By: Anthony Mennito, DMD – Medical University of South Carolina
Patient History: Tooth #12 had a previously placed PFM that had recurrent decay to such an extent that the tooth became unrestorable. Patient elected to have the tooth extracted and replaced with a three unit IPS e.max® bridge fabricated using the PlanScan CAD/CAM system.
Treatment (Temp): Shortly after the extraction of tooth #12, teeth #11 and 13 were prepared for an IPS e.max® bridge. Since the patient was still healing, it was decided that a Telio® CAD temporary bridge would be milled and placed to allow the patient to complete the healing process. The patient’s overriding tooth shade was determined to be B3. The closest Telio block shade was B1 so some characterization was required to get an esthetic match. The PlanScan was used to scan and design the bridge. Once the block was milled, I experimented with shaded Tetric EvoFlow® to try to get a match. B3 and B1 with gray accents were predominantly used. These were added to the freshly microetched surface of the Telio® CAD using a brush to apply very thin layers. These materials were then light cured and a final coat of Adhese® Universal was applied to get a shine and then light cured. The Telio® CAD temp was cemented using Telio® CS Link.
Treatment (IPS e.max®): Once the patient had healed, the preparations were adjusted and rescanned and designed using the Planscan. The IPS e.max® B1 block was milled and tried in. Occlusal adjustments were made and then the bridge was stained using Shade 2 to add chroma, Sunset in the gingival ½ and Incisal 2 in the occlusal/incisal ½. IPS e.max® CAD crystal spray glaze was then applied and the bridge was fired. The bridge was then treated with hydrofluoric acid and Monobond Plus on the intaglio surface and the bridge was then bonded in using transparent Multilink® Automix.