feb 2015

DENTISTRY
Ceramic Tooth
Restoration
In only one visit with CEREC
By Dr. Fabiola Liendo, DDS
CEREC (Chairside Economical Restoration of
Esthetic Ceramics) can generate high-quality
dental restorations with the aid of 3D computer
technology and a milling machine.
There was a desperate voicemail left on my cell phone from one of
our patients on a Sunday night. Janice was having a nice dinner at
the Cheesecake Factory with her teenage boys and husband. All of
a sudden, she bit onto something really hard, her lower right side
started hurting and a piece of her tooth was missing. Janice knew
she had really large old silver fillings done when she was a teenager.
Her former dentist recommended replacing them with crowns, but
she thought to herself - I am OK. They don’t hurt at all. I don’t
need to have crowns.
The next morning, our first patient of the day was Janice, a 44
year old mom. Luckily the tooth was not hurting at that point,
but she could feel that at least the tongue side of her tooth was
not there anymore. Disappointed, she told
me: “I knew this could happen, but since my
teeth were not hurting, I just let time go by.
I should have listened to my old dentist.”
After evaluating Janice’s tooth, it was clear
that her lower right first molar (her second
tooth starting from the back as she called
it) was missing at least two-thirds of tooth
structure. The good news was that no root
canal was needed, but this time a crown was
the only option.
After placing anesthetic on Janice’s tooth, I
noticed extra fractures and a good amount
of caries under the left of the silver filling.
“I am not surprised this tooth broke, Janice. It was all decayed
underneath that huge silver filling,” I told her, and she looked at
me with a sad face. “Do not worry, we will get your tooth back to
normal today,” I reassured her.
Removing all the fractured pieces of tooth left and reinforcing
the tooth with a build-up didn’t take too long. Then my assistant
and I started taking optical impressions of Janice’s tooth, which is
basically going around her teeth with a special camera that copies
all the structures found inside of Janice’s mouth. This helped me
create a brand new tooth, thus improving the anatomy and esthetic
of her tooth. This wonderful technology is called CEREC.
But, what is CEREC? CEREC is an acronym for Chairside
Economical Restoration of Aesthetic Ceramics. Translated, it
means that a dentist can economically restore damaged teeth in
a single appointment, using a high-quality ceramic material that
Before treatment, fractured tooth with an
existing old amalgam filling with caries,
and after, tooth restored with CEREC.
matches the natural color of the other teeth. CEREC is comprised
of a digital infrared camera, a medical grade computer and a milling
machine, all located on site. The system allows dentists to
repair a damaged tooth in one single dental visit using tooth-colored
ceramic restorations. The camera takes an optical impression
of the tooth, eliminating the need for uncomfortable impression
molds, and uploads the image to the computer. Once in the system,
we use special software to design the restoration. Then the CAM
(Computer Aided Manufacturing) system takes over to automatically
create the restoration while the patient waits. Finally, the new
custom-crafted restoration is bonded to the remaining healthy
tissue of the tooth.
Once we chose the color of Janice’s tooth
and the right porcelain material for her, we
bonded the crown over her tooth. She was
so excited to have her brand new natural
looking tooth back. “Now I see the neighbor
tooth with that horrible silver filling, and
I am afraid it will also break. I will come
back next week to have it fixed before I have
another broken tooth.” And she did come
back.
Like Janice, most of us are afraid to have
dental treatment done, but sometimes waiting
just doesn’t mean that tooth is going to get any better. In fact,
it could lead to more complications like root canals or sometimes
teeth extractions, when it is too late to save the teeth.
The ability of CEREC to meet the clinical needs of the dentist
and the expectations of our patients to achieve the aesthetic needs
is very well documented, and the long-term results have been
well proven to rival that of porcelain metal restorations. Porcelain
veneers, inlays and onlays, porcelain crowns, implant crowns and
even porcelain bridges are now available for single-visit restorations,
but CEREC may not apply in certain cases. A dentist’s
judgement and a complete and comprehensive evaluation are necessary
to determine if CEREC is right for the patient. P
Dr. Fabiola Liendo, DDS practices at Sawgrass Dental Arts in
Coral Springs.
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FEBRUARY 2015