hello and welcome to chairside live I'm your host Megan strong thanks so much for joining us in
today's episode dr. justin cheese removing some fractured ceramic crowns on number 14 in number
19 and he's replacing them with Bruck Surnow crowns milled chairside and here's one of the
great bonuses of chairside digital dentistry while the crowns are milling you can do other work on
the patient as dr. qi did in this case removing decay from the mesial of number 15 let's check
it out we have a 50 year old male that presents with a fractured Emax crown on his upper left
first molar number 14 that also appears to have super erupted most likely from the low occlusal
position of the crown on the lower left first molar number 19 we plan to replace both with
Brooks er now crowns mill chairside using the glide wall in office solution the upper left
second molar also has a large cavity on the mesial so we'll work on that while the crowns are milling
based on the pre-op radiograph I initially thought number 19 was a porcelain fused to zirconia crown
because of the radio pasady near the margins and the core so I began the removal with a 557 carbide
as I usually do for feldspathic porcelain but it was really difficult to cut through switching to
a zur cater diamond bur made the sectioning a bit easier realizing now we have a bonded
ceramic restoration I needed to make several sectional cuts through the crown to separate
it off the prep I then refine the prep with a coarse grit rounded tapered diamond and 850
Oh 1/8 on the axial surfaces to create a Shan furred margin that's position equitably I like
to ensure my crown preps have at least a half millimeter genival wall that I verify using a
pareo probe I trace the margins with the probe to confirm there's an apical stop and that it's
smooth circumferentially by establishing enough reduction at the margins it creates a sharp cable
surface finish line that makes it much easier to identify where the margins are to complete
the prep I ensure the axial walls have adequate taper and the internal angles are rounded next
I place a size 2 chord and let that sit for a few minutes while I prep the upper molar I
make sectional cuts along the buccal occlusal and lingual to the depth of the prep with a zerk ater
diamond bur I ran into an issue here when trying to separate the crown with the Christensen crown
remover when I twisted clockwise to separate the crown part of the lumineer on the second
premolar fractures off next time I'm in a similar situation I'll add a mesial to distal slot on the
occlusal and try separating along bat to hopefully apply less force against the adjacent teeth the
good news is that the patient wants to replace his veneers anyway for something more aesthetic
so at least we got a head start on that since the tooth super erupted I reduce more on the
occlusal until the prep is about one and a half millimeters below the adjacent teeth so the final
crown can be in the proper plane of occlusion I refine the rest of the prep following the same
guidelines as before chamfer margins adequate taper and rounded internal angles I also place
a size 2 chord here for gingival retraction since the margins are all equal changeable
for having set for several minutes now I remove the retraction cord from the lower molar to expose
the space between the prep and tissue which is exactly what we want for an accurate impression
once the cord is removed we dry the site very well and begin our digital impression with the
I taro element we first take a high-resolution image of the prep then add in the rest of the
adjacent teeth to complete the lower quadrant scan we'll repeat the same on the upper molar with a
high res scan of the prep followed by the rest of the quadrant as I sweep the scanner along the
occlusal buccal and lingual I watch the screen as the system continuously builds the digital model
and will deactivate the camera once I determine enough of the quadrant is captured it's really
important to ensure the contact surfaces of the adjacent teeth are captured in these scans the
digital impression is then transferred to the fast design software where we're able to custom
design both opposing restorations at the same time I build both designs to better match the
occlusal planes of the surrounding dentition and can easily verify the functional positions from
both the buccal and lingual views the final check is to establish the correct proximal and whose
will contact parameters the great thing with digital is each clinician can custom set these
values to their preferred settings after five minutes when the design is complete I'll load
a Brooks renowned block and diamond number into the fast mill while these crowns mill
it's a great opportunity to work on any other procedures the patient may need in this case
I'll remove and restore the cavity on the mesial of the upper second molar with the tooth prepped
away on number fourteen I have clear access to approach this class to lesion from the mesial
using a round diamond I begin the caries removal by extending towards the gingival occlusal buccal
and lingual until healthy sound tooth structure surrounds the decay I'll then use a slow-speed
carbide to remove the deep caries I place a dry double zero chord in the mesial sulcus
to help displace the tissue a bit more apical e is the prep with curves phosphoric acid for 15
seconds rinse and dry ensuring not to desiccate the dentin followed by a 1-minute application
of glue midi sensitizer after a minute I'll use a surgical suction to aspirate any excess
then I'll scrub scotch bond university the prep for about 20 seconds I incremental II restore
the cavity using camouflage nano hybrid flowable composite I use a fine grit diamond bur for the
grouse finishing and contouring then polish to a smooth finish with the Venus Supra polishing kit
we now have the lower crown finished and ready to try in once the sprue is removed when the
correct parameters are dialed in on the software there's very little to no adjustments needed
to the proximal contacts we cement this crown in place using three M's resin-modified glass
ionomer rely exluding plus the excess is easily removed when it enters a gel state after 2 minutes
these restorations come right at the mill with a very nice surface finish for this lower crown i
polished the surface using clinicians choice all surface access polishing kit for the upper crown
I added low fusing stain and glaze from the Obsidian CAD kit to show a comparison between
the two finishing options as expected due to the mesial compositor number 15 some adjustments are
needed on this distal contact we mark the contact using a small strip of articulating paper so I
know exactly where to reduce once the proximal and occlusal contacts are properly adjusted we
go ahead and cement this crown also using three ends rely exploding plus we were able to address
the patient's concern by efficiently delivering very strong and aesthetic Bruck Surnow crowns
each restoration took 40 minutes to mill so when fabricating multiple brookster crowns chairside
that time must be taken into consideration for your scheduling both crowns were milled using
an a.1 block but if additional characterization is desired you can see the difference the ten-minute
optional oven cycle can provide these restorations if you'd like more information on how the system
can enhance your practice please visit Glidewell dot IO thank you for tuning in for this episode
of chair sight life back to you Meghan thank you for that dr. Qi for more information on how you
can seamlessly integrate digital dentistry into your practice visit Glidewell dot IO
well that about wraps it up for this episode of chairside live on behalf of everyone here
at Glidewell dental thank you for watching and I'll meet you right back here next time