Ceramic restorations with the CEREC system

CEREC, short for “Chairside Economical Restoration of Esthetic Ceramics”, is an innovative technology that allows us to produce precise, esthetically high-quality ceramic restorations directly in our practice. The CEREC system consists of a powerful combination of devices: a 3D camera for the digital scan, a state-of-the-art CAD-CAM grinding and milling unit for the exact machining of the ceramic, and a special furnace that hardens the restoration. This technique lets us make and fit a custom ceramic restoration within a single appointment – for fast results and maximum comfort.

CEREC technology has its roots in Switzerland and was developed in 1980 by the pioneers Werner H. Mörmann and Marco Brandestini at the University of Zurich. The first version of the system, known as CEREC 1, was brought to market by Siemens in 1987. CEREC has been developed continuously ever since and has established itself as a proven method that has delivered excellent results and patient satisfaction for over 40 years.

A variety of ceramic restorations can be produced with the CEREC system, including:

Crowns: To replace the entire tooth crown. There are three main types of crown: full crowns (covering the whole tooth), partial crowns (covering only part of the tooth) and post crowns (anchored on a post in the root canal).

Inlays and onlays: For rebuilding parts of the tooth crown. Inlays fill the cavities, while onlays also cover the cusps.

Overlays: Similar to onlays, but covering a larger area of the tooth.

Veneers: Thin shells for the front teeth. Veneers are only made with CEREC in less esthetically demanding situations. In esthetically demanding cases the craft of the dental technician is required.

Bridges: To replace missing teeth by joining two or more teeth. Bridges can span a maximum of 4 units in the anterior and premolar region and a maximum of 3 units in the posterior region

The CEREC treatment is generally painless, because we use a local anesthetic that works in much the same way as for conventional fillings. To improve our patients' comfort further, we use The Wand, a modern anesthesia device that delivers the anesthetic gently and precisely. In some cases it may be necessary to polish at the gum margin, which can cause slight irritation. These soft-tissue wounds usually heal within a few days. After the treatment the tooth may be sensitive for a few days or weeks, or feel different because of the slightly altered occlusion.

Before the treatment you should make sure that you have brushed your teeth thoroughly and used dental floss. Tell your dentist about all the medication you take and about any health problems you may have.

1. Preliminary examination At the start of the CEREC treatment we carry out a thorough examination. This includes measuring the gum pockets, an X-ray, a vitality test, checking tooth mobility and the percussion test, in order to establish how sensitive to pain the tooth is. These steps make sure the tooth is suitable for a CEREC restoration.

2. Anesthesia and isolation For a painless treatment we use the “The Wand” system, a particularly gentle method of local anesthesia. We then isolate the tooth with a dental dam or Iso Vac to create a dry, clean working field.

3. Removing old restorations Old fillings or restorations are removed. If the margins lie too far subgingivally, we carry out a box elevation to position the margins of the new CEREC restoration further away from the gingiva. This allows clean isolation and prevents moisture or blood from reaching the restoration margin.

4. Tooth preparation The tooth is prepared for the CEREC restoration by being brought into the right shape. Where appropriate we shorten cusps or take the tooth out of occlusion, in order to optimize the distribution of forces and reduce the fracture risk of the remaining tooth structure.

5. Digital scan and bite registration Using the CEREC Primescan we create a precise 3D impression of the prepared tooth, of the entire arch of the upper and lower jaw and a bite registration. After the scan the shade is selected, to make sure the restoration matches the surrounding teeth perfectly.

6. Designing the CEREC restoration The individual restoration is designed and adjusted digitally in the CEREC software. In doing so we make sure that there are no interferences in the occlusion and that the contact points sit firmly, to guarantee a perfect fit.

7. Producing the CEREC restoration The digitally designed restoration is milled from a ceramic block with the CEREC Primemill. This process takes only a few minutes.

8. Try-in, finishing and fitting The CEREC restoration is checked before fitting and adjusted if necessary. It is then fired in the SpeedFire furnace, glazed if required and afterwards conditioned. The finished restoration is fitted with a special composite cement. Excess is removed and the restoration is polished carefully.

9. Completion and follow-up check After the CEREC treatment we check the bite and take a control X-ray. A follow-up check after 1–2 weeks may be recommended to secure long-term success.

After the CEREC treatment the anesthetic can still be working for some time, so there is a risk of biting injuries. It is advisable to wait until the numbness has worn off. Fluoride is applied to remineralize demineralized areas. Nothing should be eaten or drunk for at least one hour after the treatment.

Yes, to ensure the longevity of your CEREC restoration you should:

- Use a sonic toothbrush: They are more effective at removing plaque. - Toothpaste with fluoride and fluoride gel: Helps to strengthen the teeth. - Tongue cleaning: Reduces the bacterial load in the mouth. - Use dental floss and/or interdental brushes: Cleans between the teeth. - Regular check-up appointments: At least once, ideally twice a year for dental hygiene (DH).

A CEREC crown usually lasts 5 to 10 years. With good care, however, they can last longer.

A CEREC crown costs around CHF 1500, while conventional crowns can cost around CHF 2500. These are guide values only. Prices can vary depending on the situation, especially when additional procedures are required, such as root canal treatments, building up deep margins or tooth defects, gingivoplasty/gingivectomy, preconditioning of the gum, and so on.

CEREC restorations are suitable for most patients who need a dental restoration. Your dentist will carry out a thorough examination to make sure this method is right for your specific needs.

A CEREC restoration may not be suitable in the following situations:

- Defect too small: If the tooth defect is too small, a conventional filling is sufficient. - Tooth not worth preserving: If the tooth is too badly damaged and cannot be saved, extraction and possibly an implant is the better solution. - Extremely deep margins: If the margins of the restoration lie deep below the gum and are hard to reach. - High esthetic demands: In cases with very high esthetic demands, especially in the anterior region, the craft of a dental technician may be required. - Poor oral hygiene: In patients with poor oral hygiene and a high risk of decay, long-term success is harder to guarantee.

In our practice we use the latest models in the CEREC range: CEREC Primescan, Primemill and SpeedFire. Our materials come only from the best, most researched and clinically proven companies such as Ivoclar, GC, Dentsply Sirona, Kuraray Noritake and others.