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ePaper created 2017-01-24, 10:47:27 | version 1.38.0
I 11 CAD/CAM 3_2016 clinical_ partial-coverage restorations I coverage restorations. Specific to anterior teeth, in vitro and in vivo data indicates that long-term prognosisofatoothrestoredwithapartial-coverage direct or indirect restoration when possible is equal to or better than using a full-coverage restoration.6, 7 Digital impressioning and chairside CAD/CAM technologies further enhance patient outcomes for partial-coveragerestorationsandeliminatemanyof the barriers that exist in conventional workflows for partial-coverage dentistry. Perhaps the biggest con- cern dentists have with partial-coverage dentistry is provisionalization, because of the non-retentive nature of adhesive preparations. Chairside CAD/CAM, in allowing for single-visit dentistry, eliminates this problem. It also eliminates concerns of persistent pulpal irritation during the days or weeks of provisionalization, thereby further reducing the patient’s risk of subsequent pulpal complications. Digital impressioning and digital restoration de- sign also give a practitioner much more control over ensuring a quality preparation and one that appro- priatelysupportstheproposedrestoration,resulting in a more ideal restorative outcome for the patient. _Case report A 70-year-old male presented with a chief com- plaint of broken teeth as a result of a fall. Clinical examination revealed a small chip in the incisal enameloftooth#8,aswellassignificantfracturesof theincisalthirdsofteeth#9and#10,extendingwell intodentinbutwithnovisiblepulpalexposure(Fig.1). Periapicalradiographsprovidedbythepatientre- vealednoovertperiapicalpathologyorrootfractures. Periodontalexaminationfoundallprobingdepthsto be 3 mm or less, with no bleeding on probing and no tooth mobility. The patient reported a positive, non- lingering response to cold for all anterior maxillary teeth. Based on clinical and radiographic findings, teeth #8–10 were diagnosed with incisal fractures limitedtotheincisalthirdofthetoothwithanormal pulpal, periapical and periodontal status. Findings and treatment options were discussed with the patient, including partial-veneer or full- veneer restorations with either composite resin or ceramic. Because of the small size of the incisal chip of tooth #8 limited to enamel, a composite resin restoration was chosen to repair that area. For teeth #9 and #10, the patient expressed a desire to have the most durable restorative material possible but wished to limit the removal of further tooth structure as much as possible. For this reason, partial-coverage ceramic veneers were chosen to restore teeth #9 and #10. Minimal modifications to teeth #9 and #10 were made, primarily to remove sharp points and line angles and to place a chamfer margin on the facial surface to help blend the transition of the proposed restorations with the natural tooth structure. Digital impressions were made using the PlanScan Scanner (Planmeca USA, Roselle, IL) (Figs. 2a, 2b). (Photos/Provided by Clint D. Stevens, DDS) Fig. 1 Fig. 2b Fig. 2a