Dentalcompare
Clinical Director
This morning we had a patient who comes to see us from San Francisco. He had broken off the incisal edge of tooth #8, and had been super-gluing the end of it back on. The tooth had a previous root canal, and was otherwise stable. He was only going to be in town for another couple of days, and planned on heading back to his home town.
So… what were the options? We could do a large composite build-up of the entire incisal edge, but the best long term prognosis for the tooth would have been to do a veneer or crown. The challenges here were obvious:
- Do we prep now and place a provisional, hoping the patient gets a chance to make it back south to Santa Barbara before the temp crown falls apart?
- How do we account for the variable colors and translucency noted on each of his teeth in the anterior? Twelve veneers were not a realistic alternative in this case.
There are two pieces of dental equipment that saved us today, and many times in the past. The first was our CEREC. We were able to prep the tooth, scan the area, design the crown, and mill it out within the hour. I find that often the impression of CEREC is that its “hurry up” dentistry, that its quick and sloppy with poor esthetics. The reality is that this is the ultimate “garbage in, garbage out” machine. I have often used the example of Photoshop from Adobe. If you know what you are doing, it is a powerful tool to create something beautiful. If you don’t spend much time with it, you can make a mess of just about anything. CEREC is the same way. Make a good prep, take the time to make a good design, and you will have an excellent result. The fact that it happens faster than traditional lab work does not mean that it is inferior. Is email any worse than snail mail at getting a message across?
The second piece of equipment is our Ivoclar Vivadent P300 oven. With this we were able to use a high translucency block of e.Max, and customize the color of the restoration. We added golds, browns, whites, and blues to try to replicate the variable color and calcifications of the adjacent teeth. We all know that a single anterior tooth is one of the hardest things to get to match perfectly. We were able to sit chairside with the patient with our palette of colors and customize the shades right next to the other teeth. There was no need to have the patient go to the lab, or have the lab technician come to our office.
We cemented with Ivoclar Vivadent Multilink, the entire process taking under two hours. The next time you think that the traditional way of doing things is the best way, think again. It’s a reminder to me that in this profession, there is always an opportunity to learn, improve, and provide even better care for our patients.