Simple and Efficient Single-Visit Treatment

Josh Fowler, DMD, DICOI
Dr. Fowler is a dedicated digital dentist who spent the last decade maximizing and leveraging digital technologies in his practices. He graduated from the University of Louisville School of Dentistry in 2007 and went directly into private practice. Realizing that the future lies in advanced technology that can be readily delegated to maximize clinical efficiency, he began his journey into those technologies. Mainstays of his practice are scanning, CAD design, in-offi ce milling, CBCT, and 3D printing. Dr. Fowler enjoys all aspects of dentistry and operates 2 general dental practices in Colorado.

Simple and Efficient

Single-Visit Treatment

With a growing number of materials available for CAD/CAM restorations, the 2 most important criteria to consider are simplicity and versatility. For example, there are several ways to create a strong bond when using a glass ceramic, whereas bonding and luting zirconia requires a totally different set of steps. In my office, we created systems with minimal steps that are easy for our Expanded Function Dental Assistants to follow. This ensures that each protocol is adhered to exactly without missing any steps. The systems are also helpful to our associate doctors, as it allows them to provide fast treatment without sacrificing quality. 

In this case, a 74-year-old woman presented with a tooth No. 14 that met all the criteria for a full coverage CAD/CAM crown (Figure 1). After anesthetizing, the tooth was isolated (Isolite, Zyris) and prepared. The mass of the amalgam combined with some de-cay beneath it led to an undercut cavity in the mesial portion of the tooth (Figure 2). An adhesive was applied (All-Bond Universal, BISCO) and the tooth was built up using a dual-cure core buildup material.

The preparation was finished and smoothed using fine-grit diamonds, and the margin was polished. A small amount of retraction cord was placed at the mesial for separation between the margin and the tissue, ensuring proper scanning. All other margins were kept supragingival, which is my preference when treating elderly patients due to its cleansability and easy inspection. 

Since I am extremely confident in my BISCO bonding materials, I don’t need to rely on mechanical retention for my crown, which allows for shorter walls and ensures bonding to any enamel that remains. 
 

Once the preparation was completed, the necessary scans were taken. The zirconia crown was designed, milled, and fired in-office. After polishing, the intaglio was air abraded with aluminum oxide, and we were ready to cement. The crown was tried in and checked for occlusion, marginal precision, and floss passage. These were all correct without the need for adjustment, so we proceeded to prepare the crown.

The intaglio was primed with a zirconia-specific primer (Z-Prime Plus, BISCO), which enhances adhesion between indirect restorative materials and resin cements. The Isolite was replaced and the tooth was dried for isolation during restoration. I completed selective etching of the remaining band of enamel encircling my preparation and applied All-Bond Universal. Its extremely thin layer makes it ideal for use under crowns (Figure 3).

After light curing, the prepared crown was lined with resin cement (Duo-Link Universal, BISCO) and placed on the tooth. The margins were tack-cured for 2 to 3 seconds and the excess material was cleared away. The interproximal margins were cleaned with floss, the retraction cord from the mesial was removed, and the crown was cured again (Figure 4). We then took another x-ray to verify seating. One of my favorite features of Duo-Link Universal is that it is radiopaque, allowing for easy visualization of any excess cement (Figure 5). This excess cement was easily identified and cleared away, and the patient was satisfied with her new crown.

All-Bond Universal and Duo-Link Universal are a simple and versatile set of materials that make treatments a breeze. If I need to delegate bonding of a crown, my assistants can handle it without convoluted steps, ensuring that the proper protocol is followed each time. With the excellent characteristics of these materials from BISCO, I have full confidence in my restorations and their durability.