CEREC Results By: Robert Henkel, DDS

Being an active contributor to the CEREC threads on the message boards, some of the most frequent comments and criticisms of CEREC dentistry is that of esthetics. To make a monochromatic block of porcelain have a natural appearance is not easy. Proper preparation technique and ceramic block selection is critical. And often times that is not enough. Staining and glazing of the restoration is necessary to bring out the best of what is possible with this technology. In response to the many requests to post completed CEREC cases, I have taken photos of some of the results which can be achieved with CEREC. These are everyday cases, not just the “trophy” cases in my collection.

Conclusion: CEREC is what you put into it. I have taken a great deal of time to learn to deliver a restoration which closely mimics the surrounding anatomy, occlusion and esthetics of a natural tooth. If one looks carefully, each is different, but still reflects the overall appearance of the surrounding teeth. Each of these cases is an exercise in minimally invasive dentistry. Very little additional tooth structure was required to be removed to complete these restorations. Alternatively, a buildup and crown could have been done, but ultimately that would have lead to even more tooth reduction. When full or partial coverage is indicated, then adhesively bonding an onlay or crown can be more conservative than other more invasive modes of treatment.

Dr. Henkel maintains a private practice in Woburn, Massachusetts concentrating on computerized and laser dentistry. Dr. Henkel is a graduate of Northwestern University Dental School (1990) and completed an Anesthesiology Residency from Medical College of Pennsylvania. He is also recognized as a clinical assistant to Dr. Stewart Rosenberg, teaching the use of the Waterlase, as well as providing hands-on instruction in the use of CEREC 3D in his own office. He can be contacted by email at rhenkeldds@comcast.net, as well as on the message boards at Dentaltown.com.

Mgroets | Posts: 9 | Posted 12/16/2003 | 1:08:02 AM
What is the chair time for something like the third case?

Rhenkeldds | Posts: 2339 | 12/16/2003 | 7:15:10 AM
I typically schedule 1.5 to 2 hours for a case like this. During the “down time” I do another restoration or admin work.

FrankNelsonDDS | Posts: 2365 | 12/16/2003 | 3:00:39 PM
I am curious how long to stain and glaze? Is it one pass or do you usually have to do it once and touch up?

Rhenkeldds | Posts: 2339 | 12/16/2003 | 7:15:10 AM
My whole protocol for developing the anatomy and staining and glazing is actually really simple. I learned it all from Gary Maxon from Vident(Vita) I only use a rubber pre-polishing wheel prior to glazing. As far as anatomy goes, I typically only use two burs, a fine-grit cylinder and a fine-grit mini sharp pointed football diamond. It is really not the bur, but knowing how to place the grooves. I Cemented with Simplicity and VariolinkII .The camera is a Canon G2 with the Photomed diffuser.

Husaskin | Posts: 22 | 12/19/2003 12:16:53 PM
You’ve done some gorgeous work here. I do have a question though. You left the lingual cusps intact in the third case. What’s the longevity of the restoration since the lingual cusps are functional?

Rhenkeldds | Posts: 2339 | 5/11/2004 11:08:41 AM
There was a tremendous amount of remaining tooth structure supporting the lingual cusps. I do not feel it is necessary to remove healthy, well supported tooth structure. As far as being “functional”, there are not any working contacts on those lingual cusps, that interference has been selectively removed.