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Inlay to Demo the Ease of CEREC 3D

Continued on page 30

Chaim Wexler, DDSAs posted on the Case Presentation section of www.dentaltown.com, followed by Townie Comments

This is a case I presented a while ago before the upgrade fromCEREC 3 to CEREC 3D. It’s a perfect example of how fast this tech-nology is changing for the better. It is almost impossible to hold on topreconceived notions of CAD/CAM dentistry. This field is reinvent-ing itself on an almost semi-annual basis.

Figure 1: Pre-op view of #29

Figure 2: Side view of #29 pre-op

Figure 7: This is right out of the milling chamber…notgreat esthetics, monochromatic and no occlusal definition

Figure 8: Same inlay after occlusal adjustment and stainand glaze but not cemented. The margins will be finishedafter cementation

Note this case shows that CEREC can produce beautiful lab quality chairside porcelain inlays in a short time.

Figure 4: Prep com-plete. Note that thisis a divergent prep

Figure 3: X-ray #29 Figure 5: Prep is cov-ered with powder

Figure 6: Cavo surfacemargin (almost perfectin the divergent prep)

Figure 9: The inlaycemented in

Figure 10: Anotherview of same inlay

Fig. 1 Fig. 2

Fig. 7 Fig. 8

doctored | Ed | Total Posts: 4716 | Post 2/19/20031:56:49 AM

Hello Chaim. I would have reshapedthe mesial of # 30 to enable a better proxi-mal contact and placed a direct compositewith better margins and esthetics in 15minutes. If it were my tooth I wouldchoose that option without any hesitation.

Why was the amalgam removed? The radiographs indi-cate much greater problems with the restorations thathave been placed on #2, #30 and #31. I wish I hadsomething positive to say, but I don’t. I hope the patientgets those horrible crowns replaced.

jrtmolar | Jason | Total Posts: 4416 | Posted 2/19/200311:30:08 AM

You have posted great work in the pastand I have learned a ton from you. Thatbeing said, I agree with Ed 100%. I thinkthis is a case of “when you own a hammer,everything looks like a nail.”

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CAD/CAM InlayTownie Clinical

Continued from page 28

Continued on page 32

Townie Comments as posted on theCase Presentation section of www.dentaltown.com: Inlay to demo theease of CEREC 3D

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Dr. Chaim S. Wexler is a 1984 grad-uate of Columbia University SDOSwhere he is a clinical assistant professor.He is an ISCD certified CEREC trainerand a mini dental implant courseinstructor. Dr. Wexler is the director of

the Metro CEREC Institute, which specializes in teach-ing advanced techniques in the CEREC system and alsothe Sendax mini dental implant. He can be reached at(212) 740-7427 or email cw362@columbia.edu.

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32 dentaltown.comMarch 2005

CAD/CAM Inlay Townie Clinical

marshall_white_dmd | Total Posts: 7653 | Posted 2/19/2003 12:37:42 PM Beautiful case, Chaim. You are truly a master with that thing.While I agree with Ed and Jason that I would have done a direct, I also don’t have a CEREC. And I do

appreciate your tack wherein you don’t charge anywhere near as much for a CEREC as most of us do for ourindirects. If you can make that fly in terms of profitability and for the benefit of your patients, more powerto you.

REBELYELL | Total Posts: 10 | Posted 2/19/2003 6:32:29 PMChaim, how long did it take to final cementation from amalgam removal? Do you have a post-insert x-

ray. I thought it came out very nicely. Thanks for sharing it.

chaimwexler | Total Posts: 1924 | Posted 2/20/2003 7:01:31 AMEd, as I said in the forum, the reason this case was chosen is to demo certain points about CEREC tech-

nique. This tooth is accessible and easily photographed.While you can argue about the quality of the existing crowns that were put in 15 years ago, the bottom

line is that they are functional, asymptomatic and I can’t justify removing them. The patient has no problemwith them and they have limited funds.

I agree there are different ways of doing this tooth. You might not believe this but when you get proficient at CEREC, something like this is much easier than a direct composite. There is actually less of the busy work which I define as placing matrix bands, layering composite, using a Contact Pro andother devices.

It’s actually quite easy to do a CEREC.

Keats | Shaun Keating | Keating Dental Arts Laboratory | Total Posts: 2070 | Posted 2/20/2003 9:53:15 AMGreat job Dr. Wexler, just make sure you keep sending me your bridges.

jrtmolar | Jason | Total Posts: 4416 | Posted 2/20/2003 7:03:03 PMI’m sure that once you get proficient, as you are, CERECs are easy to do. But please GIVE ME A

BREAK. You admit that funds are a problem, what would you have done in your mom’s mouth? No waywould it have been anything other than a direct. $%@@, I don’t even think I would have touched theamalgam.

What did you charge and what was the total chair time? Just trying to understand.

doctored | Ed | Total Posts: 4716 | Posted 2/21/2003 1:28:34 AMIs the picture #4 of the completed preparation?

Dr. Bone To You | Tarun | Total Posts: 3515 | Posted 2/21/2003 7:31:33 AMJason and Ed, I certainly hope I don’t read this correctly...you both don’t see a need to replace this amal-

gam? If you look again at picture #1... there is clear evidence of marginal breakdown with a gap the size of aBig Mac. This restoration is obviously in NEED of upgrading.

Now the method of upgrading is up to each individual dentist...that is of no consequence.The more I see pictures of cases like these, the more I continue to believe that the CEREC technology is

still not ready for me.Continued on page 34

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doctored | Ed | Total Posts: 4716 | Posted 2/21/2003 4:53:56 PMTarun, I agree the amalgam was not in great shape but I think there are many other problems evident on

the BW that I would have addressed before treating this tooth. In an ideal world we would treat everything,but in this case I would have focused efforts at damage control to the crowns that are causing perio prob-lems and undoubtedly have more caries under them. If I was going to treat this tooth I would do it with aninexpensive direct technique. I wonder what the circumstances were that resulted in those crowns to beginwith. Most temporaries fit better. They look like mushrooms.

chaimwexler | Total Posts: 1924 | Posted 2/23/2003 7:20:50 PMBy the way, my mom is in Israel with a temp on one of these “serviceable” amalgams that allowed decay

and fractured. My buddy finally got one of these CEREC over there and when I go to visit, I will place aporcelain restoration.

OK time break down for a two surface CEREC…on a #29.• Anesthesia via Septocaine infiltration: 3 min?• Prep, powder impression: 5 to 7 minutes• Design: one minute• Milling time: 10 minutes (this time is used for hygiene checks and schmoozing or another CEREC)• Adjust polish and cement: under 12 minutes

This case took longer because of stain and glaze, price under 500 dollars.I want to see the time breakdown on a two surface widely opened composite.I bet the difference in actual dentist time is under five minutes. Plus, it’s much less work to do a CEREC.

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