Cerec : Turning a bad day into a good one
One of the great things about having a CEREC and being able to do same day dentistry for patient is the ability to take an unproductive day and turn it around. Â
The end of May and the beginning of June is always a tough time of year with school getting out. The schedule tends to fall apart when we call to confirm and people remember school events or child care issues that crop up the last minute due to kids being out of school.Â
This case called in right after our morning huddle. They had pain in an upper molar. Once we examined them and found a radiolucency on the radiograph.Â
We discussed the need for endo, build up and a crown. The patient had already taken the time off work to come see us and was very happy that we could complete the whole thing that day.Â
The tooth was scanned in biocopy and then prepared for full coverage Emax crown. In this case we did not have any caries to worry about. If this had been a carious tooth I still prepare it to ideal making sure the margins are clean with no decay near them. That is then imaged and the caries removed and endo started. The prep was then imaged and the design made. Because this was done in biocopy we don’t have to worry about taking an opposing or a buccal bite. You can even image and prepare the tooth with the rubber dam on.Â
Once we had the imaging done we isolated the tooth with a rubber dam for the endodontic procedure. Note in this case we kept the margins super gingival so the clamp is able to engage the tooth without concern. With the esthetics available to use with the HT Emax we don’t have to worry about hiding our margins. If there was a need to prepare all the way to the gingiva then use a tissue-engaging clamp and place it on the keratinized gingiva.Â
The endodontic procedure is then started. The restoration is done milling before the endo can be finished. That’s okay, since we left the margins exposed I just pull the rubber dam over the adjacent teeth to expose the proximal contacts.  The Emax crown is then tried in. The occlusion does not need to be checked since it is a biocopy. If you want check it after it comes out of the oven you can.Â
The Emax crown is then handed off to my assistant to stain and glaze while I finish the endo. Â
Once it is out the oven and the endo is done and the crown is cemented. Â In this case due to the supra gingival margins Variolink Esthetic DC was used. Â For the access opening I just make sure that the cement goes into it to act as a build up. Â The same would be true if I had excavated out caries from and area. Â The crown was prepared to ideal and now we just use the resin cement as a build up as well. Â As you can see in the photos the margins while supra gingival dissappear due the blending characteristics of the HT Emax and the transparent Variolink Esthetic cement. Â
Â
So now my really light morning had a root canal, build up and crown to help turn a bad morning into a productive one.
Â
Nicely documented D and great way to fill up a day.
Do you ever place bonder and composite directly into the access, but keep the material below the height of the access, to make 100% sure your endo is sealed? I agree and understand that the resin cement would act fine as a buildup, just have seen the other method done many times.
Spectacular Case with awesome documentation! A well written explaination to boot. That is a very prodcutive appointment for the patient and the dentist.  I love these cases. The margins disappear nicely on the restoration. Â
Thanks for sharing your knowledge,
JustinÂ
On 7/20/2015 at 3:29 pm, Ernie Johnson said...Nicely documented D and great way to fill up a day.
Do you ever place bonder and composite directly into the access, but keep the material below the height of the access, to make 100% sure your endo is sealed? I agree and understand that the resin cement would act fine as a buildup, just have seen the other method done many times.
I have done it both ways. Â I do it the way you describe when I get done with endo quick enough that the crown has a while still. Â That way I can give the patient a little break. Â In this case since the rubber dam stays on when I bond the crown the endo is still clean. Â I would only be concerned if for some reason I took the rubber dam off. Â
Great case and documentation...I love being able to offer RCT, build-up, and crown in one appointment...and the patients definitely prefer it as well!
