The future of restorative dentistry is … digital!

Contemporary restorative dentistry is changing dramatically over the last couple of years. Especially the development of intra-oral scanning devices and the introduction of new composite and hybrid ceramic materials suitable for the fabrication of CAD/CAM restorations opened the doors towards full digital restorative dentistry.
The present case describes the integration of a full digital workflow for the restoration of an endodontically treated lower molar, of which the structural integrity was compromised due to dentine cracks, with an indirect biomimetic CAD-CAM composite restoration.
1. Initial situation after endodontic treatment.
Pic 1
2. Endodontic access opening before sealing and build-up with GC everX posterior.
Pic 2
3. Overlay preparation on mandibular first molar after Immediate Dentin Sealing.
Pic 3
4. The oxygen-inhibition layer of the IDS is removed by additional light curing after application of glycerin gel.
Pic 4
5. Overlay preparation after re-finishing of the enamel margins.
Pic 5
6. Buccal view of the overlay preparation with both jaws in occlusion.
Pic 6
7. Aadva intraoral scanning device.
Pic 7
8a.  Scan of the lower jaw with overlay preparation on the mandibular first molar.
Pic 8a
8b. Scan of the upper jaw.
pic 8b
8c. Bite scan.
Pic 8c
9. Computer-aided design of the overlay restoration. (Aadva Dental CAD).
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10. The fit and adaptation of the milled overlay restoration is evaluated on the digitally fabricated models.
Pic 10a
11. Internal aspect of the Cerasmart restoration.
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12. Internal aspect of the Cerasmart restoration after sandblasting.
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13. Internal aspect of the Cerasmart restoration is cleaned with phosphoric acid.
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14. Application of Ceramic Primer II (silane coupling agent).
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15. The IDS-layer is cleaned and reactivated by sandblasting. Neighbor teeth are protected with Teflon tape.
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16. Enamel margins are etched with phosphoric acid gel.
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17. Application of a dual-cure self-etch adhesive system. Super Floss (Oral-B) is inserted into the interproximal areas and will help to remove excess luting agent.
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18. Seated overlay restoration. Excess luting composite needs to be removed with a probe and Super Floss.
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19. All margins are covered with glycerin gel and additionally cured.
Pic 19
20. Cerasmart restoration after finishing and polishing.
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Case by Dr. Filip Keulemans, research associate at Turku Clinical Biomaterials Centre (TCBC) at University of Turku (Finland).


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