Clinical Case Study: Glass-Ceramic Tabletop Restoration

By Dr Andrew See. Aesthetic Dentist and Educator, Founder of Dental Mastery Academy.

BDS Hons (Syd), FRACDS, MSc(Lond), PGDipDentImplantology, FCGDENT(UK), FICOI, MFDS RCSEng

A 54-year male with a history of bruxism presented with cracks in tooth 16. The tooth tested vital. After removal of the existing amalgam restoration, extensive radiating crack lines were found propagating from mesial to distal and buccal to palatal. Due to his bruxism and history of cracked teeth that needed endodontic treatment, it was decided to protect the tooth from further cracks with a cusp-capping tabletop restoration.

Cusps were reduced to the minimum required thickness (1.5mm) of the indirect material. Dentine was sealed with 3M™ Scotchbond ™ Universal Plus Adhesive and the cavity was lined with 3M™ Filtek™ Bulk Fill Flowable. A lithium disilicate (IPS e.max ®) restoration was fabricated with CEREC ®, stained and glazed.

Bonding was performed with 3M™ RelyX ™ Universal Resin Cement using a selective enamel etch protocol and 3M™ Scotchbond ™ Universal Plus Adhesive as the restoration primer and tooth adhesive.

Delve into the step-by-step case study below or download the article published in 3M's 'Solutions for Dentistry' publication (April-June 2024 Edition) by clicking on the thumbnail below.

Clinical Steps for the Glass-Ceramic Restoration

1. Removal of old amalgam revealed cracks running under buccal and distobuccal cusps.
2. Tabletop preparation with minimum required occlusal reduction of 1.5mm.
3. Dentine sealed with 3M™ Scotchbond™ Universal Plus Adhesive; cavity lined with 3M ™ Filtek™ Bulk Fill Flowable Restorative.
   
4. Composite was sandblasted (50 μm alumina) and enamel was etched followed by application of 3M™ Scotchbond™ Universal Plus Adhesive.
   
5. Lithium disilicate restoration, HF etched and silanised with 3M™ Scotchbond™ Universal Plus Adhesive.
   
6. Seating of tabletop on 3M™ RelyX ™ Universal Resin Cement layer applied to the preparation.
7. Restoration in place, excess cement was removed right away with floss and instruments.
8. Finished margin after final light cure through glycerin gel.

Conclusion

Cusps were reduced by 1.5mm for the minimum thickness of the indirect material. This type of preparation utilises the adhesive bonding to enamel and results in a minimally invasive preparation and protects the tooth from further
crack propagation.