Since detailing a full arch Cerec reconstruction case carried out in one day in a previous Dentistry article (April 2004), I have carried out many similar cases. Not every restoration has been a Cerec as in that case, but many have been at an increased vertical dimension.
I would like to share with you another reconstruction case at an increased vertical dimension, to get across how easy it is to do with a good working knowledge of occlusion and a Cerec 3 machine.
The real beauty of this treatment is its simplicity. With no complicated communication with a highly skilled and expensive lab utilising articulators and so on, you can reduce hassle and recalls for the patient and reduce chair time.
The treatment is consequently less expensive and more easily affordable for the patient, resulting in a greater acceptance of treatment. It is also very profitable for the dentist as it is very time efficient, and does not result in any lab bills.
Case study
‘Jim’ was a new patient with a very broken down dentition with severe attrition of the anteriors. He did not arrive requesting treatment for this. I guess in retrospect his teeth had been steadily disintegrating for a long time and he was just accepting it as simply a part of the ageing process. But, always on the look out for these satisfying and enjoyable cases, I suggested a full mouth reconstruction and he went for it.
Treatment plan
• Step 1: Mount some study models on a ‘Denar’ articulator in centric to decide which teeth to restore and how. Some would need Cerec restorations and some would need composite, while other teeth might just need simple composite build-ups or a little judicious grinding.
• Step 2: Splint therapy with a CRA to reduce inflammation of the TMJs, as there inevitably would be in a grinder like this patient. Also, it was necessary in order to make sure he could tolerate an increased vertical dimension.
• Step 3: Once splint therapy had been completed an initial appointment was booked to restore and build up the posteriors at the increased vertical dimension as well as to create canine guidance. From studying the mouth, radiographs and mounted study models, a morning/afternoon session was deemed suitable for this.
• Step 4: The treatment involved carrying out two Cerec restorations and three composite restorations as well as two small composite build ups, all with centric stops. I left him this way with anterior guidance coming from his canines also.
• Step 5: Two days later, a whole day was booked to carry out four Cerec crowns on his upper incisors, six Cerec veneers, and to make sure everything was equilibrated with canine and anterior guidance. Two weeks later a short appointment was required to check equilibration and tidy things up if necessary.
Everything went according to plan with the exception of our decision to do a Cerec restoration instead of a composite on the 7 , which we carried out on the last appointment.
The upper incisors were stained and glazed in a furnace after milling, while the lower veneers were simply shaped and polished after placement as is normal with posterior Cerec restorations. Cerec blocks are made from a dense ceramic which enables them to be polished very nicely; allegedly, ‘as good as a glaze’.
Obviously, care must be taken not to over-heat the teeth but this is easier when polishing multiple units. I use ‘ceraglaze’ diamond impregnated rubber cups from Prestige Dental (0800 591175) which I find brilliant. Shaping the lower makes the creation of perfect anterior guidance very simple.
The patient was very happy with the result and there have been no problems. His jaw is nice and loose and his teeth come together with a satisfying ‘clack’ indicative of an equilibrated dentition.
