No Prep Veneers - Cerasmart
This was an ortho case on a 15 year old with peg laterals. Orthodontist suggested "just a little bonding". After discussing the case with Mom. we decided to go with 2 no prep veneers until the kid is done growing at which time we'd then transition into something a bit more permanent. Without touching the teeth we imaged and then marginated manually. 2 Cerasmart veneers were milled out of a single block. Cerasmart was used as it can be repaired with composite if needed and it mills out razor thin margins. The veneers milled down to 0.5mm. The restorations were bonded in place with Variolink esthetic neutral. Fun case and way better than hand stacking the composite directly.
Since these are usually so thin I see polishing the only thing needed with these hybrid materials. This is where the great milling performance of the material shines.
For cases with a bunch of characterization I will do it as a cut back and layer composite
This is the perfect use for this material. Quick, easier to do then bonding and will last a lot longer. Great service Bob.
On 7/14/2016 at 8:31 am, David Edelson said...Nice! Why Cerasmart over Vita MarkII? Was Cara in recently ;-)
Same reason I did Lava Ultimate on my son 4 years ago:High lustre polish, razor thin margins, mills thin wityh no fracture, and ease of repair. Nice job Bob.
Mark and Carrie - The shade was A2 and milled with the 12S burs. I've always had good luck with the 12S.
Dave - I am not discussing materials with you ;) Just kidding. I wanted a resin block for the reasons Marc mentioned. The kid is a jock and I know I will be repairing these at some point.
Thad - Those were just polished and mostly intraorally. Tough to polish those tiny things on the lab bench.
So what will be your more permanent solution? I have a 20 year old with exact shaped teeth. Would it be wrong for me to go with Cerasmart as a more permanent solution due to the fact that it mills out the margins so well?
He has been reluctant to do anything but after what I saw you posted today, he is all ready.
Great case Bob! It looks fantastic.
Your gauge is even cool!!
Kirsten that will be a really cool case too. Post pics after :)
Nice job Bob.... nice tx of the young patient. As an exercise, place another age on your patient, and wonder if you would do anything different? As in Kristen's case..... 20 yr old... I was noting the "permanent solution" that we dentists often assign to ourselves...
Mark
Nice Bob!!!
I've got 3 nephews with the exact same cerasmart peg lateral veneers and several young patients. Every time I hear "a little bonding" and peg lateral this is my go to. I hate trying to bond those things by hand. Takes forever and there are always ledges interproximally
On 7/14/2016 at 7:48 pm, Ryan Hamilton said... Nice Bob!!! I've got 3 nephews with the exact same cerasmart peg lateral veneers and several young patients. Every time I hear "a little bonding" and peg lateral this is my go to. I hate trying to bond those things by hand. Takes forever and there are always ledges interproximally
I thought I was the only one!
On 7/14/2016 at 6:57 pm, Mark Stockwell said...Nice job Bob.... nice tx of the young patient. As an exercise, place another age on your patient, and wonder if you would do anything different? As in Kristen's case..... 20 yr old... I was noting the "permanent solution" that we dentists often assign to ourselves...
Mark
I do battle with this everyday.
Kirsten. That case of yours is worth a whole different discussion on esthetic planning. The pegs can certainly be treated in the same way I handled this case, but there are more challenges with yours. Ortho may be a good idea. The gingival contours are a bit of a challenge as well.
Permanence is another great topic. My gut is to go with a glass ceramic, but who knows if Empress or emax or Celtra would last any longer? We just have to do our best...
Karen. Here's the screenshots of the margination. No real rules other than paying attention to the patient's occlusion.
Do you anesthetize and pack cord in these cases to get the margin subgingival, which seems to me to be necessary for proper contour, or just scan and marginate equigingival? Whenever I do " a little bonding" on pegs, I use frank spear's technique with a metal toffelmire band tucked below tissue to get a feather margin and good emergence/contact contour. Agree it's kind of a pain and want to try this method next time.
Nice case Bob! The only thing I would do different in my office is use the the laser to even the gingival contours out. Then place the margin right at the new ly exposed area of the tooth. You can do that with cord as well but I like the laser myself. Personally I ask the question what if this were one of my kids. I would do exactly what Bob did when ever possible. Even if the result is great not amazing you are saving tooth. That will be huge 20 years down the road. Nice one Bob!!
Fun case. I have loved using Cerasmart for my restoration material, but mainly for Inlays/Onlays. It polishes really well with just a bristle brush and some diashine.
Bob,
when you do these, do you adjust your margin thickness in parameters? Have you used Duo for these much?
On 9/21/2016 at 11:35 am, Thad Vincent said...Bob,
when you do these, do you adjust your margin thickness in parameters? Have you used Duo for these much?
Hi Thad. I don't touch the margin thickness parameter. I have not used Celtra yet for a situation like this, but it would mill out fine.
Good Morning Everyone
Thank you for bringing his back up. I have a patient with old composite on her peg laterals and I will be redoing them. I thought it was cerasmart, and I did a screen shot of your margination. Thanks Bob! I post pics. I want them longer than what she has. Would you do biocopy and lengthen. Or bio individual?
did you sandblast or etch and prime?
Carrie
Kristen: Has your patient had ortho? The spaces appear big and you may wind up have very large/wide teeth, even if you restore the canines and centrals. I would recommend ortho first.
