APPLETON COMPREHENSIVE DENTISTRY

Digital Restorative Dentistry GLENN E APPLETON DDS

CEREC Digital Impression System

allows a dental practitioner to produce an indirect ceramic restoration using a variety of computer assisted technologies, including 3d photography and CAD?CAM. With CEREC, teeth can be restored in a single sitting with the patient, rather than the multiple sittings required with earlier techniques. Additionally, with the latest software and hardware updates, crowns, veneers, onlays and inlays can be prepared, using different types of ceramic material.

Digital Impression

Requires strict isolation and gingival retraction similar to conventional impression techniques (retraction cord, electrosurgery or laser troughing)

CEREC Crown Preparations

• 6o- 8o wall taper

• Rounded internal line angles

• Smooth, crisp margins; avoid bevels

• Adequate tooth reduction

• Shoulder - 90 degrees

• Chamfer - 90 - 130 degrees

CAD/CAM Techniques

CEREC Crown Preparations similar to all ceramic restorations

Shoulder - 90 degrees Chamfer - 90 - 130 degrees

Tooth Reduction

• Recommendations based on requirements for all-ceramic strength

• Stress-bearing (occlusal) vs. non-stress-bearing (axial) areas

• Second plane of reduction in occlusal 1/3 prevents over-thinning of the crown

>1.2 mm

>1.5 mm

CAD/CAM Preparations

Conventional 2-plane occlusal reduction for PFM crown

2-plane occlusal reduction for Cerec crown note subtle 2nd reduction plane on occlusal and round line angles giving the preparation a “derby hat” like appearance. This decreases internal ceramic stresses

Spikes: How are they handled?

Make sure the gingival margins of the preparation are smooth. Any irregularities (spikes) cannot be milled

Inadequate Reduction

• Adequate reduction more important in stress-bearing areas (occlusal) compared to non-stress-bearing areas (proximal)

• Fracture is generally due to inadequate reduction

Predictable Depth Reduction • Occlusal Reduction Burs (Meisinger)

• Patterson Item 509-9734

• Ensures uniform 2mm occlusal reduction

Onlays

• Avoid using cast restoration design concepts; avoid ferrule margins

• Ceramic retention based on surface area, not from opposing walls

Ferrule Effect

Not necessary

Onlays

• Desire 2.0mm reduction over functional cusps

• At least 1.5mm over non-functional cusps

• Desire bulk of ceramic at the margin

• Avoid sharp internal angles

• Smooth walls

2 mm

>2 mm

Axial Wall Preparation

• Axial walls for inlays/onlays may be prepared vertically, convergent or slightly divergent to the floor:

Makes margins

thinner.

Greater thickness of ceramic at margins. Preservation of tooth structure.

Undercuts: crowns

Possible to record undercuts with multiple images, but the software will not build (or mill) ceramic in the undercut area!

Tight Corners

Milling corners and extensions: Diameter of burs: -Cylinder: 1.6 -Step: 1.0 We can recognize where burs cannot remove adequate material.

Arrows indicate areas of immediate binding Software will try and incorporate tapered bur in such areas, but often will leave excess material that needs to be manually adjusted Try and ensure corners have at least 1mm diameter

Proximal Margins

• Minimal separation from adjacent teeth = “bridging”

• Need separation to avoid connecting the surface, prep as close to gingival margin as possible

• Will allow easier design of contacts

Exit angle, break contact

Exit Angles • Thin ceramic margins are prone to fracture

• Difficult to record the margin accurately

• Restoration binds – incompletely seats during try-in

Cavity Margins

• An effort is required to ensure smooth margins, especially sub gingival

• Initial prep with coarse diamonds; finish prep with 40mm fine diamond (red stripe)

• Bur selection should fit the specifics of the prep

– Tapered walls

– Flared boxes

– Smooth margins

– Rounded shoulders

Smooth Transitions • Avoid sharp angles; potential to prevent seating

• Rounded internal angles ensure passive fit

• Avoid stress points under the ceramic

• Improve internal adaptation and ease of delivery

Smooth

transitions

Recurrent caries leaving unsupported enamel under the mesio buccal cusp of a maxillary 1st premolar

Prepared tooth has smooth margins and rounded line angles