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Work Flow- RCT, B/U, APC in one Appointment

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I've posted about this before, how CEREC can help you complete an RCT, b/u, APC in one appointment, often in under 2 hrs.  My last post on this topic only showed the before and after photo; no intermediate steps.

In an effort to explain the process further, I performed the same treatment on tooth number 15 and took photos along the way using my Primescan.   

Pre-op radiograph. 

Here are my steps:

  1. Anesthesia, CEREC images of opposing arch and buccal bite.  I capture the buccal bite at this stage as the patient has not lost proprioception in the area.
  2. Place IsoDry and begin preparation of the tooth. I begin with occlusal reduction and then move on to the decay.

  1. Once I have clean margins and I’m at the pulpal floor, I placed a Tofflemire matrix. 

  1. Build-up complete. 

  1. Final preparation. It took me 25 minutes from the time I picked up the handpiece to this point. 

  1. CEREC images are captured and I have a second assistant design, mill, fire the restoration while I drill through the center of the build-up & complete the RCT. 

The beauty of this approach is that simultaneous processes are occurring.  By reversing the typical RCT-crown order, I was able to complete treatment in under two hours.




Side note: my CBCT allowed me to visualize the number of canals (no MB2) and and their paths prior to initiating the RCT.  I knew prior to starting that the palatal canal did not go to the apex of the root. Had I not seen this ahead of time, I may have thought my obturation was short in my final PA. The power of these technologies cannot be overstated. They have allowed me to provide better, more efficient treatment for my patients in a consistent manner that I never thought possible before.


That's awesome and I am going to give it a try next time around.

Beautiful work Steve!  This is such a win for the doctor and the patient to have this tooth treated so efficiently and perfectly.

Excellent isolation!

That is the explanation and showing how the different pieces of technology help you execute this!

Thanks for sharing!

Beautiful, efficient treatment.