Steven Hernandez We all know CEREC is capable of producing great aesthetic results, makes restoring implants easier/faster, and can even mill surgical guides in office. For me, one of my favorite procedures is the same day root canal, build up, and crown. I know the clinical situation doesn’t always allow it, but when it does, I find that CEREC allows me to leverage my time for both the benefit of the patient and myself.
Last week, this patient appointed for an OB resin on tooth #30 and a root canal, build up, crown on tooth #31. The appointment was scheduled for 7 AM and the patient was out before 9. The appointment workflow looks something like this:
- Seat/numb patient (1 septo)
- Capture pre-op images of the opposing arch, BB, and mandibular arch.
- Use the cut tool to remove tooth #31.
- Deliver second carpule of anesthetic (septo)
- Place IsoDry.
- Prepare #31. I didn’t have to spend much time searching for the canals as the decay already involved in the pulp chamber. Also, reviewing my CBCT prior to treatment let me know exactly how many canals there were. As I know I’m doing a root canal, I don’t have to be timid about my occlusal reduction. As you can see, this is anything but a traditional prep. I would guess my prep took ~10 minutes. I don’t want to image with the pulp chamber opened, so I placed some packable resin and just took a few seconds to smooth it, simulating my core build-up (don't bond this into place).
- Capture CEREC images and pass the AC unit to my second assistant to design, mill, fire the restoration.
- Place rubber dam, remove resin in chamber, start RCT.
The RCT is relatively quick as I had already found my canals. Also, using my CBCT to estimate canal length and an M4 handpiece making getting to length relatively easy. The crown is usually out of the oven when I’m finished and is ready for try-in. I always seat the crown and let the patient see what it looks like to get their approval. After that, it’s prepared for bonding. The IsoDry is placed again in the crown is bonded in place. The resin on #30 can be completed at any time; before CEREC images, after bonding crown, etc.
The power of certain comes into play in that the crown preparation is completed prior to the RCT. If I find that I can’t get the canals dry or I need a second appointment to complete the RCT for whatever reason, I will usually mill an MZ 100 and bond that in the interim.
