Kristine Aadland When is it worth it to mill out fillings vs doing them direct? Honestly, I would be happy to mill out every filling. To not have to place another matrix band or push a wedge into unsuspecting gums and watch patients flinch (because I am sooooo strong)... it sounds amazing. It's not my reality however for several reasons: a) sometimes I can be more conservative placing a direct filling and b) cost plays a factor. One block that costs around $30 averages 4.6 comps of 3M Ultra Filtek composite. If I can mill out 2 restorations out of one block obviously that is half of that. I don't often do fillings that are that big, but there are times that it really does pay off do mill out an indirect composite- even if I still bill it as a composite filling at PPO fees. Here is one them:
Here is a prep that has a large buccal/lingual width and the distal half of the tooth has a heart shape that doesn't adapt well to matrix bands. He had that frustrating decalcifcation ring that that kept making my proximal box larger and larger.
Make sure the walls converge. This design takes minutes. It's so fast!
Bonding this in has amazing contacts that are controlled instead of leaving an open contact or point contact that wedges in food.
This was just one of those cases that was successful because I milled it and I am so happy that I own a CEREC. I used a 3M z100 block and billed it as a composite. I had total control over the contacts and the margins (not that I am a control freak or anything). There are no voids in the large fill... I easily could have used Cerasmart, Enamic or Lava Ultimate too.
Do you mill out your filings? Why or why not???
