Steven Pigliacelli, CDT, Joshua Marotta, CDT, and Mark Hartslief from Marotta Dental Studio, Inc. in Farmingdale, New York, offer a step-by-step explanation of how they fabricated a four-unit Telio CAD provisional bridge for their client, Dr. Chris Salierno:
The dentist prepared four teeth for a four-unit, anterior splinted bridge (see Figures 1 and 2).
Treating it as a standard crown and bridge case, the lab poured the models using type III die stone and subsequently pindexed and trimmed the dies (see Figure 3). The models were mounted on an articulator and polyvinyl bite indexes were made prior to scanning.
The lab placed the models onto the NobelProcera scanner. Previously, the lab could only fabricate Procera zirconia or alumina copings with this scanner but thanks to a new interface, it can now use the Telio material; IPS e.max CAD will be available as a material option later this fall. The lab set the parameters to scan (see Figure 4), selected Telio as the material choice and identified the desired shade. The dies were scanned as well as the adjacent teeth to establish proximal contacts and bite registration for occlusal contacts.
The bridge was designed using the software design tools, creating a virtual full-contour restoration.
The lab sent the digital data to Nobel Biocare and received the Telio CAD provisional bridge a few days later.
For maximum esthetics for NobelProcera milled Telio frameworks, Ivoclar Vivadent recommends using the cutback technique starting with an incisal index. If the frame is made to full contour, the index can be made directly on top of the finished product; if the frame is not full contour, some wax can be added and carved onto the framework.
The laboratory cut in mamelon formation grooves, paying careful attention to the surface to ensure the final product had a smooth harmonious transition (see Figure 5).
The entire framework was sandblasted and steamcleaned.
Next, the framework was treated with Telio monomer for about four minutes. SR Composiv, a bonding compound from Ivoclar Vivadent, was then added and light cured for 60 seconds. This specific sequence is recommended to ensure the optimal bond between the polymethylmethacrylate framework and the light-cured composite veneering materials.
The next steps were very similar to standard ceramic application procedures. The lab applied Telio stains using a brush; the working time and handling characteristics of the stains are similar to porcelain and therefore a talented ceramist with a trained eye for esthetics is the best choice to give the Telio CAD restorations the proper finesse.
After the stain was applied, the bridge was placed in the light-curing unit for about a minute. The incisal portion was applied with a spatula due to the consistency of the material and then light cured for five minutes (see Figure 6). To ensure complete polymerization of the light-cured materials, the lab gave careful consideration to which light-curing unit was used and the recommended curing time for each unit as indicated in the Telio CAD instructions for use. The bridge was shaped in the same manner as a ceramic bridge only using carbides instead of diamonds.
Once the contouring was complete, the glaze was achieved via light polishing using polishing paste and a buff wheel (see Figures 7 and 8).