Dinesh Sinha, BDS, PhD, interviews Julián Conejo, DDS, MSc, clinical CAD/CAM director in the Department of Preventive and Restorative Sciences at the University of Pennsylvania (UPenn) School of Dental Medicine, on his restorative protocol.
Q: Please explain your day-to-day work.
A: I am the clinical CAD/CAM director at UPenn, and we see a variety of patients with different restorative needs.
Q: How do you use digital dentistry to assist your cases?
A: It would be accurate to say that we no longer practice dentistry without the implementation of digital tools. We use them from the treatment planning phase through the design of the final restorations, as explained in the following clinical case.
A patient who was unsatisfied with the aesthetics of her maxillary anteriors (teeth Nos. 6 to 11) presented to our clinic. She had multiple failing restorations and gingival recessions but wanted to avoid any orthodontic or periodontal surgical treatment (Figure 1).
Figure 1. Preoperative photographs.
By using digital software for smile design (exocad), we were able to visualize how the smile line and existing gingival recession could affect the aesthetics of new restorations both before and after treatment (Figure 2). It is very difficult to show these types of simulations without the help of digital dentistry.
Figure 2. Smile line visualization (exocad).
Q: What was your restorative approach in this case?
A: For this case, we had to replace a full crown for tooth No. 9. The remaining maxillary anterior teeth were prepared for veneers. We selected KATANA STML zirconia (Kuraray Noritake) for this case due to its aesthetics, strength, and masking capability in cases where restorations have different thicknesses (Figure 3). The zirconia restorations were made by Sean Han, CDT (Master’s Arch, Phoenix).
Figure 3. KATANA STML (Kuraray Noritake) restorations.
Q: What are the other key factors that you would consider for successful restorations?
A: There are many great material options; however, proper pretreatment and cementation are critical for long-lasting restorations. We always follow the “APC (Airborne particle abrasion, Primer, and resin Cement) Concept” introduced by Prof. Markus Blatz. These restorations were cemented with PANAVIA V5 (Kuraray Noritake). The final results are seen in Figures 4 and 5. The patient was very happy with the final aesthetic result. This simple digital workflow can be used by all dentists and laboratory technicians to achieve successful prosthetic outcomes. The implementation of digital dentistry and correct material selection is critical for successful long-term clinical results.
Figures 4 and 5. Postoperative photographs.
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