The cerecdoctors.com Scientific Symposium recently concluded and there was a tremendous amount of great information from all the speakers. The speakers covered all facets of dentistry which was fantastic.

It’s always great to hear Pascal Magne speak since he approaches many concepts from a  different angle. The big take away from the meeting for me was to rethink the role of composites when we restore the posterior teeth. He showed many restorations fabricated out of Z 100 where he was able to esthetically enhance with stains that helped create beautiful lifelike restorations.

Seeing this work got me thinking about the vast materials that are now available for CEREC restorations, in particular the hybrid materials. This class of materials has demonstrated great fracture resistance and great milling performance.

Rella Christensen has told us time and time again that in our ceramic restorations, the weak link is when we try to carve in anatomy. This happens particularly when tertiary anatomy is added. Cracks start and propagate in and along these lines. To combat this fracturing, we try to be illusionists and deceive the eye with stains on the occlusal surface.

With the new hybrid materials, we can rethink how we add this anatomy. The fantastic fracture resistance allows us to change the way we do our esthetics. We can mimic what exists with primary, secondary, and tertiary anatomy.  We can use the Biogeneric Variation tool to really add to the occlusal design ( there are limits to this due to the capabilities of our milling chamber).

I have now started to carve the anatomy into my Lava Ultimate restorations. I am thinking of Lava Ultimate as an enamel replacement. Since enamel is a semi-translucent monochromatic substance, why not replace it with something that is similar. Instead of being an illusionist, you can think as an anatomist. You can carve in the anatomy and allow the contours and topography of the restoration interact with the light. By adding to the anatomy, you can allow the thickness of the restoration to allow different shades of dentin come through.

This is a whole different type mindset as related to restorations of the past, whether they be PFM’s or all-ceramic restorations.

So you don’t have to be an illusionist and deceive the eye. You can be an anatomist and include the anatomy our patients naturally have in their teeth.

Pete, your blog is interesting. How much extra time does it take you to carve extra occlusal anatomy into the Lava Ultimate restorations you place? How practical/profitable can this approach be? Out of the milling chamber our restorations are already anatomically better than anything produced by hand except restorations fabricated by the most skilled lab techs. We dentists appreciate artistry in our restorations. Almost all of our patients and most of our colleagues do not. Have you ever had a patient demand that you polish away the characterization stains you have applied to the occlusal surface of a crown or onlay. I have had this experience. CEREC already enables me to practice my profession as almost a hobby. I don't know if I am good enough to be profitable if I start adding secondary and tertiary grooves to my CEREC restorations. You have presented an intriguing, albeit impractical idea--unless you have the patients who are willing to pay for this level of dental care.

Dr Chuck
Impractical- that all depends on your point of view. I know that you take great pride in your work and strive to make you Cerecs look the best they can be. I have no doubt that you margins are great, your ceramics don't look like temps.

I know your point of view

I would say that adding increased anatomy takes a total of 30 additional seconds with a high speed handpiece. I do not picture your posterior direct restorations to have the anatomy of your fingerprint. I see you taking the time to carve your alloys and resins, why are these indirect resins have to be any different.

30 seconds to carve additional anatomy in your Lava Ultimates, A minute or two is all it takes for this great material to get a high luster and you are ready to bond in with Scotchbond and rely-x.

For these esthetic restorations they can take less time than if I stacked by hand and they look dynamite.

That is my point of view- deliver great looking and highly functioning restoration efficiently and in a cost effective way.

My gut feeling is you have the same point of view

Good question Dr Chuck- love to have the discussion