Peter Gardell The cerecdoctors.com Scientific Symposium recently concluded and there was a tremendous amount of great information from all the speakers. The speakers covered all facets of dentistry which was fantastic.
It’s always great to hear Pascal Magne speak since he approaches many concepts from a different angle. The big take away from the meeting for me was to rethink the role of composites when we restore the posterior teeth. He showed many restorations fabricated out of Z 100 where he was able to esthetically enhance with stains that helped create beautiful lifelike restorations.
Seeing this work got me thinking about the vast materials that are now available for CEREC restorations, in particular the hybrid materials. This class of materials has demonstrated great fracture resistance and great milling performance.
Rella Christensen has told us time and time again that in our ceramic restorations, the weak link is when we try to carve in anatomy. This happens particularly when tertiary anatomy is added. Cracks start and propagate in and along these lines. To combat this fracturing, we try to be illusionists and deceive the eye with stains on the occlusal surface.
With the new hybrid materials, we can rethink how we add this anatomy. The fantastic fracture resistance allows us to change the way we do our esthetics. We can mimic what exists with primary, secondary, and tertiary anatomy. We can use the Biogeneric Variation tool to really add to the occlusal design ( there are limits to this due to the capabilities of our milling chamber).
I have now started to carve the anatomy into my Lava Ultimate restorations. I am thinking of Lava Ultimate as an enamel replacement. Since enamel is a semi-translucent monochromatic substance, why not replace it with something that is similar. Instead of being an illusionist, you can think as an anatomist. You can carve in the anatomy and allow the contours and topography of the restoration interact with the light. By adding to the anatomy, you can allow the thickness of the restoration to allow different shades of dentin come through.
This is a whole different type mindset as related to restorations of the past, whether they be PFM’s or all-ceramic restorations.
So you don’t have to be an illusionist and deceive the eye. You can be an anatomist and include the anatomy our patients naturally have in their teeth.
