CEREC: Form, Function & Beauty
Posterior Advanced CEREC Training
Preamble: My Posterior Advanced Course has always had as a focus two concepts: predictability and prognosis. The more predictable each step of a restorative procedure the faster, the more stress-free, the more accurate the procedure. Think of final impression acquistion in a traditional crown & bridge procedure; if you do not take certain steps in advance such as hemostasis and gingival retraction you stand only a small chance of acquiring an accurate impression. And so it is with all procedures in restorative dentistry; speed, comfort and quality come from a technique that has a predictable outcome for each step. And with predictability comes prognosis. Every one of our restorations must have a favourable to good prognosis; our patients demand it.
How does this apply to CEREC? Have you ever clicked next in Dental Database only to have a proposal that looks like lunar landscape? Have you ever bonded a restoration fabricated using Antagonist, Correlation, Replication only to have 20 minutes of occlusal adjustment? Have you ever spent a significant amount of time (over 3 minutes) designing a restoration only to produce a mediocre result? Have you ever reduced a tooth 2mm only to have less that 1.5mm of ceramic thickness? Do I really need to continue with all of the challenges we CEREC users endure?
All these and much more are covered both theoretically and clinically. Many of the concepts will be demonstrated through video. My presentation material is both evidence-based and clinically proven. Please join me in our quest for CEREC excellence.
Module 1:
Restorative Materials: Vita, Ivoclar and 3M... a bunch of ceramics and a plastic. Each company has introduced new materials. How does one choose?
Tooth Preparations: Over 90% of challenges with CEREC can be attributed to tooth preparation. These challenges run the gamut from design issues to fit issues to issues of longevity of the restoration. The introduction of the step bur significantly redefines tooth preparation. Certain preparation rules must never be violated to predictably and consistently ensure immaculate marginal fit with adequate ceramic thickness. The step bur has created a mini-revolution in CEREC preparation design.
Treatment Planning: Is every case a CEREC case? What is the thought process that must go into every case to predictably ensure the fabrication of a final restoration with good prognosis.
Module 2:
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: Dental Database may give you some pretty funky proposals if your optical impression is not taken in a very specific way. Techniques for proper image acquisition in all design modes will be both discussed and demonstrated.
CEREC Design:
Dental Database: The old staple of CEREC, Dental Database Mode, has only limited application. We will discuss and demonstrate when and how to use this mode. The goal is a restoration that is at least close to being occlusally correct using a design time of under 3 minutes.
Dental Database with Antagonist: Achieving occlusally and anatomically correct restorations with this mode requires strict attention to a few details. This design mode can be fast and very accurate. We will discuss and demonstrate this mode in detail.
Articulation: The concept is excellent: use the patient's mouth as our "fully-adjustable articulator" The technique is not easy: there are some pitfalls along the way. This technique will both be discussed and demonstrated.
Module 3:
CEREC Design:
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.
Correlation - This is the easiest, fastest, least brain-intensive design mode in CEREC. We MUST though have something good to correlate and we MUST ensure physical matching of the images to ensure proper occlusion. Case selection, occlusally and anatomically correct correlate fabrication, image acquisition and design technique will be discussed and demonstrated.
Hemostasis: So many products; so many techniques. This discussion will allow you to choose when to use which product and technique.
Dry Field: A dry field is mandatory. If you do not have it you should not use bondable restorations. A few different techniques will be covered.
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:
Endodontically-treated teeth: The literature is clear: restored endodontically-treated teeth have a much higher failure rate than restored vital teeth. We will discuss techniques and CEREC design that improve prognosis predictably.
Finishing & Polishing: We must finish and polish our CEREC restorations quickly but for purposes of coefficient of wear we must do this well. Speedy extra-oral and intra-oral techniques are discussed. Its all in the tools and the technique.
Quadrant Strategies: There are two techniques to deal with the fabrication of multiple restorations in a quadrant. Choosing the correct technique for a particular case ensures speed. A detailed explanation of when and how to use each technique.
Practice Management: Our offices vary from the multi-operatory, multi-practitioner facility to the boutique practice. How does CEREC technology fit into each different scenario.
Ceramic Customization: For that extra touch of finesse. A very easy and very fast technique will be taught and demonstrated.
