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19 Apr 2018

A few years ago I was doing ZERO surgery in my office.  No extractions, no implant placements, nada. 

This community has a way of encouraging and pushing each other to cause some serious growth.   I was encouraged by multiple CDocs to take Gargs Continuum and start doing more surgery in my practice.

Had a great time going through the continuum with my fellow CDoc Gate$.   We went to the DR together and placed a ton of implants.

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That encouragement from other CDocs has allowed cases like the one below to become common place in my practice, where 3 years ago I wasn’t even extracting teeth.   I know this is quite boring compared to some of the full mouth rehabs we see, but this is the everyday dentistry that walks into my practice.

This pt presented to my office with a “sore tooth”.

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Extraction was completed along with graft of FDBA with PRF.  After healing, the pt returned for CEREC scan and CBCT with Orthophos SL.

“Digital waxup” using the chairside software.

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Integration with DICOM data from Orthophos SL.  This process is too easy.

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Digitally planning the placement of the implant with the restoration in mind makes restoring these as screw retained a breeze.  It also saves me a lot of stomach lining the day of surgery.

By using the position of the “digital waxup” of #30 I was able to make sure the implant was planned with lingual inclination to allow for ideal position of the screw access hole.

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Placement.

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Scan after integration.

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The planned placement makes the proposal in the software need almost no tweeking whatsoever.

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Delivered.

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Again, I know this is just a single unit restoration.   There are way more exciting cases out there on the boards.  But, I want to give a big thanks to this community, the discussion boards, and the online continuum for the incredible resources that they all are.

Critiques welcomed  nail biting

 

19 Apr 2018

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I am looking forward to delivering this case after using the Atlantis workflow.  Once my Atlantis account was set up correctly, it's not only about the weborder.com setup, you need to let Dentsply Sirona know to set up your account for Omnicam scanning. 

Once the approprate accounts are set up the workflow is a breeze and importing the Core File and using Biocopy is flawless.

The crown is Katana A1 STML, glazed only.  The Atlantis Zirconia abutment is shade 20.  The implant is Straumann 3.3 bone level.

I will post more photos once the crown and abutment is seated in the next week or so.

 


I have had mixed feelings about the Katana (especially vs e.max cad) since using it.  On one hand, the Katana STML looks and fits fantastic.  On the other hand, you can expect it to take a good 20-25 min longer than a typical e.max (if glazed) and a little less if polished.  I have gone back and forth if the time is worth it.  After using it for awhile, I found myself starting to go back to e.max CAD due to the time.  After a little more thought and clinical results, I have decided that in a lot of cases, it's worth the extra time.  The stuff just looks and fits fantastic...AND there is better detail.

That being said, the other question is should you glaze or polish.  I have done both and they both work out nicely, but I have realized that you have to be a bit careful about shade when deciding how you want to finish it.

As a general rule of thumb... polishing zirconia tends to produce a pearl effect, but it ALSO will lower the value.  For that reason, I would tend to choose a shade that matches the shade you are trying to achieve (when polishing). As you can see in the slide below, the company recommends one shade brighter when polishing due to the decrease in value... but that might be overkill. 

If you are glazing, It will increase the value and make it brighter.  In that case, I would choose a shade one to maybe even two shades darker than your target shade.

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Here is a case that illlustrates that.  Both were done in A3 Katana STML.  Tooth #13 was polished and tooth #14 was glazed.  Both were clinically great... but notice the lower value of tooth #13 that was polished.

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I hope this helps


One of the greatest advantages we have as Cerec Doctors is the ability to conservatively treat caries without having to cut the whole tooth down. Nice smooth margins, no undercuts, and a really clean Cerec scan is key! .

Here is a case using Cerasmart A1 HT.

I like to pack a 00 Cord, then a size 1, after 2 minutes I pull the second cord.

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No adjustments needed!

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Immediately post cementation. In a few weeks time, these just disappear!

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27 Mar 2018

This was a new patient emergency who called at the end of the day yesterday. We booked him in a side room first thing this morning. He fractured endo treated #9 with existing implant-supported PFM #8. I was really not wild about the esthetics of #8, but we had to match the new crown to something. This is just about the only situation where BioReference is the preferred design mode.The software will "copy and mirror" the contralateral tooth and provide a perfect anatomic match to #8 with very little effort in design. The material was emax in shade A2 LT cemented with Variolink esthetic neutral.

Side note. We had a potential new employee on a working interview this morning. Very talented administrative assistant who we were trying to convince to join our team. I took her through the CEREC process and had her present during the cementation on this case. I asked her if she knew of any office in the state that could handle a single central in 90 minutes. The patient could not stop gushing about the service and the technology.

She accepted the position. CEREC... more than just a crown machine!

 

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Register HERE for the Webinar

Expand Your CEREC® Capabilities with Confidence: New Treatment and Restoration Innovations

​March 29, 2018 5pm PST - California Time

Move beyond posterior crowns and learn new treatment innovations and material options for higher ROI. In this practical web clinic, you'll experience step-by-step protocols to confidently expand your chairside treatment with single-visit implant restorations, bioesthetic anteriors, zirconia considerations and more. Plus, novel cases and integrated workflows will be presented that can differentiate your practice while elevating the standard of patient care.

" Treatment plan single-visit implant restorations for long-term success
" Deliver the most bioesthetic, natural anterior cosmetics 
" Review available zirconia material options and shade considerations 
" Gain staff acceptance and implement immediate workflow improvements 
" Increase patient conversions and satisfaction for referral growth


 

18 Mar 2018

So although I am a Mentor and a Trainer for HS, I have enjoyed sideline status for a while being busy in private practice and soaking up many discussions here on CD.  Thanks to this forum and many great dentists to both educating and pushing my envelope.

I just got involved with a case the other day that allowed me to use many of my Cerec Tech skills that non-Cerec dentists may find challenging ways to accomplish, but certainly not the same way that we as a Cerec dentists would.

Patient A came in for Recall and had areas of recurrent decay as he usually does due to his less than ideal home care and reveals that he never restored tooth #8 which on prior recalls had a carious lesion.

The pre-op xray shows the extent of the decay and the photo of #8 and provisionally restored with a Cerec Milled Cerasmart crown.

After it was explained to patient A that #8 was not restorable, it was explained that at time of extraction an implant would be place and a temporary tooth would be placed on the implant as long as we could get adequate stability and as long as he understood that this tooth was NOT to be used for any reason other than smiling.  

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CBCT planning was performed merging Cerec data and CBCT data.

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After implant planning was performed, exporting the file cmg,dxd file back to the Cerec software allowed me to create and milled Cere guide 2 for implant placement prior to extraction.

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Patient A returned a few days later wearing the provisional that was created at the prior visit.  That provisional was removed just before the tooth was extracted so it could be used as the immediate load temp.

The extraction was performed and the guide placed.  After the initial osteotomy was created and guide pin was place an x-ray was taken to confirm position.

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Completion of the osteotomy was done and the Straiumann SLA Active implant placement was completed.

Just to confirm position I inserted the Straumann implant delivery abutment.

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At that time a Strraumann temp abutment was inserted and noted where it needed to be modified to allow for the temp to be luted to it.

The final photos show the completed implant placement and the screw retained provisional.

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Contacts were adjusted to remove any touching of adjacent teeth and because his overjet allowed, no contact with the opposing teeth was noted.


​He will be seen for a 1 week post op and regularly for 4 months until integration is completed.

 

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
View Comments (8)


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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