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.
2. Endodontic access opening before sealing and build-up with GC everX posterior.
3. Overlay preparation on mandibular first molar after Immediate Dentin Sealing.
4. The oxygen-inhibition layer of the IDS is removed by additional light curing after application of glycerin gel.
5. Overlay preparation after re-finishing of the enamel margins.
6. Buccal view of the overlay preparation with both jaws in occlusion.
7. Aadva intraoral scanning device.
8a. Scan of the lower jaw with overlay preparation on the mandibular first molar.
8b. Scan of the upper jaw.
8c. Bite scan.
9. Computer-aided design of the overlay restoration. (Aadva Dental CAD).
10. The fit and adaptation of the milled overlay restoration is evaluated on the digitally fabricated models.
11. Internal aspect of the Cerasmart restoration.
12. Internal aspect of the Cerasmart restoration after sandblasting.
13. Internal aspect of the Cerasmart restoration is cleaned with phosphoric acid.
14. Application of Ceramic Primer II (silane coupling agent).
15. The IDS-layer is cleaned and reactivated by sandblasting. Neighbor teeth are protected with Teflon tape.
16. Enamel margins are etched with phosphoric acid gel.
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.
18. Seated overlay restoration. Excess luting composite needs to be removed with a probe and Super Floss.
19. All margins are covered with glycerin gel and additionally cured.
20. Cerasmart restoration after finishing and polishing.
Case by Dr. Filip Keulemans, research associate at Turku Clinical Biomaterials Centre (TCBC) at University of Turku (Finland).