I've had CEREC 3 Chairside CAD/CAM in my practice for several years now, and I'm still amazed at how it has changed the way I handle cases. I find myself doing things with these Chairside CAD/CAM Restorations that I never could have done with traditional crown and bridge. The ability to integrate this technology into my practice has been a win win for our office and our patients.
This patient presented to the office with a chief complaint of pain and a broken tooth. The clinical examination showed the patient had a significant amount of decay on tooth #18 which went into the pulp chamber. The patient was advised of his treatment options and informed that a root canal, build up and a crown was needed to restore the tooth fully. To complicate matters, the patient was leaving the country in a few days and he didn’t want to finish the work with a foreign dentist. We were left with the charge of treating the tooth definitively.
Anesthesia was given and an i2 Dryfield Illuminator was used for isolation of the operative field. A preoperative photo with the CEREC 3 Chairside CAD/CAM was taken to copy the existing tooth form. Because the tooth was in proper function, the most ideal way to restore the tooth was to copy the preexisting tooth form. The broken part of the tooth was built up with composite and used as a copy for the final case thus ensuring that the patient's existing occlusion would not be altered at all.
The tooth was prepped and the decay was removed. A Dental Laser was used to remove the gingival tissue on the buccal and the decay was cleaned out completely. Without the isolite, a case such as this is difficult to isolate with a rubber dam. Clamping subgingivally can be tedious, uncomfortable for the patient and time consuming.
The endodontic therapy was completed and the tooth was built up with a composite material and final optical impressions were made using the CEREC system. The correlation program of CEREC was used to restore the tooth and it was milled out of a solid block of porcelain.
The final restoration was stained and glazed using the VITA Akzent Stains and cemented in place using a resin system. The photo shows the esthetics of the CEREC restoration compared to a laboratory processed porcelain fused to metal restoration. Because this was a endodontically treated tooth, sufficient occlusal reduction ensured a long lasting porcelain restoration.
Normally if we have a necrotic pulp in our office, we typically like to place Ultracal XS from Ultradent and bring the patient back for a second visit to avoid post operative discomfort. But because of this patient’s travel schedule, a 2 appointment root canal was not an option. Utilizing the CEREC technology allowed us to definitively restore this tooth in 1 visit. This would not have been possible with conventional crown and bridge.