Sameer Puri D.D.S. Ever since the introduction of the CEREC technology to my dental practice, one of the things that I have learned from the school of hard knocks of clinical practice is “don’t be overly conservative”.
Now this flies in the face of the mantra of CEREC dentistry. Since I have been exposed to the technology over a dozen years ago, it has been beat into my head to not prepare unnecessary tooth structure. “Save every last sliver of enamel” the Gurus would preach. Make sure that you don’t prep away health tooth structure. All of this I agree with. But the issue is that what has gotten me into trouble in the past has been trying to follow these words of wisdom to close to the heart.
Yes, you should be conservative. Yes, you should save as much tooth structure as possible whenever possible. Yes, you should not prepare full coverage crowns unnecessarily. However, you should also not do overly conservative dentistry when a more aggressive preparation is required. As much as your desire may be to do a conservative partial restoration, a full coverage preparation is sometimes required.
Take the case below as an example. Lots of decay, lots of old restorations, lots of work needed. We start by removing the existing restorations as well as preparing the teeth conservatively. I think perhaps I don’t have to cut down the teeth for full coverage crowns. Perhaps I can be more conservative and do partial coverage onlays. The result of my initial proposals is what you see below:
So here we are and to myself I think- “Hey, maybe I don’t need to prep anymore”. The temptation sets in to leave the restorations with a preparation similar to what you see below, albeit with some additional refinement. But then common sense takes over. Is that stain on the distal lingual of both teeth or is that the remnants of decay? If I leave it, where will the teeth be in a few months or a few years. So I pick up my trusty hand piece with the gross reduction bur and after building up the teeth with composite, I prepare both teeth for full coverage restorations.
It's a good thing that I did prepare for full coverage in this case. Decay was present on both the teeth in exactly the areas that I had suspected. That was not stain that you see on the photos but actual decay. This is a case that in the long run will serve the patient much better because while we have tried to remain conservative, the case dictated that a more aggressive preparation was required. As you can see from the photo below, the same fate of full coverage restorations probably awaits the premolars as well.
The moral of the story? Be conservative, save tooth structure. But don’t jeopardize the longevity of the case by simply trying to be overly conservative. Dentistry is difficult enough. Don’t over complicate it by not giving yourself the appropriate room to restore teeth appropriately.
