ECD IV CAD/CAM

PORTFOLIO PROJECT
Name: Sanghyun Lim, DMD2025
 Patient Presentation
 Patient history and presentation
 Diagnosis
 Tx Plan

Jessica, 38y.o female present at PCC with CC” I think I have a cavity on a tooth on the upper right.” she
indicates sensitivity btw tooth #4&#5. the tooth has become more sensitive to both hot and cold
temperatures as well as to sweets. The pain lasts for few minutes. Food debris gets stuck in that space
between the embrasures, causing inflamed gums to ache until she cleans and rinses it out.
She’s been cleaning her teeth throughout the day and night. Last dental visit was 3 yrs ago. And it was for
POE and cleaning. She reports no dental trauma and rates her dental anxiety a 2 out of 10. The pt also
reports her last physician appt 4months ago as follow-up to childbirth. Vitals signs: 140/92 RAS. 90BPM
(hypertensive) Not known drug allergies, no other systemic diseases that falls into ASA II due to
hypertension. No medical contraindication to dental treatment. No antibiotic premedication is needed.
 Patient Presentation
 Patient history and presentation
 Diagnosis
 Tx Plan

Diagnosis: Rx: #5-M-D3 and it is #5-M-Primary Caries

Pulpal diagnosis: symptomatic irreversible pulpitis
Apical diagnosis: Asymptomatic apical periodontitis

Tx Plan: RCT with Indirect restoration (CAD/CAM)

 DMOXIS note and tx plan
 Screen shot of DMOXIS note in axiUm
 Screen shot of tx plan in axiUm tx plan tab
Restoration/Caries Circumscribed
 Final Prep

Photo showing final preparation

 "The buccal cusp was covered because there was
inadequate structure at the base, which measured
1.8mm, less than the ideal 2.0mm."
Scanned Preparation with Margin
Defined
Restoration Design

 3 screen shots from occlusal view

 material thickness,
 occlusal contacts, and
 proximal contact(s).
Restoration Design

"Occlusal contact is not visible in

the photo because the contact is on
the lingual cusp."

 3 screen shots from occlusal view

 material thickness,
 occlusal contacts, and
 proximal contact(s).
Restoration Design

 3 screen shots from occlusal view

 material thickness,
 occlusal contacts, and
 proximal contact(s).
 Outcomes assessment and improvement
plan
Self Evaluation
(2-3 bullet points)
Prep • The proximal clearance is 0.7 •
mm from the adjacent teeth,
and the isthmus was
measured at 2.2 mm.
• Pulpal depth was measured at
2.1 mm, and external angles
are smooth and rounded.
• I covered weakened marginal •
ridges and buccal cusp.
• The axial depth is 1.8 mm,
and the proximal extensions
terminate at slightly more
than 90 degrees
Restoration design • Both the buccal and mesial
contacts are aqua/green,
which is ideal.
• The material thickness is
more than 2.0mm, which
is adequate.
• The occlusal contacts are
not noted since the buccal
cusp is non-functional.
Effect on Patient Outcome
(2-3 bullet points)
There is a possibility of the
crown being over-
contoured, which could
lead to the patient
complaining about a high
contact.
Since all preps were done
according to the
CAD/CAM guidelines
without major deviations,
the prognosis for the
CAD/CAM crown should
be clinically acceptable.
• There were no major deviations
noted during the scanning process,
and the proper proximal contacts
were scanned and designed. The
finish lines were traced well, but I
am unsure if I should have covered
the lingual cusp as well.
• Although there is a chance of an
over-contoured crown due to high
material thickness, all margins are
well-defined. With proper
cementation, I am expecting a long-
lasting CAD/CAM restoration.
Improvement Plan
(2-3 bullet points)
• The distal gingival clearance is
less than 0.75 mm, and I think it
would be more ideal to extend
it.
• Although I only covered the
buccal cusp, Dr. Chui suggested
covering the lingual cusp to
increase the adaptability and
retention of the CAD/CAM
fabricated crown.
• I recommend a more
conservative axial wall depth to
preserve more tooth structure.
• I suggest spending more time to
smooth the surface and round
all the line angles for improved
aesthetic and functional
outcomes.
• To improve the CAD/CAM
process, I will scan the
model more efficiently to
avoid data overload. I will
also practice using other
tools in the design section to
become more proficient.
Finally, I will mill the
crowns, cement them on the
prep, and evaluate the final
result.
END HERE FOR FALL SEMESTER
Final Restoration (Pre-Cementation)
Final Restoration (Post-Cementation)
PASS Note
 Outcomes assessment and improvement
plan
Self Evaluation
(2-3 bullet points)
Final Restoration • I noticed multiple stains on
Evaluate standard the final restoration. Perhaps
restoration categories I did not clean the
restoration properly before
• Marginal integrity
the glazing process, or I
• Occlusal anatomy and applied the layer too thinly,
function which may cause the
• Surface finish underlying material to show •
• Proximal contact and through, resulting in
contours staining. Alternatively, the
restoration may have been
fired at the wrong
temperature.
• there is no gaps between the
restoration and preparation.
• the margin of the restoration
is smooth. A rough margin
has been removed with a
finishing burs.
• No overhangs.
• Proximal contact is closed
Effect on Patient Outcome Improvement Plan
(2-3 bullet points) (2-3 bullet points)
• Aesthetically, stains on a • To improve the staining on
restoration can make it the final restoration, I will
look unattractive, take the following steps:
First, I will ensure that the
especially if they are
restoration is properly
visible when the patient cleaned and free of any
smiles. residual polishing paste or
A rough or uneven debris. Second, I will pay
margin could potentially close attention during the
irritate the gum tissue glazing process to avoid any
and make it difficult for contamination. Finally, I will
the patient to clean the check the temperature
carefully to ensure full
area properly.
crystallization and prevent
Additionally, if the staining.
margin compromises the • After the restoration is
fit and smoothness of the milled, I will take more time
surface, it can create to polish the surface
difficulty for the patient irregularities with a
while chewing. polishing kit.
• In addition, I will review the
cementation protocols
before delivering the
restoration.