Darin O'Bryan, D.D.S. The key to low stress high productive appointments is efficiency. This is both in the way you approach the case, prepare the teeth and the sequence in which you mill or fill the teeth. I will walk through case to show a few things that make the appointment quick and stress free.
The case in question is and inlay on 5 and 12 with a direct composite on 11. And before any one asks #4 is scheduled for a crown but the patient needed to wait.
The first thing to do is prepare all the teeth at once. Here is why: the milling time is going to be fast enough with inlays and onlays that the restoration will be finished milling before you can finish with the preparations. It is not like milling a full contour e.max crown where the milling time will be 8 minutes or more. Inlays and onlays milled with the new hybrid materials will mill in under 4 minutes. So first, I prepare them all. One tip that helps with fast preparation is not changing burs constantly. I start the preparation with a 556 bur in a high speed hand piece. I then hit the number one button on my electric settings. This is a slow speed setting for my high speed. No water and about 30K rpms. I do caries excavation, refine the shape and polish the margins. If I don’t like the taper a grab a fine diamond and correct the taper. I then use this to bevel the margins on the direct composite. This takes about 8-10 minutes.
Then I image #5, design and send to the milling chamber. While #5 is milling, #11 is filled with direct composite and finished.
By this point #5 is out of the milling chamber and can be tried in. It is then handed to my assistant that polishes it in the lab while I image and design #12. While it is milling, #5 is bonded into place and the cement is cleaned up. #12 is then retrieved, tried in, polished and bonded into place. The total time on this case was just under an hour and that included taking the photos.
By staging the preparation, design and mill times correctly you are always doing something which allows you to do more in a short amount of time.
If you want to learn more about efficiency using CEREC, learn more by calling cerecdoctors.com at 877-295-4276.
