In-house CAD/CAM and the use of modern materials can make restoring cracked teeth and carious lesions more efficient than ever before.
Cracks and fractures associated with amalgam restorations are commonplace in general dental practice. This is especially true if there is a significant loss of tooth structure. Every dentist sees this on a day-to-day basis.
These dental materials help to create restorations in a predictable, esthetic, and efficient way for a variety of cases. Combined with the hybrid ceramic material Tetric CAD, e.max is a complete restorative process.
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Many of these teeth are structurally compromised, and it is common to find evidence of carious lesions beneath these cracks. It is also common to find carious lesions in the adjacent teeth, mesial or distal to the cracked tooth, especially if the cracks run interproximal to each other.
An adhesive, conservative approach is the ideal method of restoring these teeth. With in-house CAD/CAM, we can achieve this with a better fit and fewer visits and much more efficiently than ever before.
Ivoclar Vivadent is a global leader in dental materials. With the advent of modern ceramics and hybrid materials, we can treat cracked teeth and carious lesions better than ever before. IPS e.max pioneered this progression and became instrumental in the movement away from porcelain-fused-to-metal (PFM). Tetric CAD, a hybrid ceramic material, complements e.max perfectly. It is fast to mill and easy to process and can be utilized alongside e.max for inlays and onlays.
This patient presented with a classic representation of the “murder house” days—a quadrant packed full of amalgam fillings, many with surrounding cracks and underlying carious lesions.
The plan was to place 4 indirect restorations, all done in a single visit. The first premolar and second molar were restored with milled inlays using IPS Tetric CAD. The second premolar and first molar were restored with full coverage restorations using IPS e.max CAD.
Although many materials are coming on the market, there is only 1 gold standard until proven otherwise. IPS e.max CAD is my material of choice for 90% of my single-unit ceramic restorations. It is backed up by over 15 years of research and it has been incredibly predictable, esthetic, and fit for purpose in our clinic.
Figure 1 shows how the patient presented before treatment was complete.
Figure 2. The patient presenting after the restoration.
After using the right materials and workflow, Figure 2 shows the quadrant with finished indirect restorations all completed in-house and within a single visit.
Figure 3. The preoperative condition of the restoration.
The beginning of treatment steps shown in Figure 3.
Figure 4. The restored and compromised quadrant.
Heavily restored and compromised quadrant. Cracks are evident in the first and second molars. Second premolar tooth structure is compromised. First premolar failing amalgam restoration (Figure 4).
Figure 5. Displayed evidence of carious lesions under all amalgam restorations.
Existing restorations and caries removed—evidence of carious lesions under all amalgam restorations. Sealing the deepest part of the preparations was carried out (Figure 5).
Figure 6. The intraoral scan taken with CEREC Primescan.
Intraoral scan carried out with CEREC Primescan. Preparations are marginated, and prep reduction to respect minimum material thickness is checked and confirmed digitally (Figure 6).
Figure 7. Full coverage and inlay digital fabrication.
Restorations designed using CEREC Primescan. A combination of full coverage and inlay restorations have been fabricated digitally (Figure 7).
Figure 8. The restoration block to mill out a Tetric CAD inlay.
An example of the milling process. A Tetric CAD inlay milled out of this restoration block. Note the sprue connection, which needs to be removed and polished and is common in all forms of milling (Figure 8).
Figure 9. Restorations fabricated using CEREC Primescan, Primemill, and Ivoclar Vivadent IPS e.Max and Tetric CAD.
Two IPS e.max ceramic onlays and 2 Tetric CAD inlays. Resin cement was used to bond the restorations—immediate postoperative. Restorations fabricated using CEREC Primescan, Primemill, and Ivoclar Vivadent IPS e.max and Tetric CAD (Figure 9).