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)
 CAD/CAM Techniques

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

CEREC Crown Preparations
similar to all ceramic restorations
Shoulder - 90 degrees Chamfer - 90 - 130 degrees
 CAD/CAM Preparations
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

>1.5 mm

>1.2 mm
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

Not necessary

Ferrule Effect
 Onlays
• Desire 2.0mm reduction over functional cusps

• At least 1.5mm over non-functional cusps 2 mm

• Desire bulk of ceramic at the margin >2 mm

• Avoid sharp internal angles

• Smooth walls
 Axial Wall Preparation
Makes margins
thinner.
• Axial walls for inlays/onlays may be prepared vertically,
convergent or slightly divergent to the floor:

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 Prepared tooth has smooth margins and
under the mesio buccal cusp of a maxillary 1st rounded line angles
premolar