i spend no more than three minutes marking the margin and designing the restoration in only 35
minutes the fully electric fast mill completes the crown i'll take you through the easy process of
using the glidewell.io cad cam system to fabricate a brux or crown chair side we have a 28 year old
male whose chief complaint is pain and bleeding gums around the crown in his lower left quadrant
he presents with a full coverage gold crown on his mandibular left first molar tooth number
19 that has localized gingivitis characterized by the swollen purple gums around the crown the
over contoured crown with an extensive overhang is the primary cause the plan is to replace the
crown with a same vis restorative approach utilizing the glidewell.io chairside system
since the tooth is endodontically treated i only administer local infiltration for
gingival pain control i begin the removal of the old crown with a 557 carbide to section through
the buckle and occlusal once i can visualize the prep i use a 90 degree christensen crown remover
to break the seal between the crown and tooth and wiggle the crown off using crown removal forceps
from the buckle view of the old prep we can see the occlusal surface of the prep is almost even
with the occlusal table of the adjacent teeth it'll be important to reduce this further
to allow adequate room for our bruxer crown i begin refining the preparation on the occlusal
using a coarse grit football diamond with the tip slightly angled downward to ensure the central
faucet area is deeper to allow for more natural contours of the crown on the axial surfaces i
use a coarse grit 850 018 bur to establish a one millimeter chamfer margin with a periodontal probe
angled toward the tooth with light apical pressure i trace along the margins circumferentially around
the tooth to verify that there's adequate reduction and it's smooth and continuous
for hemostasis i typically use ultra viscosity clear but the severely inflamed tissue around
this tooth didn't really respond so for these situations i use a 12 percent ferrous solution
astringent x which is ultra dense most powerful hemostatic agent here i'm using kerr's pink flex
tab to verify that i've established at least one millimeter of occlusal clearance for the
final prep i'm aiming to establish adequate axial reduction to create a sharp cable surface margin
adequate occlusal reduction for strength and ideal anatomy of the final restoration
and smooth and rounded internal angles so that we can have an optimal fitting restoration
since all the margins are sub-gingival i'm placing a single size ii cord into the sulcus to retract
the soft tissue for our optical impression i remove the cord after five minutes and then
isolate and dry the area for the impression once i've captured the upper lower and bite
the digital models are transferred to the fast design workstation where the first
step is to identify the margins i'll guide the software with a series of clicks along the prep
this step is made easier by creating a sharp cable surface margin and providing enough tissue
retraction after the margin is placed i then establish the occlusal in buckle orientation
so the software will know how to best position the library tooth for this prep
once fast design establishes the correct tooth orientation we can customize the initial design
proposals angulation position and size from there the software analyzes the adjacent and opposing
dentition to establish the appropriate proximal and occlusal contacts for this restoration
which can then be adjusted to the user's desired strength values
i spend no more than three minutes marking the margin and designing the restoration
when the design is completed i load and lock in a bruxer now block within the block holder
and seat a new diamond burr in the mill collet because bruxernow is a fully centered zirconia
each block comes with a new single-use diamond burr that was specially designed
for this purpose in only 35 minutes the fully electric fast mill completes the crown
the sprue connection between the crown and the rest of the block is also reduced in size by
the mill so users can easily snap the crown off i'm now using a fine grit red stripe 850
018 diamond bur to finish down the remaining sprue with light pressure i run the burr side to side
until the crown's contour is smooth and continuous in this area if proximal contacts are heavy
i like to position a cut piece of troll foil articulating paper between the crown and adjacent
tooth to mark the contact this way i'm not blindly adjusting the mesial and distal surfaces
next i check the occlusal contacts again with troll foil articulating paper
by dialing in my preferred contact settings in the design software
there's typically very little to no adjustments needed i'll now complete the finishing of the
crown with a spiral polisher from clinician's choice asap polishing kit it's incredibly easy
to get a high shine using these polishers on any type of restorative material in fact
for our chair side mill bruxer crown i only use the pre-polisher since this patient's adjacent
teeth aren't very smooth and shiny once i polish the restoration the crown is ready for delivery
i scrub a small amount of gluma onto the prep to help disinfect and clean the surface
and if the tooth was vital it would also help with desensitizing
i cement the crown with 3m's reliax looting plus which is their resin modified glass ionomer cement
after about two minutes the cement enters its gel state and makes removal of excess pretty easy
with this amazing chairside technology in less than 50 minutes we were able to capture
our digital impression design and mill a fully centered monolithic zirconia crown
i'm always so impressed with the speed in which we can deliver the strongest restorative material
we have in dentistry without any compromise in quality and fit thank you for your time