Mastery is never an accident. It is achieved only as a result of an unrelenting and vigorous insistence on the highest standards of performance.

Preparing the tooth

This section deals with the skills necessary to master the tooth preparation for the CEREC restoration.


"I couldn't live without my Powder Meister."
Dr. Joe Varno CEREC user
USA
Magnification

There is no way to say it gently. You simply cannot provide the highest quality dentistry, of any kind, including the CEREC technique, without the aid of magnification. It just cannot be done. You may be able to accomplish acceptable dentistry, perhaps even good dentistry, but not masterful dentistry without magnification. If you are searching for mastery of the CEREC technique and are not now using magnification during dental procedures, go no further. Included in this web-site will be much information, which especially to the new CEREC user may seem daunting. But the way you eat an elephant is one bite at a time, and magnification is the first bite. If you are looking for tips to make the CEREC technique easier, yet have no interest in magnification, there are still many tips here that will help you, but I can assure you that mastery will not come.
"The Powder Meister is a great device!" Dr. Clark Stelmaschuck CEREC user
Canada
There are several good magnification systems available today. Reality , "The Information Source for Esthetic Dentistry" (This publication is highly recommended! For information go to realityesthetics.com), ranks the Surgitel Telescope by General Scientific as the number one choice followed by Orascoptic Telescopes by Orascoptic Research. I have used for years the surgical telescopes by Designs for Vision and I like them very much. While any magnification is better than none, the real benefits don't start until you get to around 3.5X. At this level of magnification you start seeing the subtle differences of preparation design that can allow the CEREC to give an absolutely magnificent fit each and every time. Helpful hint! Regardless of the magnification you use, placing a small amount of imaging powder on the prep makes any small irregularities in the preparation JUMP out at you. These irregularities can then be easily corrected and the tooth preparation repowdered for the optical image.
"The Powder Meister is a MUST for the CEREC user!" Dr. Paul Niesen
USA
Illumination

While not as essential as magnification, extra illumination via a headlight makes seeing posterior areas of the mouth much easier and helps reduce the stress of working in difficult access areas. REALITY rates the number one headlight as the Zeon Illuminator by Orascoptic Research. It's pretty expensive at $1000. I have found my inexpensive lamp by Light-Tech, Inc. to be very helpful. It can be ordered by calling (941)-385-6000. The cost is around $150.

"The Powder Meister is essential."
Dr. Tom Northway
USA
Adhering to preparation principles

The principles of tooth preparation that lead to a well fitting CEREC restoration are well described in the CEREC owner's manual. The discipline in adhering to these principles will reap many benefits. While the CEREC technique represents the pinnacle of dental technology, one must keep in mind that it is, after all, only a computer and, as they say, "garbage in, garbage out".
"The Powder Meister has greatly improved my ability to powder. My patients also find it easier."
Dr. James Brennan
USA

Patient Comfort

Most dentists would agree that clinical practice can be very stressful at times. Often, the source of this stress is associated with pain management and local anesthetic injections. Fortunately, this source of stress can be completely eliminated! The clinician can now provide virtually painless anesthesia by using The WAND from Milestone Scientific . This instrument allows much more control over needle placement than with a conventional syringe. The result is the ability to penetrate tissue painlessly. (Even palatal injections can be comfortable!) In addition there is an increase in needle control which provides a decrease in missed block anesthesia. There are times that patients feel discomfort in lower molars even with a profound mandibular block. Further discomfort can be instantly eliminated with the Stabident local anesthetic system ). This system provides for a quick and predictable placement of intraosseous anesthetic. This technique can be used as the primary anesthetic technique. However, since the intraosseous placement significantly limits the spread of anesthesia (The tongue, cheek, etc. are not anesthetized and can experience discomfort during the procedure.), my preference is to use The WAND first, and the Stabident as a back-up when more profound anesthesia is needed.
"I have been using the Powder Meister these last few weeks and will be recommending it to anyone who will listen."
Dr. Bruce Kleeberger
Canada

Helpful diamonds for the CEREC preparation

There are several diamonds that I have found to be very helpful in fulfilling CEREC tooth preparation principles. When it comes to stress for the patient (and therefore the clinician) the first few minutes of the procedure seem to be the worst. The patient's logical concern is "Is this going to hurt?" or "God! How I hate this noise!" Now, while all patients may not verbalize these fears or feelings they are universal. This often translates into an extreme reluctance to open the mouth wide enough to allow easy access to the areas we have to work. At this initial stage of the procedure, rather that struggle with the patient in getting them to open wider than they are comfortable, using a very short shank diamond allows the clinician to start removing the old restoration, burying the diamond inside the prep and getting more room to work. Very soon the patient usually figures out they are safe and the relaxation process begins. From this point the patient's comfortable range of opening increases and the procedure becomes easier for everyone. Extra short shank diamonds are available from Patterson Dental. (I buy from Patterson Dental whenever I can.) Utilizing this first diamond get the appropriate depth. Sink the diamond immediately to the minimal depth that is acceptable for good porcelain strength. The most likely cause for future failure of any bonded porcelain restoration is porcelain fracture. Reduce this unwanted possibility at the initial step in the preparation process!

  Super Coarse
   Axis 807-018

Once the minimal depth is established, I switch to a super coarse 807-018 from Axis. The shape of this diamond is a long inverted cone. This is essentially a flat end cylinder that is a little wider at the end than at the base. This shape provides a very slight undercut in the preparation and eliminates the possibility of excess flair of the wall of the preparation being visible in the optical image. It also makes drawing the bottom line of the wall segment more definitive. For proximal boxes and buccal and lingual extensions, it is necessary to establish a slight flair so that the entirety of the margin is visible in the optical image. This is easily accomplished with a medium grit, flame shaped diamond.

A smooth cavo-surface margin is essential in allowing the software margin finder to accurately identify the margin and to eliminate the time consuming need to edit the margin.

Continue to Powdering the Preparation.

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