The “Poor Man’s” CEREC Crown

Introduction to the case

I posted this technique before but wanted to show it with a little more detail: link to technique.

#3 has distal decay, existing large MO filling, separate buccal and lingual amalgam fillings and some ugly looking cracks. Tooth is periodontally involved and is also unopposed. What do you do for this tooth? In my view it’s only value is for esthetics unless she opts to restore the bottom. Considering that and the perio, I hate to recommend an expensive crown. I would also hate to try an MODBLXYZ filling. This is the perfect scenario for the poor man’s cerec crown.

  • 1. Preop dual arch impression.

  • 2. Remove all decay and old restorative – in this case that didn’t leave me with much othere than a few thin cusp tips.

  • 3. Prep for full coverage staying supra G where possible and preparing a nice readable should margin and smooth edges- much like a cerec prep.

  • 4. Using the impression, place dual cured composite (I use Injectafill) in the tooth site just as you would to make temporary.

  • 5. Remove at exactly 1:30 sec.

  • 6. Allow to self cure or hit it with light.

  • 7. Trim as you would a temp- gotta get this part right becaus this is the definitive restoration. You can leave a little excess buccal and lingual as you’ll have access to finish the margins.

  • 8. Try in and verify fit.

  • 9. Sandblast internal.

  • 10. Bond as you would any other composite/all ceramic crown.

  • 11. Clean excess, finish margins, adjust occlusion (shouldn’t be much to adjust given that it is identical to their original tooth.

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Restoring a Fractured Tooth with a Deep Sub-gingival Fracture

Terry Shaw

General Dentist

Perth-Ando​ver, N.B, Ca​nada

4,053 views

Introduction to the case

25 years ago I started restoring these fractured cusps this way and have only lost a couple of the 20-30 plus teeth I have restored this way. Conventional treatment has been extraction in many cases. Some have had previous RCT.

Procedure:
I percolate Javex or bleach (same stuff I use for RC) into the fracture to clean any organic crap out and help just clean the fracture line. Then I wash profusely for 20 seconds to get rid of the bleach. Then dry and etch moving the piece open and close to suck and pump the etch down the crack. Then wash for 3 seconds and since I am using a 4th generation bonding system I place 5-6 coats of primer on the tooth and use a little more than usual to get the primer down the crack. This will take me close to 60 seconds to place these coats of primer and let it evaporate for several seconds between coats. I will sometimes write up my chart while I wait for the primer to evaporate but I know I will get a hybrid layer and good bonding results this way. Then I dry for 5 seconds and liberally apply my bonding resin and push the piece together and cure with my Valo for 20 seconds. My resin is dual cure so it cures well. The tooth is sealed and should function just fine as have the other couple of dozen I have restored this way. Some were restored this way 25 year ago and still working!

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