Q: What is your technique for indirect restorations in your office, without sending it to a lab?
A: There are many ways to fabricate indirect restorations in the office.
The high-tech answer is to use CAD/CAM technology with either Cerec or E4D. You take a digital scan of the prepared tooth, then you can easily mill either a composite or porcelain restoration. This is probably the easiest way to fabricate a very accurate restoration. You then bond in the restoration, check occlusion, and finish.
Indirect restorations can also be fabricated without the use of CAD/CAM technology, which means you can do single-appointment restorations without the upfront expense. However, we cannot produce porcelain restorations this way.
The tooth is prepared and an impression can be taken in alginate (which is very accurate when poured immediately).
A silicone model is then produced. You can use Parkell's Mach-2, or Voco's recently released GrandioSO Inlay System for chairside fabrication of indirect composite inlays. This is a complete kit to assist you in fabricating indirect restorations. It is a very fast and inexpensive way to fabricate composite inlays and onlays in your office.
To obtain your working model, you inject the silicone into the impression.
Once the model has set you can start building your restoration.
You then can start creating your restoration by injecting composite and shaping it.
The restoration is then light cured and can be removed easily from the silicone model.
Curing can now be continued using your light, and the restoration can be placed into an oven to allow for further conversion of the composite.
The restoration is then trimmed and can be tried in the mouth.
You then follow appropriate bonding protocols when seating the restoration, check occlusion, and finish the restoration.
Full crowns can be fabricated using Natural 1 (DirectCrown). In many cases, these are long-term provisional restorations that you can fabricate in your office. I discussed this topic in a previous column.
Having said all of this, in many anterior cases, it makes much more sense to do lab-fabricated indirect restorations for the improved aesthetics with either porcelain or newer composites materials such as Pearlfect veneers from Mizrachi Dental Lab.
Marty Jablow, DMD, lectures and consults extensively about integrating technologies into the modern dental practice (www.dentaltechnologycoach.com). If you have a technology question for Dr. Jablow, send it to email@example.com.
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