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I 25 case report _ CAD/CAM restoration I CAD/CAM 4_2013 The E4D design software was used to virtually create the lithium-disilicate crown restorations for thetwopremolars(Fig.7).Thesoftwarealsoenabled verification of material thickness (Fig. 8). In partic- ular, the E4D Autogenesis software was used to create ideal tooth anatomy and contours, with the buccal area 2 mm thick and the distal area 1.5 mm thick, which was perfect for the lithium-disilicate (IPS e.max CAD) material (Fig. 9). The Value 1 Impulse blocks (IPS e.max) were milled and fired in one cycle, resulting in highly estheticandmonolithiccrownrestorations(Fig.10). The implant screw access canals were sealed using a provisional inlay material (Systemp.inlay, Ivoclar Vivadent). To prepare the lithium-disilicate crowns for placement, the internal aspects were etchedwith5percenthydrofluoricacid(IPSCeramic Etching Gel) for 20 seconds, then rinsed and dried. Then, a silane primer (Monobond Plus) was placed inside the crowns for 60 seconds and also on the zir- conium abutments as a zirconium primer for 60 sec- onds, using the phosphoric acid methacrylate and sulfide methacrylate to bond to zirconium. The re- storationswerethencementedusingauniversalresin cement,withoutprimers(Multilink,IvoclarVivadent). _Conclusion IPS e.max CAD restorations provide predictable results for restoring implants (Figs. 11–14). The Value Impulse blocks lend to the creation of resto- rations that blend seamlessly with the adjacent natural dentition, yet they provide the ideal level of translucency to mask zirconium abutments. Inthiscase,thepatientwaspleasedwiththenat- ural looking treatment results that were achieved by combining the IPS e.max CAD material with E4D in-office fabrication technology._ _References 1. Wolf D, Bindl A, Schmidlin PR, Lüthy H, Mörmann WH. Strength of CAD/CAM-generated esthetic ceramic molar implant crowns. Int J Oral Maxillofac Implants. 2008 Jul-Aug;23(4):609–17. 2. Guess PC, Att W, Strub JR. Zirconia in fixed implant prosthodontics. Clin Implant Dent Relat Res. 2012 Oct;14(5):633–45. 3. Shenov N, Shenov A. Dental Ceramics: An Update. J Conserv Dent. 2010 Oct-Dec: 13(4):195–203. 4. Poticny D, Potincy J, Klim J. CAD/CAM in-office tech- nology innovations after 25 years for predictable, eesthetic outcomes. The Journal of the American Dental Association. 2010;141:55–95. 5. Buehler B. Simple and efficient crown fabrication with an advanced CAD/CAM system. 2012; Dental Tribune. 6. Thompson VP. Durability (reliability) of all-ceramic crowns (Web cast); event.on24.com/eventRegistration/ EventLobbyServlet?target=lobby.jsp&eventid= 163956&sessionid=1&key=B2F0098B49AAEA431E78 38ECF9721EFB&eventuserid=28400352. Accessed April 21, 2010. Fig. 14_Postoperative close-up view demonstrating the excellent colour, function and aesthetic properties of the Value 1 Impulse block. The monolithic crowns seamlessly match surrounding dentition and blend with perfect translucency to mask the underlying zirconium. Walter G.Renne,DMD, is a 2003 graduate of the College of Charleston and a 2008 graduate of the Medical University of South Carolina College of Dental Medicine. He is active in undergraduate dental education and holds a full time faculty position in the Department of Oral Rehabilitation at MUSC.He is the course director for CAD/CAM technologies and ceramics and runs the E4D CAD/CAM clinic at MUSC.Renne maintains an active general dentistry practice utilizing both the CERECAC and E4D systems.His special interests in patient treatment include advances in CAD/CAM dentistry,adhesive dentistry and conservative dentistry.He is active in dental research and currently has a patent pending for a new dental adhesive that is permanently antimicrobial in addition to having revolutionary bond durability components that prevent enzyme degradation of the hybrid layer.This bonding agent may prevent recurrent caries and bond breakdown in the long term.You may contact Renne at renne@musc.edu. CAD/CAM_about the author Fig. 14