CEREC: The Art Form
Anterior Advanced CEREC Training
Preamble: There is only one goal to the fabrication of anterior all-ceramic restorations via CEREC technology: the final esthetics must be at least as good (or better) than what a competent commercial lab can produce. Of course, it's a given that marginal fit must be as good or better than a commercial lab. It's also a given that the prognosis of the final restoration must be at least as good as a restoration produced by a commercial lab.
No one said that producing multiple anterior all-ceramic restorations in a single appointment was easy. The rewards though are huge both from patient and doctor satisfaction. And with proper pre-op analysis, strict attention to both tooth preparation and image acquisition and comprehensive care of the details of anterior guidance and esthetics the appointment can be both efficient and very productive.
If you're looking for a way to build the cosmetic side of your practice, or to unleash your creative flair, or simply to eliminate all single-tooth commercial lab fees please join me in our mutual quest for excellence in the very hot world of cosmetic dentistry.
Module 1:
Restorative Materials: Vita, Ivoclar and 3M all have ceramic materials. Some ceramic blocks have multiple chroma and opacity; some blocks claim better translucency, flourescence and phosphorescence. To complicate matters today's dental consumer is well informed and the new world of cosmetic dentistry is very demanding. How does one choose a block from so many choices?
Tooth Preparations: In the CEREC world we live by the tooth preparation and we die by the tooth preparation. The prep was never so important as with anterior restorations. The step bur redefined the anterior prep. The milling mode one uses is equally important for success. An evidence-based argument is used to prove why we have no choice but to prep in a very specific way and use specific milling modes.
CEREC Smile Design: There are some smile design concepts that are simply inviolate in the CEREC world. These concepts and their relevance to CEREC anterior design will be discussed in detail.
Module 2:
Shade Acquisition: Accuracy with a base shade is mandatory. If we fail we have no chance of dealing with the more subtle nuances of prep shade, ceramic thickness vs. resin cement thickness and resin cement shade and opacity. Selection of base shade with bullet-proof accuracy can be accomplished within seconds with the right tools. A technique that will never fail you will be discussed and demonstrated.
Opaquing Medium: There are several different methods to achieve this incredibly important step. Techniques will be taught and demonstrated to hopefully improve your love-hate relationship with the opaquing procedure.
Optical Impression Acquisition: Anterior CEREC work requires an optical impression angle that respects the preparation to avoid overmills and subsequent thin (and therefore weak), unesthetic (headlight effect) restorations. The technique will be discussed and demonstrated.
CEREC Design: Dental Database: The old staple of CEREC, Dental Database Mode, has only limited application in the anterior segment. We must fully understand this mode though because we may need to use it as our 'back-door' plan. We will discuss and demonstrate when and how to use this mode.
Replication - This seldom used mode does have clinical relevance with proper case selection. There are though some nuances to the technique that must be respected. This mode will be both discussed and demonstrated.
Module 3:
CEREC Design: Correlation - This is the design mode of the Pros for anterior restorations. Everything from producing something good to correlate (resin mock-ups vs. diagnostic wax-ups) to properly correlated optical impressions to fast design will be discussed and demonstrated.
Anterior Guidance and Occlusion: Debonds, fractures and incisal edge ceramic chipping are almost always due to occlusion and improperly designed anterior guidance. Evidence-based, clinically-proven concepts will be discussed. The adjunctive modality of T-Scan will be presented both for pre-op analysis and post-op finishing of the case. Simple and effective fabrication of a nightguard along with techniques to sell your patients on the concept of nightguards will be discussed.
Hemostasis: Some products provide excellent hemostasis and others should never be used in the anterior segment. We will discuss materials and techniques to firstly avoid the need to use hemostatic agents and then materials and techniques that do the job without gingival recession or black lines.
Bonding: So many materials; so many opinions. A bullet-proof technique is mandatory for a good prognosis. Several materials and techniques allowing for predictable success will be discussed.
Module 4:
Finishing, Polishing and Ceramic Customization: Shaping, contouring, adding subtle nuances to a lifeless piece of ceramic until it reflects and refracts light as would nature truly is art. We will discuss and demonstrate and you will be surprised at how a systematic, controlled method produces art so fast. This is the fun part.
Quadrant Strategies: There are two techniques to deal with the fabrication of multiple restorations in the anterior segment. Choosing the correct technique for a particular case ensures speed. A detailed explanation of when and how to use each technique will be given as well as demonstrated.
Practice Management: Our offices vary from the multi-operatory, multi-practitioner facility to the boutique practice. We will discuss how to market and appoint these complex, multi-tooth, anterior CEREC cases.
