, it's very hard to recover and create a truly natural look. The papillae loss meant we would never have a biomimetic result, but we pulled out all the tricks to make it as natural-looking as we could. I'm honestly just very happy to have this one finally completed, even with it's shortcomings.

12 Jan 2017

Posted by Ross Enfinger on January 12th, 2017 at 01:04 pm
View Comments (6)


The mantra goes "pink esthetics before white esthetics" and I thoroughly agree. What our scalpel-wielding friends can achieve for our patients is truly remarkable. Here's an anterior restorative case with combination clinical/esthetic crown lengthening that simply would not have been possible without perio surgery:

embedded image

embedded image

05 Sep 2016

Posted by Ross Enfinger on September 5th, 2016 at 04:23 pm
View Comments (19)


It must be a full moon, because I've recently had three or four cases of young patients falling and causing a fair amount of dental trauma. This beautiful young woman was very happy that we could get her smile back!

embedded image

embedded image

11 Jan 2016

Posted by Ross Enfinger on January 11th, 2016 at 12:06 pm
View Comments (14)


#5-13 are prepped and designed, so I have complete artistic control over the esthetic choices in this case. Looking for some feedback before try-in.

embedded image

embedded image

embedded image

30 Dec 2015

Posted by Ross Enfinger on December 30th, 2015 at 06:34 pm
View Comments (7)


embedded image

embedded image

embedded image