The fabrication of a CAD/CAM ceramic

crown to fit an existing partial remov-

able dental prosthesis: A clinical report
Tae-Ho Yoon, DDS, MSD, PhDa and Won-Gun Chang, DDS, MS, PhDb
Tufts University School of Dental Medicine, Department of
Prosthodontics and Operative Dentistry, Boston, Mass
The application of computer-aided design/computer-assisted manufacturing (CAD/CAM) technology to fabricate
a retrofit ceramic surveyed crown to an existing partial removable dental prosthesis (PRDP) is described. The fab-
rication of a surveyed crown by using CAD/CAM technology enables precise and easy replication of the shape and
contours as well as the rest seat of the existing abutment tooth, ensuring excellent adaptation to the existing PRDP
framework with minimal adjustment. (J Prosthet Dent 2012;108:143-146)

Dental disease such as dental caries it scans and duplicates the planned ing a PRDP, which had been fabricat-
can be found under a supporting res- shape or contour of waxing or cast.10 ed 1 year previously. The PRDP was
toration of an existing partial remov- The purpose of this clinical report is clinically acceptable, and the patient
able dental prosthesis (PRDP). The to describe a technique for fabricat- was satisfied with the prosthesis. Clin-
fabrication of a new crown to retrofit ing a retrofit ceramic surveyed crown ical examination revealed a fractured
the PRDP is indicated if the PRDP is for an existing PRDP by using CAD/ maxillary right second premolar with
clinically acceptable and/or remaking CAM technology. a disto-occlusal rest seat serving as an
the prosthesis is not indicated.1,2 In this abutment tooth for a maxillary PRDP.
instance, a restoration must be made CLINICAL REPORT Recurrent caries associated with an
to conform to the existing PRDP, and amalgam restoration was found. The
various direct and indirect techniques A 74-year-old woman presented periapical radiographs were normal
have been reported to accomplish to the Department of Prosthodontics and the patient reported no discom-
this.3-8 However, this procedure typically and Operative Dentistry, Tufts Uni- fort (Fig. 1). However, a necrotic
requires the existing PRDP to be sent to versity School of Dental Medicine, pulp was diagnosed as the tooth was
the dental laboratory, with adjustments complaining of a fractured restora- nonresponsive to cold stimulation
often required during insertion. tion on a maxillary right second pre- (Frigi-Dent; Ellman Intl Inc, Oceans-
While metal ceramic crowns with molar. The patient’s medical history ide, NY). After removal of the amal-
retentive contours in the veneering revealed no contraindications to den- gam restoration and excavation of the
porcelain have been accepted when a tal treatment. The patient was wear- caries, the remaining tooth structure
retrofit crown is fabricated, their fab-
rication is difficult and time consum-
ing. The laboratory phase of crown
fabrication involves surveying repeat-
edly as the restoration is made to en-
sure the planned contours are present
in the final restoration.9,10 Ceramic
restorations have been suggested as
a predictable and successful alterna-
tive to conventional metal ceramic
crowns.11-15 The application of com-
puter-aided design/computer assisted-
manufacturing CAD/CAM technology
can be useful as an alternative method
1 Periapical radiograph of maxillary right second premolar
of fabricating a surveyed crown since
shows dislodged amalgam restoration and fractured cusp.

Assistant Professor, Tufts University School of Dental Medicine, Department of Prosthodontics and Operative Dentistry.
a

Private practice. Seoul, Korea.

b

Yoon and Chang

144 Volume 108 Issue 3

2 Tooth prepared for cast post and core after endodontic 3 Cast post and core cemented and tooth preparation
therapy. finalized for impression.

4 Scanned image of maxillary right second premolar
from existing diagnostic cast.
was insufficient to support a crown.
A cast post and core was fabricated
and a surveyed crown to fit the exist-
ing PRDP was recommended. Since
a diagnostic cast of the tooth before
the fracture occurred was available,
the use of a CAD/CAM technique
to scan and duplicate the tooth was
suggested. This treatment option was
presented and the patient agreed.
Endodontic therapy was per-
formed and the tooth was prepared
for the cast post and core (Fig. 2).
Autopolymerizing acrylic resin (Pat-
tern Resin LS; GC America, Alsip, Ill)
was used to form the post and core
pattern, and a tooth was prepared to
establish an appropriate finish line.
An interim crown was fabricated by
using a prefabricated post (Parapost
XT; Coltene Whaledent, Cuyahoga
Falls, Ohio) and acrylic resin (Cold-
pac Tooth Acrylic; Patterson Dental,
Chicago, Ill), and its buccal contour
was adjusted to fit the existing PRDP.
The Journal of Prosthetic Dentistry
5 Scanned image of prepared maxillary right second
premolar from definitive cast after impression.
After trial placement and verifica-
tion of the fit, the cast post and core
was cemented with a resin cement
(Rely X Unicem; 3M, St Paul, Minn).
The preparation was refined and the
definitive impression for the crown was
made with vinyl polysiloxane impres-
sion material (Imprint; 3M) (Fig. 3). A
shade guide (Vitapan Classical Shade
Guide; Vita Zahnfabrik, Bad Sackingen,
Germany) was used to determine tooth
shade, and the impression was poured
with Type V dental stone (Die-Keen;
Heraeus Kulzer LLC, South Bend, Ind).
The patient’s maxillary diagnostic
cast and definitive cast were scanned
with a hand-held digital scanner (E4D
Dentist; D4D Technology LLC, Rich-
ardson, Tex), and a definitive ceramic
crown was designed to duplicate the
original tooth shape by using the
clone feature of the supplied software
(Figs. 4-6). The finished design infor-
mation was transferred to a milling
machine (E4D Mill; D4D Technology
LLC), and the crown was milled from
a lithium disilicate B2 low translucen-
cy shade block (IPS e.max CAD; Ivo-
clar Vivadent, Schaan, Liechtenstein).
After the milling procedure was com-
plete, the crown was characterized
(IPS Empress Universal; Ivoclar Viva-
dent) and fired in the furnace (Pro-
gramat P500; Ivoclar Vivadent) to
be crystallized and glazed according
to the manufacturer’s recommenda-
tions. The occlusion was adjusted on
the mounted cast and polished with
a porcelain polishing kit (OptraFine;
Ivoclar Vivadent).
After clinical evaluation and the
patient’s approval, the restoration
was luted (Variolink II; Ivoclar Viva-
dent) in accordance with the manu-
facturer’s guidelines (Fig. 7). The
existing PRDP and the occlusion re-
quired minimal adjustment (Fig. 8).
The crown has been in satisfactory
function for a year.
Yoon and Chang
September 2012
6 Duplicated image of maxillary right second premolar
crown from diagnostic cast is superimposed on prepared
tooth of definitive cast.
7 CAD/CAM milled ceramic crown was adjusted and
cemented.
145
retrofit surveyed crown should be fab-
ricated after waxing the missing tooth
structure to an ideal shape and con-
tour by using the patient’s PRDP.
Possible disadvantages of this
technique include the restoration of
the abutment tooth with a ceramic
crown. However, in this instance, the
existing PRDP was a tooth-supported
design, and the restored tooth was not
the distal abutment, thus reducing
the risk of fracture. Another possible
limitation of the imaging technique
is scanning subgingival preparations
intraorally. Therefore, a conventional
impression with displacement cord
is recommended to make a definitive
cast. A further limitation might be the
shoulder preparation design recom-
mended by the manufacturer, which
requires extensive tooth reduction
and may cause the fracture of a small
tooth. For this patient, tooth structure
was preserved by limiting the gingival
extension of the tooth preparation.
Additional gingival extension was not
needed as the ferrule was adequate,
and the patient accepted the esthetics
of a supragingival margin, which also
facilitated the cleaning and mainte-
nance of the restored tooth.

SUMMARY

The fabrication of a retrofitted
crown under an existing PRDP was de-
scribed. A chairside CAD/CAM scan-
ner was used to record the patient’s
existing cast. The technique provided
a durable and esthetic result. The ac-
curacy of the scanning technique al-
lowed for precise replication of the
tooth without the need to modify the
porcelain surface. The ceramic crown
fabricated required minimal modifi-
cation and adjustment to fit the exist-
ing PRDP framework.
8 Retrofit ceramic crown is well adapted under patient’s
existing PRDP. REFERENCES

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DISCUSSION
The advantage of this technique
allows the entire procedure to be per-
formed without depriving the patient
Yoon and Chang
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Corresponding author:
Dr Won-Gun Chang
945-5 Superior Tower, 4th floor
Daechi-Dong, Gangnam-Gu
Seoul 135-280
KOREA
E-mail: chang@gmail.com
Fax: +82-2-568-0679
Copyright © 2012 by the Editorial Council for
The Journal of Prosthetic Dentistry.
Yoon and Chang