Conservative CAD/CAM Onlays
A healthy 29-year-old female presented for treatment on her lower left quadrant. Her treatment plan included replacing the leaky and broken-down amalgam fillings over the posterior sections of her mouth. The patient previously treated her upper 2 quadrants. In this particular case, I treated the lower left quadrant.
I used HiRes Loupes (Orascoptic) at 3.5X magnification, along with digital X-rays using DEXIS Platinum Sensors (DEXIS) to come to a diagnosis. I found the patient's molar teeth had such large fillings that onlays or crowns were the best options.
Before treatment day, I showed the patient her teeth using the GXC-300 intraoral camera (Gendex). We discussed her treatment options and choices of restorative materials. We also discussed the option of no treatment and the consequences of each option.
The final treatment chosen for this case was to treat teeth Nos. 18 and 19 with 2 conservative CAD/CAM onlays using CEREC Bluecam (Sirona). This type of treatment gave the patient a restoration that would last a long time with proper home care.
I also chose to do a conservative distal-occlusal filling on tooth No. 20. After clearing out the amalgam and because most of the walls of the tooth were intact, I used a distal-occlusal resin filling on tooth No. 20 as it was the most conservative material.
The patient already knew of the value of conservative onlays since she had this procedure done successfully in other quadrants of her mouth. This was the most conservative treatment, and it was also the one that would hold on to as much healthy enamel as possible. Treatment went well, and the only challenge I encountered was that I could not use the iZolation unit (iZolation) as the patient was having some issues with gagging.
The restorations came out wonderfully using the materials we commonly use on these procedures. I tried in the onlays and then glazed them in the oven. Finally, I cemented the 2 onlays with BeautiCem SA (Shofu) for a number of reasons. This cement has many great features: it is a self-etch, self-adhesive, dual-cure resin cement with less than 12 m film thickness. It has high bond values and excellent physical properties with bioactive benefits of fluoride release and recharge, antiplaque effect, and acid neutralization. I took a final x-ray to assure no cement was left behind. I did the filling in a conservative manner and shade matched it. The patient loved the results and the fact that they were all done in 1 visit and at 1 time so she could make it home in time to pick up her daughter from school.