After graduating from The University of Michigan School of Dentistry, Dr. Derek Vinkovich completed his General Practice Residency at Akron City Hospital in Akron, OH. He is an active member of Spear Study Clubs and maintains a private practice in North Royalton, OH, where he takes a special interest in using CAD/CAM technology to provide optimal care to his patients.
A 29-year-old woman presented following root canal therapy on tooth No. 4. Digital radiographs were taken using a photostimulable phosphor plate (ScanX, Air Techniques), which showed appropriate fill and no periapical radiolucency (Figure 1). The tooth was temporized with a temporary filling material and cotton pellet on presentation. A core buildup and crown were recommended as ideal definitive treatment. The patient consented to the proposed treatment, and no anesthesia was required.
Removing the Temporary
The temporary material and residual caries were removed by using a Microcopy NeoDiamond 0512MS pear-shaped, short shank diamond bur (Figure 2). Using a phosphoric etch, universal adhesive, and a core buildup material, a buildup of No. 4 was completed (Figure 3). Due to the amount of remaining tooth structure, no post was required to retain the buildup. After the core material was allowed to fully cure, No. 4 was ready for crown preparation.
Preparing the Tooth
The tooth was prepared using a sequence of Microcopy burs. Contacts were broken using the NeoDiamond 0512MS bur (Figure 3). Occlusal depth cuts were then made using a NeoBurr 331 carbide (Figure 3). This is an effective bur for generating appropriate reduction due to its cutting length of 1.8 mm.
An egg-shaped NeoDiamond 1900F was used to complete the occlusal reduction and connect the depth cut lines, and a NeoDiamond 0816.6CS flat-end taper shorty diamond was used to create a circumferential margin (Figure 4). A NeoDiamond round-end taper shorty diamond was used to complete the preparation and create a chamfer margin. A NeoDiamond 1900F and a NeoDiamond 3314.10VF very fine grit pointed-cone finishing bur were used to remove sharp edges and corners prior to impression taking. These Microcopy diamonds allowed for an easily attainable smooth and clear preparation (Figure 5).
Retraction paste (Traxodent, Premier Dental) was used both as a hemostatic agent and to provide soft-tissue retraction prior to the digital impression. An intraoral scanner(TRIOS 4, 3Shape) was used to take digital impressions of the preparation and opposing arch, as well as to confirm appropriate reduction (Figures 6 & 7). The scan was processed for lithium disilicate crown fabrication.
