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Case Study
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Procedures for Preparing, Staining, and Cementing in Chairside CAD/CAM Dentistry: A Case Report

Learning Objectives:

This case study describes the clinical procedure involved in the use of a chairside CAD/CAM system. Upon completion of this case study, the reader should:

  • Understand the benefits of working with a chairside CAD/CAM system.
  • Recognize the significance of proper preparation design an digital impression capture on restorative success.

 

When used appropriately, direct resin procedures provide acceptable clinical results. Nevertheless, as the size of the preparation design increases and a large bulk of composite is used, a greater amount of cuspal deflection and deformation will occur within the tooth. The author recommends direct restorations be used for small or medium carious lesions and that indirect restorations should be used for restoring larger lesions or when cuspal replacement is involved. 

There are numerous CAD/CAM protocols available on the market enabling practitioners to provide metal-free, aesthetic, indirect restorations. These CAD systems range from laboratory systems to chairside systems. With laboratory systems, a traditional impression is made and forwarded to the laboratory. The laboratory pours the model and scans dies using the system’s scanner. A coping is then designed on the computer and fabricated using the system’s milling chamber. The laboratory technician then layers the final porcelain on the coping material and returns the restoration to the clinician. 

Chairside CAD/CAM systems work in a different manner. The tooth is prepared by the clinician in the traditional manner, but instead of a traditional polyvinyl or hydrocolloid impression, a digital scan is taken of the tooth chairside. The restoration (eg, inlay, onlay, crown, or veneer) is then designed, milled, and cemented on the tooth all in a single visit. 

Ceramic reconstruction has proven to be a viable and substantiated clinical technique with acceptable clinical margins as well as enhanced aesthetics when the restorations are stained and glazed by the practitioner. By placing the final restoration on the tooth, the benefits of sealing the tooth immediately can be realized for decreased postoperative sensitivity and increased comfort for the patient. 

 

*Director of CAD/CAM, Scottsdale Center for Dentistry, Scottsdale, Arizona; private practice, Tarzana, California.

  

Related Reading:

  1. Spreafico R. Direct vs. semidirect vs. indirect restorations: Establishing criteria for clinical decision making [interview].  In: Sadan A, ed. Quintessence of Dental Technology 2003. Hanover Prk, Il:Quintessence Publishing; 2003:82-89.
  2. Morin D, Delong R, Douglas WH. Cusp reinforcement by the acid-etch technique. J Dent Res 1984;63(8):1075-1078.
  3. Liebenberg WH. Controlling contacts and contours using preformed ceramic inserts. Compend Contin Educ Dent 2000;21(2):147-150.
  4. Choi KK, Ryu GJ, Choi SM, et al. Effects of cavity configuration on composite restoration.  Oper Dent 2004;29(4):462-466.
  5. Nikolaenko SA, Lohbauer U, Roggendorf M, et al. Influence of c-factor and layering technique on microtensile bond strength to dentin. Dent Mater 2004;20(6):579-585.
  6. Kuijs RH, Fennis WM, Kreulen CM, et al. Does layering minimize shrinkage stresses in composite restorations? J Dent Res 2003;82(12):967-971.
  7. Versluis A, Douglas WH, Cross M, Sakaguchi RL. Does an incremental filling technique reduce polymerization shrinkage stresses? J Dent Res 1996;75(3):871-878.
  8. El-Badrawy WA, Leung BW, El-Mowafy O, et al. Evaluation of proximal contacts of posterior composite restorations with 4 placement techniques. J Can Dent Assoc 2003;69(3):162-167.
  9. Broderson SP. Complete crown and partial coverage tooth preparation designs for bonded cast ceramic restorations. Quint Int 1994;25(8):535-539.
  10. Dietschi D, Spreafico R. Adhesive Metal Free Restorations: Current Concepts for Esthetic Treatment of Posterior Teeth. Carol Stream, IL: Quintessence Publishing; 1997:79-99.
  11. Magne P, Belser UC. Porcelain versus composite inlays/onlays: Effects of mechanical loads on stress distribution adhesion and crown flexure. Int J Periodont Rest Dent 2003;23(6):543-555.
  12. Swift B, Walls A, McCabe JF. Porcelain veneers: The effects of contaminants and cleaning regimens on the bond strength of porcelain to composite. Brit Dent J 1995;179(6):203-208.
  13. Canay S, Hersek N, Ertan A. Effect of different acid treatments on a porcelain surface. J Oral Rehabil 2001;28(1):95-101.
  14. Barghi N, Berry T, Chung K. Effects, timing and heat treatment of silanated porcelain on the bond strength. J Oral Rehabil 2000;27(5):407-412.
  15. Magne P. Immediate dentin sealing: A fundamental procedure for indirect bonded restorations. J Esthet Rest Dent 2005;17(3):144-155.
 
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