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Non-Retentive, Adhesively Retained All-Ceramic Posterior Restoration

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25/07/2012 at 4:31 pm #15753
DrAnilDrAnil
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 Figure 1  TECHNIQUE The first step is to drill down into the central fossa to the hilt of the #330 carbide bur.

Figure 1

Figure 2  TECHNIQUE The #330 bur passes to the buccal side maintaining the same depth.

Figure 2

Figure 3  TECHNIQUE After locating the depth in the central fossa, the bur is moved to the buccal, lingual, mesial, and distal, maintaining the same depth.

Figure 3

Figure 4  TECHNIQUE Using either a #330 (pictured) or #167L carbide bur, a horizontal cut is made connecting the buccal and mesial depth cuts, which then removes the mesial‚Äìbuccal cusp.

Figure 4

Figure 5  TECHNIQUE Occlusal view after the mesial‚Äìbuccal cusp has been removed. Remaining filling material will be removed at later steps.

Figure 5

Figure 6  TECHNIQUE The distal‚Äìbuccal cusp is now removed.

Figure 6

Figure 7  TECHNIQUE The mesial and distal‚Äìlingual cusps are removed in the same fashion.

Figure 7

Figure 8  TECHNIQUE Remove any remaining restorative material with a modified shoulder diamond bur. This will create an isthmus.

Figure 8

Figure 9  TECHNIQUE CA 12-fluted finishing bur is used to break the interproximal contacts.

Figure 9

Figure 10  TECHNIQUE An end-cutting bur is used to smooth sharp line angles at the interproximal margins.

Figure 10

Figure 11  TECHNIQUE An inverted cone diamond bur is used to create more orientation grooves between the isthmus and outer buccal and lingual tables.

Figure 11

Figure 12  TECHNIQUE A 12-fluted tapered finishing bur is used to smooth the prepared surfaces, which also reduces the thickness of the smear layer.

Figure 12

Figure 13  TECHNIQUE Finished "table-top" preparation.

Figure 13

Figure 14  TECHNIQUE Digital scan of the occlusal view showing the ease in depicting the margin.

Figure 14

Figure 15  TECHNIQUE Digital scan of the buccal view.

Figure 15

Figure 16  CLINICAL CASE Occlusal view of tooth No. 30. Note the defective 3-surface filling with a portion of the distal‚Äìbuccal cusp missing and fracture lines on the lingual and buccal surfaces.

Figure 16

Figure 17  Occlusal view of a cross-pattern at the depth of a #330 carbide bur.

Figure 17

Figure 18  The mesial‚Äìbuccal cusp was removed with a horizontal cut that connected the mesial and buccal depth cuts.

Figure 18

Figure 19  The #330 bur continued through the buccal depth cut to the distal depth cut removing the distal‚Äìbuccal cusp. The existing filling material remained as a temporary reference point.

Figure 19

Figure 20  The remaining cusps on the lingual side were removed in a similar fashion. Then the remaining filling material and caries were removed.

Figure 20

Figure 21  A #7801 finishing carbide bur was used to break the mesial contact. This cut provides a straight interproximal line aiding in tracing the digital margin on a monitor or in the laboratory.

Figure 21

Figure 22  Occlusal view of the finished preparation.

Figure 22

Figure 23  Monitor view of the scanned preparation with the margin indicated.

Figure 23

Figure 24  The milled lithium-disilicate all-ceramic restoration was tried in for fit and occlusal verification. Surface stains were then applied.

Figure 24

Figure 25  The bonded restoration in place. (26.) Intraoral view of the restoration.

Figure 25