Indirect and Direct Restorative Protocols - Caulk

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› “A distinct chamfer or rounded shoulder, very similar to a PFM preparation, enables effi cient scanning of my preparation and ensures the proper fi t of my CERCON Zirconia restorations.” Lou Graham, DDS Private practice, Chicago, IL. › Protecting Your Investment All-ceramic restorations offer superior aesthetics and represent a signifi cant investment on the part of the patient. Bruxism following treatment can cause fracturing, resulting in a failed restoration and the need for additional treatment. iNterra INoffi ce Nightguard (DENTSPLY Caulk, Milford, DE) can help protect the investment by: ■ Providing a comfortable fi t to ensure patient compliance; ■ Cushioning the teeth to prevent damage to the restoration; ■ Providing wear resistance to ensure that the restorations will remain protected for many years; and ■ Enabling a single-visit, in-offi ce solution that protects the patient’s new smile. With more than 45 million patients affected by bruxism, prescribing an iNterra INoffi ce Nightguard (DENTSPLY Caulk, Milford, DE) nightguard represents a clear long-term benefi t to the longevity of the restorations and the health of the patient. Nightguard images appear courtesy of Dr. Mike Malone, Lafayette, LA. to the benefit of both dental patient and professional. The development of complementary material technologies (eg, zirconia) has furthered the benefit of CAD/CAM to the dental field by ensuring long-lasting, durable results in all-ceramic restorations. Accurate preparation and impression taking are still required of the clinician to ensure accurate scanning by the selected CAD/CAM system. Precise fit of the final restoration and the artistry of the laboratory technician are also necessary to develop natural aesthetics (Figures 3 through 6). The benefit of CAD/CAM technology is that it allows these professionals to dedicate more time to their art and their practice, while providing strong, aesthetic results faster. ■ 20
› PRINCIPLES & PRACTICES Cementation Guidelines: Clinical Recommendations and Requisites › Abstract: Cementation of an indirect restoration involves numerous variables that include the luting material itself and the clinical technique used to seat the veneer, crown, bridge, or inlay/onlay. Composite resin cements are often used in conjunction with dental adhesives and chemically bond to numerous restorative materials, facilitating their adaptation to a properly conditioned tooth surface. This presentation discusses a series of considerations and clinical requisites that can aid the practitioner in this important phase of treatment. In fixed prosthodontics, the clinician’s ability to achieve an aesthetic, functional outcome depends on a variety of factors that include the cementation protocol. The luting cement used in such procedures has to possess high compressive and tensile strengths in addition to serving as an adherent between the natural tooth structures and the selected restorative material. Among numerous other favorable characteristics of an ideal cement are its biocompatibility, radiopacity, ease of delivery (eg, handling, working time), and low film thickness. For their part, resin cements are categorized as one of the following based on their activation mechanism: ■ Light-cured: Recommended for indirect ceramic or composite restorations less than 1.5 mm in thickness; ■ Dual-cured: Ideal in porcelain veneers, composite veneers, and other indications in which light penetration is limited to 1.5 mm to 2.5 mm through a dental restoration; ■ Chemically cured: Indicated for restorations (eg, all-ceramic crowns, metal restorations, intracoronal restorations greater than 2.5 mm in thickness) that will not transmit light upon seating. Care should always be taken to ensure that the cement’s shade is compatible with the desired restoration upon seating of a ceramic restoration (Figure 1). An ideal resin cement will possess strong adhesive properties and marginal integrity, and will protect against marginal microleakage (see Sidebar). Furthermore, its flow will be defined by the height and taper of the preparation; the higher and more cylindrical the preparation, the less cement will escape, and a greater cement line will be present. Once the fit of the ceramic restoration has been confirmed and its intaglio surface has been treated, the prepared teeth should be conditioned (Figures 2 and 3). Today’s total-etch and self-etch adhesives simplify the seating appointment by combining steps (ie, etching, priming, bonding) previously involving multiple components. If the total-etch technique is selected, the clinician Figure 1. Shade selection of the resin cement may signifi cantly affect the fi nal shade of all-ceramic restorations (Courtesy: D. Greenhalgh, Mill Creek, WA). Figure 2. Once the tooth is conditioned, the interior of the ceramic restoration should be treated with a silane coupling agent to improve adhesion and ensure a durable bond. 21
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Indirect and Direct Restorative Protocols - Caulk

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