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14 Mar 2018

Just finished a fun case that I thought I would share...patient presented as a 27 year old female unhappy with her "dark tooth" after having root canal therapy due to trauma on tooth #8 as a teenager.  She last had it bonded about 10 years ago, and the color has been dark for awhile:

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So, we discussed options, and I had her see the endodontist to see if they could do some internal bleaching to give us some help prior to restoring the tooth.  Her natural teeth were in the A-1 range, so any improvement would be helpful...after bleaching, we saw a little improvement:

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So, onto the restoration...as has been mentioned previously, these single central incisors are so much more fun with the ability to mill, texture, and characterize chairside for our patients.  In this case, we went with e.max A-1 MT.  Textured the restoration post-mill, and then glazed and fired...

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In reviewing the post-op photos(taking and reviewing these regularly has really made a difference for my self-assessment), it appears I may have gotten a little too aggressive with the white stain on the distal line angle...I also think I could have rounded the disto-incisal line angle a little more. What we see in the photos that I feel really made the case work is the way the texture allows light to properly reflect off the tooth surface and mimic the adjacent central:

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Had a really crazy week last week, so just felt the need to post a case that I was overall pretty happy with to send some good vibes into the universe! I encourage anyone on here to really continue to take photos and analyze your work.  It will pay off big time with future cases, not only with your ceramics, but any esthetic work you are taking on.

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08 Mar 2018

Posted by Peter Gardell on March 8th, 2018 at 01:43 pm
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There hs been some discussion lately on clearance and how to plan accordingly. Many great items we can add to our armenatarium to help with clearance. Router bur from Meisinger is a huge help, as can be the lowly 330 bur ( please check the length of the bur yourself since manufacturers vary).

Now you may think that when you are replacing a crown with recurrent decay, and it looks like nice porcelain work you can cut corners and just prep away. Unfortunately these are the cases where you to be very careful with clearance

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Here the Porcelain looks adequate when we get down to metal

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But as we sink the 330 to depth we have gone down past the cement into tooth structure.

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And with the removal of the crown we see the depth grooves and the sharp line angles of the prep.

 

Ceramic does not like a cast metal prep, it will not survive long term if we follow the tenets beat in our heads in dental school. Don't take anything for granted, prep the restored tooth as you would a virgin tooth delivering the adequate clearance, smooth transition and smooth margins that out Cerec produced restorations like

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01 Mar 2018

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. 

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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.  

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Anesthetic.  Preparation of #6 was completed.  Images captured.

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Final Design with BIOCOPY images confirmed a precise copy of her previous restoration.

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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)

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Immediate delivery pic

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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.  

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There are very few procedures that are more profitable and efficient than restoring implants.  Typically, by the time the implant is ready to restore, the patient is committed to treatment and ready to get their tooth.  This usually reduces the number of financial issues and limits no-shows and cancellations.  The icing on the cake is if you are restoring with CEREC, you can count on the cost of restoration (whether custom abutment and crown or screw retained restoration) to be considerably less than it ever has been.

But, we all know that ideal world doesn't happen every case.  Most of the "complications" I have experienced are due to  poor coordination of care with the surgeon, or improperly setting expectations from the patient.  I've see where the patient agrees to surgery at a specialty office but forgets about their financial responsibility for the restoration.  I've experiences the surgeon including an abutment in the cost of surgery, which means the restorative specialist now is stuck with a stock abutment that the patient has paid for, when in reality we would prefer to use a custom abutment or screw retained restoration.

Even worse than any of these financial barriers that can be raised is when the surgical outcome deviates from ideal, which creates a fundamental dilemma in how to restore the implant.  We've all see cases where we have to go through all kinds gymnastics simply to restore the implants.

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Wouldn't it be nice to have something predictable and straightforward to design instead?

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To predictably set yourself up for this type of straightforward, no-nonsense restoration, properly planning the surgical case from the beginning is an absolute must.  The general dentist acts as the quarterback for our patients.  We create the plan and then either hand off to another person on our team or throw the touchdown ourselves.  Something I see too often in dentistry is the "hands-off referral" where we send the patient on their way with a referral slip and don't even hear anything about the patient until a progress note from the specialist.  This is not a good approach in general, but especially when it comes to implant dentistry.   Whether we provide the surgical services ourselves, or send the patient to a specialist, we can make our restorative lives better and ensure our patients have a better outcome by planning the case properly before we begin.

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In this case, I planned out the surgical aspect by merging Galileos and CEREC data.  The way I plan this out is with the restorative outcome in mind from the beginning.  I can account for proper angulation to allow for a screw retained restoration in both the #5 and #12 positions.  I also ensure proper depth of placement to allow for the ideal emergence profile.  Finally, I made absolutely certain to avoid an anatomic concerns, like the sinus cavity, adjacent teeth and implants, and the thin buccal plate.  I then fabricated a surgical guide based on this plan that would allow me to execute exactly as I planned out.

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The beauty of all this hard work and planning is when the implants were ready to restore, I knew I would have no trouble at all obtaining great results with proper angulation and depth to allow for ideal screw retained restorations. The restorations were imaged, designed, and fabricated with the CEREC tibase workflow using e.max LT as the final material.  Custom shading created the final lifelike touch to the restorations

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Sometimes there are cases that need attention from a specialist colleague.  Using this workflow and this way of planning out the case allows us to still get to this point from a restorative aspect.  And if we plan the case out properly from the beginning, and follow proper guided surgery protocol, we all can see this type of result from all of our implant cases

27 Feb 2018

Posted by Jason Retter on February 27th, 2018 at 02:48 pm
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He broke the distal half of his central off into the attachment, crestal area. None of these teeth respond to cold, including the broken tooth. No teeth are tender to percussion. 

He wants a simple solution and I'd like to provide him with one. I can do a composite restoration and hope for the best. I'm concerned though that I'm gonna cause gingival inflammation by violating the biologic width and/or a periapical abcess. What do you think is the right call here? I think I need to address the other central as well before the same thing happens.

 

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19 Feb 2018

Posted by Bob Dawe on February 19th, 2018 at 08:52 pm
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There is a use for all of the tools in the mill (or manufacture) phase of the software.

Of course we all use the sprue tool to get the sprue placement away from the perfect proximal contact we just created. 

Then there is the move tool which we can use with the multilayer blocks to alter where the dentin and translucent areas of the crown will be.

And both tools can be combined to effect a more gradual transition of shades on these blocks.

But both tools and both aspects of the move tool can be used to make an exceptionally large crown fit into a block that at first proposal would appear to be impossible.

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13 Feb 2018

Posted by Daniel Butterman on February 13th, 2018 at 06:48 pm
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With more people expanding into Atlantis for some CEREC implant restorations, I thought I would post about the ability to print the core files.  Keep in mind that this is an option that you will soon be able to order through Atlantis, but it's nice to be able to do it own your own if you have a 3D printer.  I use it for my larger cases and I also do it for cases that I send to the lab, since labs have a very difficult time printing Atlantis core files for stacking porcelain.  The .STL file can be found in the .ZIP file that Atlantis sends to you after you approve the abutment design.

In order to print the model, a base needs to be added and then a second model needs to be made with all of the gingiva removed to have a clear view of the sub gingival margins.

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In order to remove the tissue, you just select the abutments and delete everything else.

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You then add a cylinder and combine it with the abutments to hold them in the proper orientation.

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Both models are printed and the restoration can be tried on and finalized.

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09 Feb 2018

Posted by Liz Manji on February 9th, 2018 at 10:40 am
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VITA INTRODUCES “SMART” FIRING UNIT

FOR CHAIRSIDE RESTORATIONS

                                  New VITA SMART.FIRE® boasts easy-to-use interface with one-step

material selection and program start

YORBA LINDA, Calif. (Feb. 7, 2018) — To meet the special needs of chairside milling dentists, VITA has introduced the VITA SMART.FIRE, a fast, efficient and compact firing unit for chairside restorations, including the crystallization, glaze, stain and corrective firing of all common chairside materials.

Featuring an intuitive user interface, materials may be selected in one simple step. In addition, customizable material-specific programs are already pre-installed for simple firing. The VITA SMART.FIRE system includes a durable firing unit for robust firing technology and reliable function, an intuitive touch control unit with a high resolution, 10-inch display and an integrated service drawer for easy access to important accessories, such as firing trays and platinum pins. The fully automatic temperature calibration produces reliable results, and a software-based assistance function is also available for supported, step-by-step firing.

With the VITA SMART.FIRE, CAD/CAM restorations can be completed chairside, even for monolithic, ceramic restorations. The convenient, compact size means VITA SMART.FIRE can also be set up quickly and simply, and is mobile for use in any treatment room.

VITA is a leading provider of innovative dental products. From premium denture teeth and veneering materials, to digital shade measurement, furnaces and CAD/CAM restorations, VITA helps laboratory technicians and clinicians deliver high quality and esthetic results to patients quickly and efficiently.

For more information on VITA SMART.FIRE, visit www.vitanorthamerica.com or call 800-828-3839.

 

 

08 Feb 2018

Posted by Daniel Butterman on February 8th, 2018 at 06:05 am
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Doing veneers in a single visit with CEREC still blows me away.  These are e.max MT, with the case completed in 2.5 hours (with 2 mills).

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07 Feb 2018

Posted by Ross Enfinger on February 7th, 2018 at 10:15 am
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Beautiful case as always!!!!
I see patient has a wear, how did you address her envelope of function? I see also #24 lost incisal restoration ( I might be wrong), if yes, did it happen during provisional wear? Gregory