Blog Author: Steven Hernandez
Yes, it's true. Love seeing something like this on the schedule; 18-MO, 19-MOD, 20-MOD, 21-DO. Why? CEREC. Prior to having my CEREC system, a quadrant of CL II direct composites was not cause for celebration. Why? Because I would be tied-down to one operatory, start-to-finish, unable to do another/more profitable (and fun!) procedure. Sorry, but tinkering with matrix bands, wedges and clamps doesn't excite me. And sometimes, despite my best efforts, I'd remove a matrix band and find a void or open contact or...
With CEREC, my attitude (and how I approach the case) has completely changed. Let's look at a recent case:
Carmen presented with failing amalgams and interproximal decay in the LLQ; #18-MO, 20-MOD, 21-DO
My workflow with CEREC is fast, predicable and results in better restorations that I can provide by hand. In this case, I designated #18 & 20 as BIOCOPY restorations using the 3M MZ100 blocks. These blocks are resin, not porcelain. And unlike a composite that I place in my office, these are already polymerized; no shrinkage. The result, better fit and longer lasting.
I delivered anesthesia and captured BIOCOPY images.
I prepared both #18 and #20...initial designs.
Only small changes were required before both designs were complete. To leverage my time while the restorations were milling, I prepared #21. Once #18 & #20 were seated, I built the contact against #20.
1. Don't forget about the MZ100 blocks. I find them useful for fillings, tempoary crowns, etc.
2. If you have an EDDA and your state allows it, have them mill/deliver the restorations.
3. CEREC allows you to leverage your time. While the restorations are being designed/milled, you're free to perform other dentistry.
This past Jan, we had a new patient walk into our office. She was distraught over a broken front tooth. I met her and saw an existing Cantilever bridge from #6-7 with #7 completely missing.
She still had possession of the pontic and stated being happy with the shape/contour/esthetics of the previous restoration. Tooth #7 was placed in the mouth and BIOCOPY images captured.
Anesthetic. Preparation of #6 was completed. Images captured.
Final Design with BIOCOPY images confirmed a precise copy of her previous restoration.
The only alteration of the design was on the palatal surface of #7; occlusion/protrusive contacts with the opposing arch lead to failure (see arrow)
Immediate delivery pic
The pt was so happy that she took time out of her busy day to write this wonderful review. Again, without CEREC, this final tx option wouldn't have been possible. To date, she has referred 2 other pts to our practice. These are the pts that you know will be with you for life. They will be raving fans and ambassadors for your practice.
Pt contacted the office today at 2pm and reported a broken front tooth. Crown and RCT completed years ago, not by me. Occlusion was evaluated and, with the remaining tooth structure, I felt enough ferrule could be gained to place a post/core, crown. At 78 years old, her main concern was church tonight and how she couldn't bear to be seen (it's Wed in the South, ya'll). With the hx of RCT, no anesthetic was necessary. Cord packed, post/core, prep. CEREC images. Design, mill Empress A2 Multi. Bond in with RelyX Ultimate. I know immediate before/after pics aren't the best for presentations, but I think in this case it highlights the power of what we can do. While I love implants and guided surgeries, having the ability to replace a front tooth in under 2 hours still blows my mind after 7 years with CEREC. It may not be guided surgery or printing sexy/cool, but it's bread and butter dentistry that pt's truly appreciate.
Female patient with existing bridge from #7-10; 8 and 9 are the pontics. She's not happy with the esthetics and won't even smile fully due to how bad it looks. No worries...I have CEREC. She's not interested in implants and I'm not comfortable using laterals as abutments. So, we decide to do 2 bridges; #6-8 and #9-11 (cantilevers). She was anxious to begin so Mr Know-it-All here didn't feel a wax-up was needed b/c I could knock it out of the park. Let the scanning begin!
So CEREC images are taken. In the ADMIN screen, I designate #6, 7 as crowns and #8 as a pontic. I then designate #11, 10 as crowns as #9 as a pontic. HERE'S WHERE I SCREWED UP. I did not notice that the computer thought I was designing a 6-unit bridge and not 2, 3-unit bridges. Notice how all 6 teeth are connected? Yeah...I missed that.
I finish my design and finally notice the problem. Oh crap. I went back to the ADMIN screen and attempted to change it. Nope...not permitted. If I re-designated the teeth, I lost the design. I solved my problem by creating a space/gap between the centrals. How? Dial in the contacts to where you want. SAVE the case. Use SHAPE ANATOMICAL tool to move one central and create a gap. Mill that bridge. Close the case WITHOUT saving it and you open it back up with the centrals/contact perfect again. Use the shape tool on the other tooth and mill that bridge.
Yes, it wasn't fun adjusting the contacts and shaping the bridges but I made it work. Here's the mistake I made and how to avoid it
Note the arrow and how the computer has all the teeth connected. Click on the chain and remove it to designate the case as 2 separate bridges.
Hope that helps someone avoid the fun I had milling these (each took an hour) and adjusting the contacts. Yes, I could have redesigned the case but I also wanted to see if my work around worked. Here are the immediate delivery pics.
cerecdoctors.com Mentor Dr. Steven Hernandez shared this case on the Discussion Boards:
I remember a day when I used to either send the partial to the lab or use some sort of material and hope to capture the contours of the clasps. No more. With CEREC, what was once hard is now easy. This patient fractured his previous crown; nothing worth saving/imaging for Biocopy. Workflow...
1. Capture bite
2. Image top arch
3. Prep tooth
4. Image tooth
5. Add gingival mask folder, seat partial, image with partial in place
If you want to learn more about this case visit https://www.cerecdoctors.com/discussion-boards/view/id/36042