feb 2015

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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. 86 FEBRUARY <strong>2015</strong>
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