CASE PRESENTATION
Advanced Technology Raises the Level of Care
New technology seems to surface every day in the world of dentistry. This case report will document two very impressive new technologies used with the same case. A 70-year-old male presented with a full dentition, including third molars and no contraindications to dental treatment. His chief complaint was intermittent pain on the lower left posterior area with biting pressure. Intraoral examination revealed prior amalgam restorations on tooth No. 18 (Figure 1). Removal of the distal amalgam revealed a mesial-distal fracture line below the amalgam (Figure 2). This was consistent with “Cracked Tooth Syndrome,” and it appeared the fracture may have extended into the pulp area.
It seems that endodontics has always struggled with finding methods to instrument and cleanse the internal canal morphology, given the commonly convoluted shape. The GentleWave System (Sonendo) uses broad-spectrum acoustic wave energy with advanced fluid dynamics to create a vacuum effect of fluids to help cleanse the canals to a microscopic level of bacterial removal. The obturation was done with a single solid gutta-percha cone that was used to drive the obturation medium into the inaccessible areas.
A preop image was extracted from a 3D CBCT taken by Mobile Imaging Solutions and did not show any striking abnormality for tooth No. 18 (Figure 3). After a discussion of the treatment options, alternatives, benefits, and complications, the patient agreed to endodontic treatment for No. 18 using the GentleWave technology. The postop radiograph shows the remarkable obturation (Figure 4).
Same-Visit Restoration
Immediately following the endodontic procedure, the access was filled with CLEARFIL DC CORE PLUS light-cured core material (Kuraray) and the tooth was prepped for a full-coverage zirconia restoration (Figure 5). The restoration would be performed using the glidewell.io In-Office Solution, which includes the iTero Element intraoral scanner (Align Technology), the fastdesign.io Software and Design Station, and the fastmill.io In-Office Mill (Glidewell Dental).
An intraoral digital scan was taken using an iTero Element scanner, and the STL file was exported directly to the fastdesign.io Software and Design Station. The fastmill.io In-Office Mill technology provides an excellent solution to immediate in-office restorations. Crowns can be made in an hour, as was done in this case. The fastmill.io can mill Obsidian (lithium silicate), Camouflage (nanohybrid), PMMA (BioTemps), and BruxZir (fully sintered zirconia) (Figure 6). Crowns made with the fastmill.io do not need to be sintered in an oven after milling. This eliminates the shrinkage that occurs with post-mill sintering. The crown was separated from the sprue and the area polished (Figure 7). The CAD design software is made to be fast and functional through its extensive library of proposed crown shapes and useful software tools.
Final polishing is not required after milling, but can be done easily using sequential slow-speed polishing wheels. Following the manufacturer recommendations, Ceramir (Doxa Dental) was used to lute the final restoration to the prepped tooth structure (Figure 8). As an empirical observation, it has been noted that the tissue surrounding zirconia restorations tends to adapt exceptionally well to the zirconia.
Conclusion
As we seek to raise the level of care for our patients, we are learning that technology can often provide a much-desired boost to the level of care we provide. This case demonstrates the value of cutting-edge technology to a dental practice and our patients (Figure 9).
Go-To Product Used in this Case
fastmill.io In-Office Mill
Manufactured in the United States by Glidewell Dental, the fastmill.io In-Office milling unit is a 4-axis computer-controlled mill that encapsulates technologies originally developed for the laboratory production floor in a form that fits comfortably in the dental practice. The fastmill.io makes it possible to prescribe and deliver same-appointment BruxZir Solid Zirconia restorations, with no sintering oven or dental laboratory required. The unit features a quick, electric-powered spindle and quiet operation.
About the Doctor
Dr. Jones is a graduate of Virginia Commonwealth University School of Dentistry, where he serves as an Adjunct Faculty Associate Professor. He is co-founder of the American Academy of Clear Aligners (AACA) and Founder/President of Mobile Imaging Solutions, an onsite CBCT imaging service. He maintains a general dentistry practice in Richmond, VA.
