Bread & Butter with Tetric CAD HT
I received a sample of Ivoclar Vivadent's Tetric CAD. This was a case that I thought would be more of an onlay and my mind was dead set on using the block. In my humble opinion this block is perfect for inlays and onlays. The tooth's condition dedicated my prep and with the presence of distal decay that wasn't apparent on the radiograph and with the small buccal breakdown, I changed gears and went with a crownlay prep. In the past, I would typically use IPS e.max HT or MT for these crownlay indications.
Tetric CAD is in the category of hybrid ceramics. It has great edge stability during milling, polishes easily and doesn't have to be fired. With a flexural strength of 272 MPa, it is higher than the other hybrids. I bonded this restoration with Ivoclar Vivadent's Variolink Esthetic DC Warm cement under rubber dam isolation. I have attached a CEREC Materials spreadsheet that I posted earlier this month for those that would like to see the different materials and their properties and indications.
This appointment was less than an hour from start to finish. Polished only. Despite the fact that the value is a bit high occlusally, it still blends beautifully around the margins.
Great case Dan! Figured I’d give you some love on the cdoc site since all the love seems to be on Facebook
Hi Daniel Nice result. How does this material compare to Cerasmart. Would you have used cerasmart here?
Also did you use adhese universal as recommended?
Thanks
Gautam
The material handles and blends like Cerasmart. I could have used Cerasmart here as well. As I said in my post I typically will use e.max MT or HT for crownlays but I’m not worried about a hybrid in this case.
And yes, selectively etched enamel and used Adhese Universal with the Variolink Esthetic DC
I have a bunch of these blocks but I am afraid to use these for crowns. Aren't hybrids too flexible for crowns?
Nice case Dan... jury is still out for me on full coverage hybrids— I haven’t documented it well enough, but it “seems” like I have a whole lot of bonded “provisional” hybrids lasting too long, and too many definitive hybrids failing too early... case selection is important of course which better documentation would be more helpful...
Nice case! Thanks...
Mark
Daniel,
Case selection for this is imperative. Personally I wouldn’t do it for full coverage unless I have enamel to bond to and can properly isolate. Ideally rubber dam isolation. Don’t get me wrong, I’ve had some debonds with highly resilient, lower flexural strength materials.
Here are a few things to watch of when they have failed in full coverage situations:
1) Terminal tooth in the dentition
2) Teeth with a lot of sclerotic dentin and little enamel to bond to
3) Deep subgingival margins
4) Difficulty to proper isolate area
5) Heavy bruxers and flat plane occlusion.
This is purely anecdotal but hopefully my experience with materials 3M’s Lava Ultimate, GC Cerasmart and VITA Enamic can help allow you to be selective in your cases.
With the release of the speedfire oven, this has changed my material choices and find myself cementing a lot more cases because it is easier, less technique sensitive and predictable with Zirconia as a chairside option. As I stated earlier, I see Tetric CAD being a wonderful option for inlays, inlays, provisional Maryland bridges. As you dive into full coverage, there is a lot more scrutiny that needs to happen with case selection.
Dan
On 9/29/2018 at 6:43 pm, Daniel Kim said...I used Cerasmart for full coverage for several months at the recommendation of the mfr. rep when it was brand new. After about 90 days they started popping off. No fractures, just clean debonds. We replaced them with emax as they did. They're great for partial coverage, blend nicely, and look great. They're my go-to for inlays and onlays, and they're great when you need something fast. I just wouldn't trust a hybrid with full coverage.I have a bunch of these blocks but I am afraid to use these for crowns. Aren't hybrids too flexible for crowns?
On 9/29/2018 at 8:47 pm, Daniel Wilson said...Daniel,
Case selection for this is imperative. Personally I wouldn’t do it for full coverage unless I have enamel to bond to and can properly isolate. Ideally rubber dam isolation. Don’t get me wrong, I’ve had some debonds with highly resilient, lower flexural strength materials.
Here are a few things to watch of when they have failed in full coverage situations:
1) Terminal tooth in the dentition
2) Teeth with a lot of sclerotic dentin and little enamel to bond to
3) Deep subgingival margins
4) Difficulty to proper isolate area
5) Heavy bruxers and flat plane occlusion.
This is purely anecdotal but hopefully my experience with materials 3M’s Lava Ultimate, GC Cerasmart and VITA Enamic can help allow you to be selective in your cases.
With the release of the speedfire oven, this has changed my material choices and find myself cementing a lot more cases because it is easier, less technique sensitive and predictable with Zirconia as a chairside option. As I stated earlier, I see Tetric CAD being a wonderful option for inlays, inlays, provisional Maryland bridges. As you dive into full coverage, there is a lot more scrutiny that needs to happen with case selection.
Dan
Thanks Daniel for your explanation. There is a doctor who does a ton of crowns with Vita Enamic. His recommendation is to put retention grooves with small saucer burs. I have placed these actually on second molars which may require RCT later. It is nice to go through soft crown when doing RCT. With my limited experience, they held good. The only problem is they look like temps
On 9/29/2018 at 8:50 pm, Josh Fowler said...On 9/29/2018 at 6:43 pm, Daniel Kim said...I have a bunch of these blocks but I am afraid to use these for crowns. Aren't hybrids too flexible for crowns?
I used Cerasmart for full coverage for several months at the recommendation of the mfr. rep when it was brand new. After about 90 days they started popping off. No fractures, just clean debonds. We replaced them with emax as they did. They're great for partial coverage, blend nicely, and look great. They're my go-to for inlays and onlays, and they're great when you need something fast. I just wouldn't trust a hybrid with full coverage.
Thanks Josh for sharing your experience with me. My rep just told me last week to use Tetric Cad for crowns. I might actually try these with retention grooves and strong bonding on selected cases. I’ll let you you how they turn out
Personally I don’t think the retentive grooves will help you long term other than helping give you a positive seat for anti rotation. This isn’t like gold and you can’t get the same type of retention as a classic 3/4 gold crown with grooves. I wouldn’t just start trying them out. Enamel bonding is the key to success.
As far as polishing goes, I haven’t had the issues of Enamic, Cerasmart or now Tetric CAD losing its luster over time. It doesn’t look as good as e.max or other traditional ceramics, but I wouldn’t never say mine look like temporarys over time. I use the Meisinger CEREC doctors polishing kit and then use a stiff Robinson Bristle brush with fine Diashine to get a high luster at the end. Has worked very well for me. I’ll show you a two year follow up on a case when I get to my computer.
Retentive grooves will likely get overmilled anyways. Minimal benefit to them.
Nice case Wilson!
Encouraged by Daniel, I started doing Tetric Cad crowns. The only problem is that I can't make them shiny with polishing like I do with Celtra Duo.
I don't know if you can see the retentive grooves I placed right before bonding.
#4 is between PFM crowns. #'s 28-31 are EMax crowns.
I find it polished well. What is your polishing protocol? Diashine is very important to deliver a nice luster
+1 to Pete’s remarks. Diashine Fine with a stiff Robinson Bristle Brush works well after polishing with the Meisinger CEREC doctors kit.
Just so we are clear because I don’t want my remarks to lead to another 3M Lava Ultimate fiasco. Tetric CAD is a hybrid block. It is a nice block but I wouldn’t make it my go to for crowns. It’s nice that you don’t have to bake it and that makes it faster but if you have enough reduction, you can do the same with Celtra Duo.
If you read my remarks about the retentive grooves I don’t think they will work or add any benefit. They tend to get overmilled. I felt good about my case doing full coverage because I had enamel margins 360 degrees around the tooth. I could easily isolate with a rubber dam to cement them. As I stated in the first part of the thread, debonds are definitely the big fear for hybrid blocks in full coverage situations. Let’s make sure we are choosing our cases wisely. I don’t want you to wake up 6-12 months from now with a bunch of debonding crowns.
On 10/2/2018 at 3:03 pm, Daniel Wilson said... +1 to Pete’s remarks. Diashine Fine with a stiff Robinson Bristle Brush works well after polishing with the Meisinger CEREC doctors kit. Just so we are clear because I don’t want my remarks to lead to another 3M Lava Ultimate fiasco. Tetric CAD is a hybrid block. It is a nice block but I wouldn’t make it my go to for crowns. It’s nice that you don’t have to bake it and that makes it faster but if you have enough reduction, you can do the same with Celtra Duo. If you read my remarks about the retentive grooves I don’t think they will work or add any benefit. They tend to get overmilled. I felt good about my case doing full coverage because I had enamel margins 360 degrees around the tooth. I could easily isolate with a rubber dam to cement them. As I stated in the first part of the thread, debonds are definitely the big fear for hybrid blocks in full coverage situations. Let’s make sure we are choosing our cases wisely. I don’t want you to wake up 6-12 months from now with a bunch of debonding crowns.
Got it!!
