Chances are you don’t know what CEREC is and you might not even know if your dentist uses it. CEREC technology is an advanced dental tool where 3-d photos are taken of your tooth and a perfect restoration for the tooth can be made from a milling machine right there at the dentist’s office in a matter of minutes.

It’s rather amazing to watch. There are no temporary or second visits. You get everything you need done in a matter of minutes instead of in a number of visits.

So how does this system work?

Using this computer system a dentist can take a 3-dimensional photo of your tooth, then using a computer assisted design program he shapes the new tooth or crown to perfection. Next colored ceramic blocks from which the new tooth or crown will be made are looked over to find the best matching color to your teeth. Once the colored block is chosen it’s placed into the CEREC milling chamber - from there the magic begins. The milling chamber cuts the block into the exact shape the dentist designed on the computer. In all it takes only a few minutes for the block to be cut into it’s perfect shape. Plus the milling chamber is actually much smaller than you might expect - it’s comparable to a mid-size printer.

And once the block is shaped the dentist simply places this into your mouth using dental cement and any other needed materials. So total the process is over in one visit and you’re ready to get back to enjoying life. Those days of getting a temporary and having to come back to have it fitted are now long gone!

So next time you visit your Atlanta dentist ask him about CEREC.

Is it health for you or your kids to gorge on tons of candy this Halloween? You might be surprised at what the answer is. Dentists are now reporting that eating larger amounts of candy at once is better for your teeth rather than having many snacks of candy though out the day.

Why would this be? Well, the cause of cavities is sugars or starches that enable bacteria in dental plaque to produce acids and if this attack of bacterial acid lasts 20 minutes or more it can lead to a loss of tooth-mineral, and eventually cavities - according to the American Dental Association.

So a child or adult who eats a piece of candy every few minutes or longer is more susceptible to tooth decay because the long-lasting snack on the candy creates an acid attack on teeth that lasts the entire time the candy is in the mouth. Therefore spreading out candy over time - like having a piece every now and then through out the day - would be less healthy for your teeth than eaten it all at once or in a quicker time period.

Consequently one approach that many parents might take is to allow their children to eat all the Halloween candy they’d like right after trick or treating and then throw the rest away. The same could be done by adults, where one could stock up all the candy received, eating it all at once, and then throw the remaining pieces away. But of course the choice for how you manage your child’s or your own candy intake this holiday is up to you. With that said remember this dental candy tip over this Halloween and have a safe and ghostly night.

When we think of the dentist most people think of drills, pulling teeth, and general uncomfortableness. Although this might have been true for some dentistry in the distant past, the truth is that dentists today have many amenities that help make your visit as comforting and relaxing as possible. In fact you might be stunned at how luxurious a visit to a dental office can be.

With so many amenities available for patients here is a quick list of some of the top 5 most comforting dental amenities:

1. Body-contouring dental chairs. These are so much more relaxing than some of the rigged hard chairs you might have experienced before. It’s surprising what a difference it can make for your visit.

2. Blankets to keep you warm. It always feels nice and very caring when you are offered blankets to keep warm. These make for an enjoyable visit.

3. Massaging pads. Of course these make for a very relaxing visit.

4. DVD & music players to listen to while receiving dental work. These definitely help not only with the noise but also take your mind off the dental procedure you might be getting.

5. A refreshment and coffee bar. It always seem to feel welcoming when you have refreshments at an office - almost like your right at home.

Invisalign is an effective alternative to braces for patients who have full adult dentition and complete jaw growth, and it is effective on a broad range of cases. Typically Invisalign works on a wide range of dental mis-alignments, such as overly crowded teeth, widely spaced teeth, crossbite - upper and lower jaws are misaligned, overbite - upper teeth bite over the lower teeth, and underbite - lower teeth protrude past the front teeth.

Check out one of our Invisalign testimonials from patients who received Invisalign under our care. As well on our Invisalign Atlanta web page we cover more information on the Invisalign process.

So will Invisalign work for you? To better determine if you are a candidate for Invisalign call us today at 404-872-7755.

Top educators, clinicians and dental industry leaders from across the country gathered in Scottsdale, AZ April 24-25 for the official opening of the $50 million Scottsdale Center for Dentistry. The Center serves as a world-class continuing education facility led by a world-renowned faculty who provide the latest in programs, seminars and hands-on training for dentists from all disciplines. Mr. Imtiaz Manji, Founder and CEO of the Scottsdale Center and Dr. Gordon J. Christensen, DDS, MSD, PhD, Dean of the Center, served as co-hosts during the two-day event.

“A tremendous amount of work by so many people has helped make the Scottsdale Center a reality,” says Mr. Manji, a leading national educator of dentists on the business side of practice management.

“And the official opening fulfills our mandate to offer the best in unbiased continuing education workshops, programs and services to practitioners and other dental professionals.”

The celebrations featured a half-day Lab and Industry Event on April 24, where dental laboratory invitees listened to Dr. Christensen give a presentation on the future of the industry while Mr. Manji addressed the importance of relationship vs. business capital. Norbert Ulmer, Director of Laboratory CadCam Solutions, gave a glimpse into the future with his presentation on digital restorations. The April 25 Speakers Event for leading clinicians featured a full day of presentations and live demonstrations and included a discussion on Passion and Professionalism by Mr. Manji, a CEREC^® demonstration by Dr. Sameer Puri and Dr. Rich Masek, a demonstration on Zirconia-based Crowns by Dr. Christensen, an address on Cone Beam Technology by Dr. Don Tyndall, and an Endodontics video demonstration by Scottsdale Center Director of Endodontics Dr. Cliff Ruddle. The outstanding team of faculty members continues growing and includes Dr. George Bailey (Co-Director, Implant Dentistry); Dr. Barry Freydberg (Director, Technology – Overall); Dr. Harald Heymann (Director, Esthetic & Restorative Dentistry); and, Dr. Mollie A. Winston (Co-Director, Implant Dentistry).

“Our faculty team will continue to grow as more positions are filled,” says Dr. Christensen. “Each member is totally aligned with the Center’s vision of excellence and will help prepare new dentists and update experienced dentists with the tools, techniques and principles to provide the best treatment to all patients, regardless of cost.”

Events were capped off with an official ribbon-cutting ceremony featuring Mr. Manji and Dr. Christensen, followed by a celebratory dinner.

The Grand Opening attracted a “Who’s Who” of the country’s top clinicians. Some of those special guests included: Dr. William Becker, Dr. Joel Benk, Dr. Alan Boghosian, Dr. Bruce DeGinder, Dr. Terence Donovan, Dr. David Hornbrook, Dr. Howard Glazer, Dr. Paula Jones, Dr. Karl Koerner, Dr. Gerard Kugel, Dr. Sandra McLaren, Dr. Joseph Massad, Dr. Richard Mecall, Dr. Dale Miles, Dr. Armen Mirzayan, Dr. Mark Morin, Dr. Dan Nathanson, Dr. David Newkirk, Dr. Robert Pick, Dr. Nelson Rego, Dr. Jeffrey Rouse, Dr. Jose Luis Ruiz, Dr. Rick Schwarting, Dr. Bruce Small, Dr. Irwin Smigel, Dr. Jon Suzuki, Dr. John Svirsky, Dr. Terry Tanaka and Dr. Martin Zase.

Esthetic dentistry is a relatively recent discipline in the realm of dentistry. The materials, techniques and technologies we now employ in the dental operatory and laboratory are the best ever in terms of providing the ultimate in strength, longevity and esthetics. We are now able to deliver esthetic restorations that are virtually impossible to differentiate from natural dentition. But this was not always the case. In the primitive days of restorative dentistry, the beauty and anatomical realism of the restoration were not as important as reestablishing the ability to eat and speak. Restoring masticatory function was the first and foremost concern.

Using modern techniques, materials and processes both in the operatory and at the laboratory, we are now able to regularly produce indirect dental restorations with precise and predictable fit, finish and anatomical accuracy. The creation of a dental restoration requires two components to be successful: a scientific component and an artistic one. Before the advent of in-office CAD/CAM restoration systems such as CEREC 3D, indirect cosmetic restorations were primarily the domain of the dental laboratory. CAD/CAM dentistry and its associated machines, computers and programs represent the scientific principles of restorative technology. The majority of the parameters we deal with here, as in most science, are absolutes. We can instruct the CAD/CAM system to produce a crown coping slightly larger than the preparation stump to allow for the exact amount (in microns) of space required by the bonding agent. We can “show” the system where the opposing and neighboring dentition are located, and it will, in a matter of milliseconds, propose an occlusal anatomy that fits and functions as naturally as the real thing. While machines are excellent in dealing with parameters, values and measurements, they are not yet able to accomplish the artistry required to produce an esthetically ideal restoration. Esthetics encompasses the art of the restoration that only a skilled artisan can accomplish. CAD/CAM systems have freed the lab technician from repetitive, labor-intensive fabrication tasks. On the lab side, this freedom allows the technician to concentrate more on the art and esthetics of the restoration.

Because the CEREC crown is milled from a VITA block—a single, solid block of industrially manufactured machinable ceramic material—microflaws or cracks were not a concern. Furthermore, certain variables that are attributed to entirely lab-fabricated restorations can be eliminated by using the CEREC 3D plus laboratory cutback and esthetic porcelain application technique described herein. For example, there is no issue with shrinkage of impression material, nor is there concern for shrinkage of stone used to pour the models—these steps are eliminated with this technique. The accuracy of the fit is predetermined at the dentist’s office, so the dentist has the confidence of knowing that the margins are ideal before he sends the restoration to the lab for build-up and characterization. Of course, the original and primary intent of chairside CAD/CAM restorations is to design, fabricate and place all-ceramic indirect restorations in a single patient visit, thereby eliminating the need for any lab intervention. However, there are certain unique case circumstances that can benefit greatly by employing a synergistic combination of both traditional lab-based restorative techniques and chairside CAD/CAM.

Like all things on earth, nothing stays the same. Change is inevitable. Things get better and they get worse as time goes on. This constant flux of life pertains to business as well. We have all felt the repercussions of a fluctuating economy this past year. As a new year is ready to unfold, I would like to share with you how I found a way to work less without scarficing income, increase the quality of care provided to our patients, even in an economic downturn.

A little over two years ago, I discovered a technology that I considered to be one of the biggest breakthroughs in restorative dentistry since the implementation of posterior bonding — chairside CAD/CAM. Since my discovery, this CAD/CAM system has brought more excitement and revenue to my practice than I could have hoped for. It has enabled me to offer high- quality restorations to my patients in one visit, and to be confident about the work that I do.

The patient saves money, too!

Financially, the patient saves money in the long run. Dentists often see failed crowns, root canals, bad extractions, etc. Now you can offer your patient an alternative in preventative care that will last much longer than a composite or amalgam. That means the CEREC restorations actually cost the patient less over the life of the restoration. If these patients then follow proper oral hygiene maintenance, they will be making fewer visits to have alternative restorations redone. Providing patients with the best noninvasive care, helping them maintain healthy tooth structure, and offering them better aesthetic alternatives add up to a satisfying experience for them and for us.

Recently, one of my technology-savvy patients told me about how he enjoys being able to “timeshift.” The first thing I thought was maybe he invented some sort of time machine. Turns out, that is not too far from the truth. Timeshifting, he says, is a new buzzword to describe the function of digital video recorders (DVRs) that connect to television sets. Say you have a favorite TV show that airs at 10 PM but won’t be around to watch it. Not a problem when you can simply “timeshift” the show to fit your own viewing schedule. In other words, these programmable DVRs will, at the press of a button, record TV shows onto a hard drive and allow you to view them at a later time. This technology is really nothing more than a convenience item, and some would say a frivolous luxury. But I say give it time. It is amazing how rapidly life’s luxuries become so pervasive and routine that they shift from “cool new tech toys” to absolute “cant-live-without-it” necessities. Look what happened with the Internet, cell phones, Blackberries (the mobile computing devices, not the fruit!), and iPods. They have become ubiquitous, and most who own and use them say they have become necessities of daily living.

This got me thinking about technologies in dentistry that many in the profession initially wrote off as gimmicky, faddish or just a nonessential high-tech item. Digital radiography comes to mind, and so does in-office CAD/CAM. I enjoy new technology and am often one of the first to incorporate new devices, tools, and techniques into my practice. I’ve got lasers, digital radiography, and CEREC 3D (Sirona Dental Systems). All of these have become an integral part of my treatment armamentarium-so much so that I have come to rely on their practical application in everyday dental practice. In a way, these high-tech tools have enabled me to incorporate my own brand of timeshifting.

With digital radiography, radiographs are viewable within seconds, not minutes. Plus, digital radiography gives us the ability to recognize changes over time by superimposing a radiograph of a certain tooth over a radiograph of that same tooth taken weeks, months, or years earlier. Because it is digital, the computer can highlight and display only those areas that differ between the two images, resulting in a snapshot of any physiologic or pathologic changes that occurred over time. How’s that for timeshifting?

Chairside CAD/CAM restorations also allow me to timeshift by completing most cases in one appointment rather than the 2 or 3 required with lab-involved procedures. As for soft-tissue lasers, they’re easier to use than a blade, and due to their ability to produce immediate hematosis and tissue cauterization, we’ve shifted healing time from a few weeks to just a few days. But I digress. Let us move on to a case report in which all of these technologies and more were utilized to provide the patient with what I call “good, old-fashioned, state-of-the-art treatment.”

CASE STUDY CAD/CAM Restoration Design

CEREC software allows the dental professional to select the design technique that is most appropriately suited to the clinical situation. Deciding which one to use is influenced by the preoperative condition of the teeth and the restorative goals. For teeth that are intact and possess a pleasing, anatomically correct form that the clinician wishes to copy, Correlation Mode is most often employed. Correlation uses 2 optical impressions and allows the clinician to copy an existing tooth and all of its morphological characteristics and replicate it on the restoration. The contour of the original tooth will be kept as well as height information. Another mode, Dental Database, taps anatomical data for the tooth to be restored. Dental Database is ideal when replacing cusps, as it will automatically design the cusp in the buccal-lingual, mesial-distal and cervical-occlusal dimensions, as well as allow the development of custom embrasures, marginal ridges, contacts, and and contours for that specific clinical situation. Lastly, Replication Mode allows the clinician to copy an image of the contralateral tooth, which is converted into a mirror image, thus resulting in a restoration with perfect morphological symmetry. For this particular case, Correclation Mode was chosen, and although the patient’s existing teeth would not function as ideal correlates, this was easily remedied with a diagnostic wax-up that would later serve as a correlate model. Dental Database was not used because there were no cusps involved with these veneers, and Replication was not used because the case did not call for a simple duplication of the patient’s existing anatomy.

Pateint Presentation

Several existing factors were taken into consideration and serves as an impetus for using the CEREC Correlation technique. First, the patient’s natural teeth were too small, resulting in diastemas between the central incisors, both maxillary lateral incisors, and cuspids. Additionally, her teeth were too short, which created a “gummy” smile appearance. So, in this patient’s case we were dealing with several pre-existing conditions that were less than ideal. An orthodontic solution to her cosmetic goals was presented first, but the patient declined this option. Therefore, I decided to have my dental laboratory technician create a diagnostic wax-up of ideal tooth morphologies for each of the patient’s 8 teeth that showed when she smiled and thus were to be restored.

Teatment Planning

Performing a diagnostic wax-up is an integral part of any cosmetic restorative treatment plan. It allows the clinician predictability of end results by controlling the many restorative factors leading to a successful cosmetic and restorative outcome. It enables the clinician to know where the incisal edge position for the anterior teeth will need to be, where the protrusive and lateral excursions will function, how large and long the teeth will be when inserted, and what the contours and line angles will be in order to meet aesthetic and restorative goals. Using the CEREC system, these wax-up serve well as the correlative models. The CEREC computer will superimpose these correlative images over the images of the preparations. The marriage of these perfectly proportioned wax-up teeth and the preparations of her natural teeth will come together to form the design of the patient’s veneers. Now, some may say, “Why get the lab involved-doesn’t that defeat the purpose of chairside-fabricated CEREC restorations?” My answer to that is “No, it does not.” As I have gained confidence and experience using my chairside CAD/CAM computer, the desire and ability to perform more complex cases has increased; incorporating the services of a ceramist merely adds to the process. This approach still benefits the patient with reduced chair time and optimal results. The overarching function of CEREC is to create restorations that are milled from single, solid blocks of extremely strong, aesthetic, and long-lasting all-ceramic material. Not only did we accomplish that, was also completed the case within 2 short visits over a time span of 3 days. Of course, that is not the same as a single-visit, same day case completion, which is what 99% of CEREC-generated restorations represent, but we did manage to complete this rather complex case in a remarkably brief time frame with excellent results. The patient’s initial appointment was on a Monday, and her final restorations were placed Wednesday morning. In dentistry, where time is of the essence, fast is good. But faster and better is best. This case falls under that principle and gives new meaning to the phrase “best-case scenario.” Following is a review of the veneer fabrication procedure from preparation to placement and all steps in between.

Veneer Fabrication Procedure

First, extraoral photographs were made of the patient’s smile, resulting in a record of her preoperative facial, left and right smile conditions. These were used to help the doctor and the patient evaluate her smile, the lip line, and how broad it was, which helps determine the correct number of veneers necessary to achieve the desired cosmetic outcome. Additionally, it helps the patient gain understanding and motivation to move forward to the next step of treatment. Before-and-after pictures allow patients to see the difference themselves and can also be shown to new and existing patients to help market the practice. Next, preliminary alginate impressions were taken and poured up into lab stone. The lab technician then performed a full diagnostic wax-up using mounted casts on a Combi Articulator (Denar). The articulated wax-up ensured that we were able to lengthen each of the patient’s teeth to an aesthetically pleasing size, making the centrals 10.5 to 11 mm, in order to achieve the desired aesthetic, biomechanical, functional, and dento-facial results. ¹ After a consultation appointment was completed and the patient accepted the treatment plan, minimal gingival recontouring was performed using an Oddysey Diode Laser. This had the result of increasing crown length on some of the shorter teeth and also established an improved aesthetic contour of the gingiva. As previously described, the patient’s teeth were too small, which required her restorations to be lengthened in order to produce an aesthetic appearance with balanced and symmetrical proportions. The soft-tissue diode laser (Oddysey) was used to remove and reshape overgrown gum tissue at the crown of the teeth. Minimal crown lengthening was necessary to reduce the “gumminess” of her smile and, at the same time, create harmony in her gingival contours. The patient was then appointed to return 10 days later for veneer preparations. At the veneer prep appointment, a full-arch impression was taken of the patient’s preoperative dentition to be used for provisional veneers that would be worn for about 48 hours. After anesthesia was initiated, 2 full-arch putty wash impressions of the patient’s preoperative dentition were prepared using Provil Novo fast-set PVS impression material (Heareaus Kulzer). Next, an OptraGate (Ivoclar Vivadent) was used to retract both upper and lower lips. Then teeth Nos. 5 through 12 were conservatively prepared with only 0.7 mm of facial reduction and a 1 mm to 1.5 mm incisal reduction necessary to accommodate the all-ceramic CEREC veneers. With this conservative preparation technique, approximately 70% to 100% of her natural enamel remained intact in the preps. The 2 PVS wash impressions were finalized and and poured up in CAM-base stone. Rather than immediately taking separate optical impressions of all 8 of the prepared teeth, I injected an acrylic temporary material into a PVS impression of the patient’s preoperative dentition. The patient’s temporary veneers were made using EXACTA Temp Xtra and cemented in place; the patient was then dismissed. Next, the optical impressions of the patient’s prepared teeth were taken from on of the CAM-base stone models of the preparations. This is an example of timeshifting in action. Instead of taking individual optical impressions of the patient’s actual 8 veneer preparations in her mouth, which would have required her to sit for an extra 15 to 20 minutes, I let her go and took the optical impressions from the stone preparation model. This saved time for her and shaved time off the total procedure. Once the optical impressions of the preps were taken, another CAM-base stone model was fitted with and EXACTA Temp Xtra copy of the diagnostic wax-up teeth. This EXACTA Temp Xtra model was used as the correlate model, because the CEREC computer will design the veneers based on this model. The model was sprayed with IPS Contrast Spray which enables the CEREC to capture an accurate image of each tooth. Once the preparation image was captured for for one tooth, an optical impression of the correlate was taken. Next, the CEREC software combined the preparation images and the correlate images to form the basis of the veneer designs. The computer proposes a veneer design for each of the 8 teeth, which will require minimal to no adjustments since they are based on data obtained from both the ideal diagnostic wax-up and the preparation models. Once satisfied with the veneer designs, each tooth is virtually separated from its mesial and distal neighbors and they are now ready to be milled out of separate blocks of all-ceramic material by the CEREC milling machine. This material was selected due not only to its aesthetic properties, but also for its inherent strength and fracture resistance that has been shown to increase after oven-glazing, which is a process these veneers would undergo during the porcelain cut-back and characterization phase at the lab. Upon completion of milling, the veneers were tried-in on a stone model of the preparations and then taken to the lab for finalization. This included beveling back the incisal one third to incisal one half depending where we wanted enamel characterization. A putty index was used to transfer the incisal edge position from the diagnostic wax-up. We were able to create dentinal structure form by adding porcelain using add-on porcelain kit containing color modifiers and IPS Style shade and stain kit used for ProCAD blocks. After they were fired in a vacuum furnace for 15 minutes, and additional enamel porcelain layer was placed over that modified veneer, vacuum fired, and glazed. They were then shipped back to the dental office via courier. Wednesday morning, just 2 days after her prep appointment, the patient returned to the dental office for placement of the final restorations. Upon anesthesia with a single palatal injection for her maxillary 6 anterior teeth and a buccal infiltration for her bicuspids, her temporaries were removed and the preps were cleaned and readied to accept the veneers (Figure 13). Before cementation, the underside of each veneer was gently air-abraded with a 50-µm alpha-aluminum particle using a Danville Micro Etcher. This created a roughened texture and increased the surface area to enable maximum adhesion with the bonding agent. Next, the undersides of the veneers were treated with 5% hydrofluoric acid-etch, followed by the application of Clearfil Porcelain Bond. Each tooth was etched with 32% phosphoric acid etchant for 15 seconds and then washed for 20 seconds using water. Nexus 2 base clear enameling cement (Kerr) and OptiBond Solo Plus bonding agent were used; the bonding agent was light-cured using the Blue-phase curing light (Ivoclar Vivadent), excess cement was removed with a hand scaler and No. 12 Nard-Parker, and adjustments were made using a red stripe finishing diamond. The veneers were polished using Ceraglaze polishing cups and points. The patient’s teeth were examined at a recall appointment 2 weeks later. She reported no problems or functional issues, and loved her new smile. Her gingival tissue also demonstrated excellent healing.

Conclusion

Incorporating the use of proven, high-tech tools and equipment in complex procedures assists the clinician in achieving favorable outcomes. Some of this success can be attributed to the nature of computers and their ability to simulate real-world conditions in a controlled, digital environment, an environment where we can shift time to the future, allowing us to see end results on-screen before we apply the “digital steps” taken to get those results into practice reality. Computers allow us to ask “what if?” and then test - and verify - our theories in virtual simulation. If the results are not what we anticipated, we hit the “undo” button and try again until the results are right. This degree of end-result predictability can lead to a higher level of treatment acceptance and patient satisfaction by way of streamlined, efficient, and more confident approaches to treatment, with demonstrable outcomes. Dr. Benk is a nationally recognized teacher and an internationally certified trainer in the CEREC 3D method, an author, and a lecturer on high-tech integration and practice management. He has lectured to and trained more than a thousand dentists on how to achieve outstanding clinical and aesthetic results with machinable ceramic restorations using the CEREC 3D method. He has published multiple articles about practice intergration and achieving excellent clinical results with chairside mechinable ceramics. Dr. Benk is currently in private practice in Atlanta, Georgia.

Advances in dental technology and cosmetic dentistry have helped solve the problems of patients, the dentist, and office staff. Today’s baby boomer generation is demanding more and more cosmetic procedures and they look for the dental office able to deliver to them that “winning porcelain smile” as quickly and efficiently as possible. These “time-impaired” consumers are eager for treatment once they realize that their dentists can deliver aesthetic, long-lasting restorations and a beautiful smile in both posterior and anterior regions of the mouth.

Cosmetically aware patients seek out the high-tech dentist. Today’s state-of-the-art dental practice may contain such items as digital x-rays, electric handpieces and intraoral and extraoral photography. The dentist fitting this profile will have a clean, modern office and make every effort to distinguish the practice accordingly to help attract this type of patient. The staff works together to develop the kind of relationships that help get patients through the hurdles sometimes encountered while working toward the cosmetically restored smile. With proper case selection and training, unpredictable aesthetic outcomes have become few and far between, thanks to the explosion of advanced technology in today’s dentistry. Nothing is more frustrating for both the doctor and patient than an aesthetic restoration that falls short of expectations. And the demand for cosmetic dentistry is at an all-time high; bleaching, veneers, implants, laser gum surgery, bone grafting, all-ceramic restorations, and invisible braces have all become the standard in dental practices rather than the exception. Television shows such as “Extreme Makeover” have become a catalyst, driving patients into the dental office seeking a new, cosmetically pleasing smile makeover. One of the greatest challenges facing today’s dentist is keeping up to date on technology and trends in the industry. Those who are able to possess an edge that will allow them to take a leadership position in today’s dental marketplace will actively be evaluating new technologies and incorporating those that benefit the patient, dentist and practice. Fortunately, manufacturers strive to develop user-friendly products with reduced learning curves. Once mastered, new technology and systems can be a very welcome tool for the cosmetic dentist. Additionally, master clinicians continue to raise the bar by developing predictable techniques that routinely produce life-changing aesthetic results for both the patient and dentist alike. The following case report provides an example of meeting an aesthetic need by utilizing new technologies.

CASE REPORT

A 27-year-old patient presented with the chief complaint that her front teeth were too flat. She also felt that her laterals were too short and wanted to have something done to improve her smile (Figure 1).Utilizing a Canon G3 camera with a diffuser macro lens, extraoral photographs were taken of her smile, including both maxillary and mandibular teeth. Restorative options were discussed with the patient to determine her preferences and goals for the treatment. The patient was shown the CASEYY video on the goal of cosmetic dentistry and was provided the options available to improve her smile. Due to a limited budget, the patient opted to lengthen her maxillary laterals and aesthetically contour the maxillary centrals, cuspids, and 6 mandibular anterior teeth.

After placing CEREC 3D (Sirona Dental Systems) posterior restorations, the patient asked if the veneers could be completed in one visit (Figure 2). The Easy-shade digital shade guide (Vident) was utilized to determine that a TriLuxe block (Vident) would be an optimal aesthetic match. Both laterals were mocked up with composite (Figure 3), generating additional porcelain thickness so that the milled restoration could be contoured along with the remaining teeth to achieve the smile result the patient envisioned. The CEREC 3D Correlation program was used since it allows the dentist to make an exact copy of the tooth (in this case, the composite mock-ups). A thin coat of titanium dioxide powder (Figure 4) was placed on the mocked-up laterals and a pre-operative optical impression was taken of teeth Nos. 10 and 7 (Figure 5). The optical impressions were stored in the Image Catalogue under the CEREC 3D Occlusion icon. Both teeth were then prepped for veneers, reducing the incisal 2mm with a butt joint on the palatal margin (Figure 6). A No. 7 retraction cord was then placed in the facial sulcus. The mesial and distal proximal margins were extended lingually, and the contact was opened (Figure 7), allowing the margins to be easily coated with powder (Figure 8) and virtually trimmed using the CEREC 3D software trimming tool. This type of margin also makes it easier to seat the veneer and polish the lingual margin after seating. A sloping shoulder facial margin was placed, with a crisp, clean, and easily defined cavosurface margin. The sloping shoulder allows the porcelain to disappear into the tooth, creating the ultimate chameleon effect. An optical impression was made of the powdered preparation (Figure 9) and placed into the Image Catalogue using the Acquire Preparation icon. When using the CEREC 3D Correlation Program, the occlusal view is generated, and an outline of the facial, lingual, mesial and distal heights of contour is traced to obtain the mocked-up veneer’s mesial/distal dimension and the facial/lingual heights of contour. The next step is to copy as much of the mocked-up preoperative tooth as possible by using the Copy Line function (Figure 10). This function allows the copying of anything inside the generated line; in this case, the incisal edge and mesial, distal, facial and lingual surfaces. The veneer was then proposed on the virtual model (Figure 11). The final edits to the restoration were then accomplished, paying close attention to the interproximal to ensure that enough porcelain would be milled to fill the facial embrasures. The veneer was then previewed (Figure 12) before milling to ensure that the sprue was located on the mesial of the TriLuxe block so the the 3 layers of porcelain (facial, body, and cervical) would be milled out to the correct position. With milling completed, the sprue was cut off using a diamond wheel mounted on a straight handpiece, and the veneer was tried in (Figure 13). Contact pressure was carefully adjusted to preserve interproximal porcelain from the facial so that the facial embrasure remained closed. Once try-in was completed, the veneer was polished and the surface to be bonded was microetched with a Danville Micro Etcher. This sandblasting process functions both to remove the oily residue left from milling and to produce a better surface for bonding. The porcelain surface was then etched with 5% hydrofluoric acid for 60 seconds and thoroughly rinsed and dried. Monobond S (Ivoclar Vivadent) silanation agent was painted on, then completely dried after 60 seconds using a dry air syringe. Excite (Ivoclar Vivadent) was placed on the porcelain surface, and the veneer was then placed under a dark lid, ready for bonding. The preparation was cleaned with a peroxide scrub in an effort to remove all of the powder coating, then etched with 36% phosphoric acid for 15 seconds. Multiple applications of Gluma (Heraeus Kulzer) were applied to the rinsed-off wet dentin. After the first coat, it was blown dry, and an additional 2 or 3 coats were applied and dried so that the dentin appeared shiny. It was then light-cured for 20 seconds. Prime & Bond NT (DENTSPLY Caulk) was then placed, air-thinned, and light-cured. Variolink II base clear (Ivoclar Vivadent) was loaded into the the veneer and light-cured for 60 seconds. The excess cement was then removed and the veneer was polished. Aesthetic contouring of the incisal embrasures was completed, creating a rounded embrasure and a much softer smile line, which was the patient’s aesthetic goal from the outset of the procedure (Figure 14).

CONCLUSION

By utilizing the latest advances in technology, we are able to quickly and accurately respond to the patient’s demand for a highly aesthetic smile. Dr. Benk is a graduate of Emory University Dental School where he served on the faculty before the dental school closed. He is a cerified trainer in the CEREC 3D method and teaches and lectures on both Advanced and Basic techniques to dentists and their staffs. He is private practice in Atlanta Georgia.