Posted 1410 days ago
E.Max has been the main restorative material in my practice for the restorations of Office Cerec® for a decade. This report documents a mandibular box of previous sheet that illustrates the superior quality of adjustment, aesthetics and ease with this material. I even thought that I am constantly in platform with new materials, I am maintaining at least one use of 75 % of E.Max for crowns, insults, veneers, 2–3 fixed bridges of units and restorations of implants. My first experience with Cerec was to create a single Crown Dooring unit a Cerec Acception Program. By not having technical or clinical experience with the digital production of the restorations in the office, I made a crown that I glaze in Scottsdale and cemented in the first premolar of my patients next Monday in my Brooklyn Ny office. This crown was designed and ground after scanning a stone that my local laboratory had poured and used to make a PFM crown. The aesthetics, the marginal adjustment and the ability to have control of the process sold me immediately and it was the impetus for my transition to a fully integrated digital practice. I was able to compare this crown with the PFM manufactured in the laboratory and discovered that there were many advantages to produce in the restorations of the office. I was able to control morphology, occlusion and aesthetics with greater competition, all while accelerating production and improves the quality of my restorations. It no longer depends on a laboratory to create all my restorations saved my response time, reduced laboratory rates and the cost of printing materials in an immaculate way.
Which mainly supplied restorations of a single unit has expanded to the production of crowns of implants, bridges and multiple cases of units. Having control of occlusion, contour and aesthetics raised my ability to produce high quality restorations in a timely manner that satisfies or exceeds the patient’s expectations in an extremely high percentage of my cases. Over the years, these restorations have had exceptionally well depending on a success rate of almost 100%.
A valuable biocopy design option
Have restorations replaced several times due to porcelain fracture, recurring decomposition and endodontic failures led this patient to a several years treatment plan. Porcelain fractures were produced because or inappropriate occlusal elimination and squeeze. I diagnosed him and presented him with a full mouth rehabilitation years ago, but he refused because he restored his dentition more than once before becoming our patient. Since then, many of its existing restorations have failed and were replaced by crowns. Multiple teeth became desperate and required implant teeth replacements. For more than a year, the lower plates of Bond and would return to emergency duration of the duration. The incisal wear of porcelain through the anterior mandibular previous segment, marginal LED and the recession of the wing tissues exposes the structure of the exposed teeth, creating triangular spaces that became food traps. While traveling outside the state on a business trip, sheet # 25 reappeared. This incident convinced him to have the # 22-26 teeth treated together with # 28. He took this occurrence in the boat to finally accept his replacement. (Fig. 1)
Figure 1: Preoperative condemnation of the lower veneers #s 22-26 and Crown # 29.
The case was a challenge due to its occlusion and the width narrows of the incisive mesial distal. I planned to use the biocopy design mode function in the chair software such as the basic plan and design, although with modifications to improve the result. I captured a digital impression with primescan of the existing dentition in a biocopy folder. I selected E.Max as material to make their veneers because the restorations in my experience are aesthetic, depending on a strong marginal adjustment that seals the structure of the underlying tooth and avoid recurring decomposition. (Fig. 2-3)
Figure 2: Digital printing of existing mandibular dentition (biocopy) for use in the design of a new restoration and occlusion morphology.
Figure 3: Intraoral photo of prepared teeth 22-26.
Exemptions from existing porcelain veneers and modified preparations. The first modification made was to provide 1.5 mm of incisal reduction and the second was to extend the mesial and distal preparations interproximally towards the lingual of each tooth. The # 22 tooth was already prepared for a crown, so this preparation was extended beekeeping to obtain additional coverage of the cervical margins. The retraction was injected into each groove and left in the teeth for about 90 seconds rinsed to properly expose each margin. Priman captured the thesis margins quickly in an incredible detail. The arc and the opposite bite were optically impressed by completing all the information necessary to design and manufacture the case. The timing was performed quickly with a putty and a bisacrylic matrix of Luxatemp in a B1 tone, together with preparations in one piece. I use excite, which is a total adhesive of the release of fluoride, fluoride, a single component. One difference is that I do not record my teeth and trust the primer to retain these provisions, in addition to wrapping the material interproximally to provide mechanical retention. I rarely have provisions that separate between impression and insertion visit when using this technique. This tone was light that adjacent teeth would only remain in place for approximately 1-2 weeks.
The scans moved from the acquisition phase to the model phase where each preparation was marinated. The biocopy model was then used to describe any usable information in prioperative morphology that could be useful in the initial design phase of newly proposed restorations. I made use of the network function to create a uniform incisal plane and improve occlusion. I sent my scan to a digital laboratory to print matrices and mount superior and lower models so that I make the necessary final adjustments of fresh restorations before crystallization and insertion. (Figs. 4-7)
Figure 4: Marginated digital printing model phase.
Figure 5: Margination completed 22-26, 28.
Figure 6: Completed marginalization and verification of authorization after design.
Figure 7: Occlusal clarification.
This case is a good example of how to use the biocopy function can make the manufacture and insertion of CADCAM restorations not easy, which requires few or no adjustment that performs the insertion phase. Providing sufficient interoclusal space was an important factor in the development of fracture -resistant restorations. The provisions remained in place without any problem and once eliminated I could unite in the five previous restorations using the ivoclar variolink aesthetic light plus the resin material. The restorations were recorded with 9.5% hydrofluoric acid for 15 seconds, then they were silenced. The teeth were treated with a total engraving technique before lutating each E.Max restoration. This is a permanent light or a dual curing luteal compound that is easy to use and the stability of the shadow of Mintains approximately time. The tone selected for these restorations was Mt B1. This shows a higher value, with an average transsence, which mixes well with the existing dentition. This case documents how these monolithic ceramic blocks can be processed in office with efficiency and high quality to satisfy even demanding restorative situations. (Figs. 8-15)
Figure 8: Copy line # 26.
Figure 9: Use of biocopy as a reference to design restorations.
Figure 10: Restoration design using the network (Controlg), ready for the factory.
Figure 11: Blue phase restorations E.Max ground and equipped in the printed model.
Figure 12: Final design of restorations ready to mold.
Figure 13: E. Max of the model, verifying the occlusion before the crystallization phase.
Figure 14: Restorations E.Max Glazed and finished ready for insertion.
A 9 -month recreation visit did not documented any change in the appearance of these veneers and a fabric response favorable to the new ceramic material compared to the original presentation. I have total confidence that thesis restorations will continue to be aesthetic and work in the coming years. (Figs. 16-18)
Figure 16: #S 22-26 veneers with a high aesthetic value of Variolink before separation.
Figure 17: occlusion immediately after cementation or 22-26 and 28 E.MAX restorations.
Figure 18: 9-month recovery visit 22-26, 28 Restorations E.Max.