CERASMART® 270 and G-CEM ONE™- A Winning Combination
By Karyn M. Halpern DMD, MS
Patient Presentation
A 45-year-old healthy male presented for a hygiene visit and exam without complaints. After a clinical and radiographic examination, large distal proximal caries was observed adjacent to a failing occlusal-lingual resin restoration on tooth #3. In addition, tooth #2 was diagnosed with both occlusal-lingual pit and fissure caries as well as mesial proximal decay (figures 1 and 2, below).
Upon being shown and advised of the findings, it was recommended to restore the large lesion on tooth #3 with a single-visit CEREC® onlay and restore the smaller lesion on tooth #2 with a direct resin restoration.
Figure 1: Tooth #3 failing occlusal-lingual resin and large distal recurrent decay
Figure 2: Radiographically evident proximal caries on tooth #2 mesial and #3 distal
Technique
The failing resin restoration on tooth #3 was removed, and the extensive distal decay was excavated. The remaining undermined and thin distal lingual cusp was prepared for cuspal coverage. Caries detector was applied to assist in verification of complete caries removal (figure 3, below). The pit and fissure caries on tooth #2 was removed, as well as the decay on the mesial wall that was accessed directly. G-aenial™ Universal Flo flowable composite was used to restore #2 mesial, occlusal-lingual, and was also placed on the pulpal floor of the preparation of tooth #3.
As with all CEREC® restorations, the key to success comes down to the preparation. For a partial coverage onlay, the preparation must have draw with no undercuts, especially in the interproximal box. The internal line angles should be round and smooth, with straight exit walls on the interproximal.
Figure 3: Onlay Preparation tooth #3 and application of caries detector to assist in caries removal
After the composite restoration on #2 and the preparation on #3 were complete, the lower jaw, upper jaw and buccal bite were recorded using the CEREC® Primescan in the Acquisition Phase. The virtual models were created and the margins on the virtual preparation were created using the auto margin finder crown using the CEREC® 5.2 software (Figure 4). Once the design was completed, the onlay restoration was fabricated using a CERASMART® 270 A2 LT block with Dentsply Sirona’s MCXL. It mills quickly and predictably without any marginal chipping (figure 5). It also saves time since no firing is needed.
Figure 4: Margination using auto margin finder
Figure 5: Milled margins without any marginal chipping
Once milled, the sprue was removed. The restoration was then trial seated, verifying margins were closed and the contact was checked with floss. The restoration was then characterized using the OPTIGLAZE™ Color red-brown stain in the occlusal fissures followed by a clear coat of OPTIGLAZE™ Color.
To deliver the onlay for final placement, G-CEM ONE™ self-adhesive resin cement was used in “Adhesive cement mode” by combining it with G-CEM ONE™ ADHESIVE ENHANCING PRIMER (“AEP”). AEP accelerates the chemical cure of the cement to allow for optimal bonding. It allows for extremely easy cleanup which makes it even more advantageous.
Once bonded into the tooth, the restoration margins blend seamlessly with the surrounding tooth structure (Figure 6, below).
Figure 6: Occlusal view of final seated CERASMART®270 A2 LT restoration #3 after cementation
Advantages
This clinical case demonstrates how predictably and efficiently a partial coverage CEREC® onlay can be designed, fabricated, and placed in a single visit using CERASMART® 270 and G-CEM ONE™ resin cement. CERASMART®270 mills beautifully without chipping and saves significant chairside time, as no firing is needed. It can be characterized easily with OPTIAZE™ Color to match existing esthetic or simply polished and placed. When combined with G-CEM ONE™ with AEP, the result is a strong and esthetic restoration that blends seamlessly with the surrounding tooth structure.
Beautiful Karyn. I love using Cerasmart. Have you noticed anything significantly different with the 270?
Kirsten
Nice work.
Could you not move the sprue to the proximal surface?
I prefer Panavia V5 Clear after Telio DS. Never have and problems with debonds nor with sensitivities.
On 8/4/2021 at 10:28 am, Kirsten Andrews said...Beautiful Karyn. I love using Cerasmart. Have you noticed anything significantly different with the 270?
Kirsten
Hey Kirsten :) thank you ! So in a blind test, I do not think I would be able to correctly identify Cerasmart vs Cerasmart 270... 270 comes in the same shades and translucencies as the original Cerasmart. The only thing I notice in regards to its appearance is the LT in the 270 a bit warmer than the original Cerasmart.
The main difference between the two is the properties/technology of the cerasmart 270 is different than the original cerasmart. The 270 has improved flexural strength, higher filler weight, and is more radioopaque. According to GC, the 270 has a new full coverage silane coating that provided better bonds to resin cement and less stress to the bonding surfaces.
I had the opportunity to test it before it was released and have been using it since. no issues to report.
On 8/4/2021 at 10:29 am, Armin Giessmann said...Nice work.
Could you not move the sprue to the proximal surface?
I prefer Panavia V5 Clear after Telio DS. Never have and problems with debonds nor with sensitivities.
Hi Armin! How are things by you? Thanks for the compliment :)
Not sure if I am misunderstanding your ques regarding the sprue. It was placed on the proximal surface... do you mean why didn't I move it away from the contact are instead?
One of the challenges of milled onlay restoration is managing the sprue. Since the restoration is so small, often the only broad enough area available for the sprue placement is the contact area . I like to use a pencil to outline the sprue and use as a reference. Then I will take a high speed flame shaped fine composite finishing bur and slowly remove the sprue. I would prefer the sprue here as opposed to the occlusal/intaglio surfaces
On 8/4/2021 at 10:53 am, Karyn Halpern said...On 8/4/2021 at 10:29 am, Armin Giessmann said...Nice work.
Could you not move the sprue to the proximal surface?
I prefer Panavia V5 Clear after Telio DS. Never have and problems with debonds nor with sensitivities.
Hi Armin! How are things by you? Thanks for the compliment :)
Not sure if I am misunderstanding your ques regarding the sprue. It was placed on the proximal surface... do you mean why didn't I move it away from the contact are instead?
One of the challenges of milled onlay restoration is managing the sprue. Since the restoration is so small, often the only broad enough area available for the sprue placement is the contact area . I like to use a pencil to outline the sprue and use as a reference. Then I will take a high speed flame shaped fine composite finishing bur and slowly remove the sprue. I would prefer the sprue here as opposed to the occlusal/intaglio surfaces
Oops, sorry. That was what I meant.
On 8/4/2021 at 11:05 am, Armin Giessmann said...On 8/4/2021 at 10:53 am, Karyn Halpern said...On 8/4/2021 at 10:29 am, Armin Giessmann said...Nice work.
Could you not move the sprue to the proximal surface?
I prefer Panavia V5 Clear after Telio DS. Never have and problems with debonds nor with sensitivities.
Hi Armin! How are things by you? Thanks for the compliment :)
Not sure if I am misunderstanding your ques regarding the sprue. It was placed on the proximal surface... do you mean why didn't I move it away from the contact are instead?
One of the challenges of milled onlay restoration is managing the sprue. Since the restoration is so small, often the only broad enough area available for the sprue placement is the contact area . I like to use a pencil to outline the sprue and use as a reference. Then I will take a high speed flame shaped fine composite finishing bur and slowly remove the sprue. I would prefer the sprue here as opposed to the occlusal/intaglio surfaces
Oops, sorry. That was what I meant.
