Highly Esthetic

CEREC So utions
By
Dr. Rich Masek
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Foreword By
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Dr. Werner Mormann
Preface By
Drs. Rella & Gordon Christensen
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 To my beautiful wife Sheri,
for her loving support and indulgence in my
passion for all things CEREC and through the
long hours spent creating this book.
Highly Esthetic CEREC Solutions
Copyright ©2005 Dr. Rich Masek & Dentistry By Design, Inc.
All International Rights Reserved

Published by Dentistry By Design, Inc,

8505 Navajo Road
San Diego, CA 92119 USA

No part of this book may be reproduced in any form or by any electronic or

mechanical means, including information storage and retrieval systems, without the
express written permission of the publisher, except for a reviewer, who may quote
passages in a review. The images in this book are protected by Copyright.
Dental Treatment by Dr. Rich Masek, San Diego, CA USA. Appropriate patient
releases are on file with the publisher.

CEREC is a registered Trademark of Sirona Dental Systems GmbH

Vita Mark II and Triluxe are registered Trademarks of Vita Zahnfabrik
ProCAD is a registered Trademark of Ivoclar Vivadent
Paradigm is a registered Trademark of 3M

ISBN: 0-9764062-0-9

First Printing January 2005

 Early Reviews For Highly Esthetic CEREC Solutions
“I am amazed with this technology! It was incredible to watch my dentist make
my teeth and put them in at the same visit* I only had to be numb once* Its
been 5 years since my CEREC veneers were done and they are still looking
great!”
Keandre Boggess, CEREC Patient
“I love the way my CEREC dentist explains the treatment and shows me on the
computer screen exactly what he is doing and why* St) many people dorit even
know that this type of dentistry exists! Hopefully, with this book, that will be
changing* A very grateful patient”
Priscilla Cordray
Nutritional Consultant & CEREC Patient
“I had many amalgam (mercury-silver) fillings from early childhood* My
CEREC dentist replaced them with porcelain in one visit- Ididrit have to
come back for fittings and adjustments were done in just a few minutes* Ihave
been very pleased with CEREC and this book helps me understand what is
being done* Going to the dentist is not my favorite thing* With CEREC,I
especially love being done in one visit”
Marybeth Wilson, CEREC Patient
“I have been on the other end of this technology for several years andIam
always impressed with the end results and how happy our patients are* Now,
after being on the receiving: end,Ihave experienced what they have* Iam totally
thrilled that after just one visitIwalked out with a completely new smile and a
new me!”
Kristin Hayes, RDA
CEREC, Patient, Chapter 1 2
"CEREC Solutions is an excellent tool that helps explam the CEREC process
and benefits to our patients* Seemg the problem before and the CEREC after
helps our patients understand and be involved in their own dental treatment”
Debbie Mitchell
CEREC Treatment Coordinator
“ÿÿÿthiswonderful technology has developed to a point where restorations can
be produced that rival conventional laboratory fabricated alternatives* l hank
you for the time and effort you spent to write this book* In this modern
time, when patients are demanding both functional and esthetic excellence
in their restorations, the CEREC system gives us a terrific tool to meet their
expectations* This book clearly shows how well it can be done* '
Ross W Nash, DDS
Fellow - American Academy of Cosmetic Dentistry
Diplomat of the American Board of Aesthetic Dentistry
“Dr* Rich Masek has been a sought after educator and mentor for CEREC
restorations for many years. I his book is just another testament to his
dedication and excellence in this field- It is people like Rich, who have
dedicated their career to sharing their expertise with others that has catapulted
dentistry to an entirely new level”
David S. Hornbrook, DDS, FAACD
Executive Director, the Hornbrook Group
...
“CEREC has changed my life for the best* Tm passionate about CEREC and
my patients are enjoying this new found enthusiasm and energy* 1 he quality of
my dentistry has improved and my patients know it that's rewarding!!! This
pearl of a book will give you insight on what can be achieved* It has seen the
future of what is to come-- or become* Great book for dentists and patients
alike**”
Dr* Eugene Lai
ISCD CEREC, Trainer, South Africa
“-***a fantastic job, the photos and quality of dental work are excellent, a perfect
range of examples of what CEREC can accomplish”
Ken Neuman, DMD
FAGD, FADI, FICD, FAACD
Vancouver, BC Canada
 Acknowledgements
Iextend my thanks to my family and friends who have permitted me the ‘‘space”to pursue my CEREC dreams. They have always known where
to find me, seated next to a CEREC machine! Iam also thankful to the superb individuals that work with me daily: Debbie, Kristin, Erin, Stacy
and Laura in my dental practice, Dental Expressions and Lyndsey in my continuing education facility, Dentistry By Design. I’heir patience with
me and total confidence m me have been immeasurable.

Thank you to my peers in the dental community and especially my fellow faculty members, Dr. Stephen Tsotsos, Dr. Bob Mongrain and Mr.
Gary7 Maxon. 1hey challenge and encourage me to ‘raise the bar”in CEREC dentistry. Thanks go to industry partners Steve Sutton, Stefan
Hehn, Buddy Auten and Willy Schneider of Sirona for their tireless support. My friends Wayne Whitehill and Brian Binnie of Vident have
provided constant encouragement and endless advocacy, thank you.

A special thanks to the American Academy of Cosmetic Dentistry organization and all of my member colleagues and mentors for setting the
standards for whichIstrive, I wish to express my tremendous thanks to Dr. Professor Werner Mormann for his vision in creating the CEREC
Method, without which, neither CEREC nor this book could have come into existence.

Thanks to all of my fellow CEREC dentists worldwide who have enthusiastically embraced this technology. Profound thanks to my students,
who have placed their confidence and trust in me to lead them into new frontiers of esthetic dentistry, but particularly for always keeping me on
my toes! It has been my privilege to teach, forIhave found that the teacher learns more than the student.

My deepest gratitude goes to all of my patients, especially those appearing in this book for their appreciation of my dentistry as well as their
patience and tolerance with all of my picture taking!

Finally, thanks be to God, who provides the highest challenge to me, ‘And whatsoever ye do, do it heartily, as to the Lord... Col 3:23

Dr. Rich Masek

 Foreword
T he standard of care in the late 1970 s was the mercury amalgam
fillingor the gold crown. It was almost considered a breach of ethics
to replace a back tooth, mercury-amalgam filling with tooth colored
composite resin (plastic) for the sake of appearance. Composite
materials were relatively7 new for back teeth and were generally not
very durable. However, having the tooth invisibly restored to its own
natural color has always been a strong desire of the patient and the
dentist,
My observation of this desire caused me to think seriously about
the possible alternatives to unsightly metal restorations. The year
was 1980, and ceramic appeared to be the best material to mimic
tooth enamel, but how could ceramic restorations be made quickly
at chair in a single visit? Through experimentation,Ideveloped a
clear idea of how the use of high teclmology by the dentist would
solve the problem. The future would be taking optical impressions’,
then designing, machining and bonding ceramic restorations,
Bonding (adhesive) technology would allow “defect-oriented”
preparations. This would be more conservative, keeping more natural
tooth structure. The concept would then be to have the CEREC
restoration designed accordingly7. Preservation of the individual
tooth structure is the main focus of the CEREC restoration
philosophy7. Preservation is both understood and desired by our
patients,
From the start,Iimagined that one day this method could be used
to even fabricate full crowns and bridges, Idid my first CEREC
1 veneers in November 986. However, aesthetically7 modest, they
were a big success for the patient and me. We started doing full
posterior (back tooth) crowns in 1994 using the CEREC 2. The
major steps for great improvement of the CEREC concept occurred
with the release of CEREC 3 in the year 2000 and the advent of the
3D (three dimensional) software in 2003.
Attending lectures by Dr. Rich Masek in 2003, 1 was perplexed and
fascinated by his accomplished mastery at using CEREC technology
for full mouth rehabilitation. In my mind,Ihad a concept of what
CEREC would do, but whatIsaw was like switching from a solo
instrument to an orchestra. He developed the idea of how the teeth
should be modified to create a more appealing smile and improved
function. He then combined the art of designing a restoration with
the CEREC software with giving the ceramic individual character by
introducing just the right touch of color and translucency,
Dr. Masek is striving to meet the highest standards of aesthetic
dentistry using high technology and this book represents the
proof of his mastery. And, in this book, he is making it so easy
for the patient to understand. Rich, please receive my sincere
congratulations for presenting this work. You are setting a milestone
for aesthetic CEREC-restorations and your book represents the
CEREC philosophy in an ideal fashion. The cases are highly
aesthetic. The text is just right for helping the patient understand
what CEREC means. 1 he format is perfect in style and in itself
very aesthetic. Iam sure that this book will be very7 well received by
patients and in our professional world.
Dr. Werner H, Mormann
 Preface
P recision machines have aided humans in many industries for
many years. However, until recently, dentistry remained a “hand
made industry”, using traditional techniques, methods and materials,
and was proud of it. Dentists and dental technicians enjoyed the
art in their metal and porcelain work and could not believe that a
machine would ever do it as well, or better, than they.
In 1985, a young Swiss dentist named Dr. Werner Mormann
moved the idea of computer aided design and machining of dental
restorations into actuality. CAD/CAM (Computer Aided Design/
Computer Assisted Machining) in dentistry now had its first
practical application. His ideas and design were called CEREC, an
acronym for CEramic REConstruction. Although the restorations
were not the equal of the finished restorations produced by hand in
a good lab, the potential of the idea was obvious. It eliminated the
mushy impression, the temporary restoration and the two to three
week wait for the lab to make the restoration. The CEREC also
eliminated the second appointment to insert the final restoration
which was white and dense like teeth.
However, the promise of easy, fast esthetic dentistry was not
delivered by the early CEREC, It required vision and patience
and hand finishing from the early pioneers who brought it into
their practices. Dr. Richard Masek was one of those pioneers. He
disciplined himself to use the CEREC in a single appointment
mode and pushed the technology to produce the more challenging
restoration configurations. He helped to expand the Academy
of Computerized Dentistry so CEREC users could learn from
each other. He held seminars and traveled to conferences to teach
and share his vision of CEREC dentistry. He understood the
potential and did all he could to draw colleagues into his vision,
Today, the CEREC software is much more “user friendly”.
CEREC uses a dense, tooth colored restorative material that
is made into ingots under controlled conditions. The dental
profession is beginning to realize that these materials may have
advantages over traditional hand placed polymers (tooth colored
“plastic”materials) and hand fabricated ceramic restorations,
A whole new industry is emerging where frameworks or
substructures for ceramic restorations are now fabricated using
computer aided design and machining. Dense, white materials
such as zirconia and aluminum oxide are used to create all ceramic
single tooth restorations as well as bridges instead of making them
from cast metal. This marks the dawn of metal-free dentistry and
Dr. Werner Mormann s CEREC is the first practical forerunner of
this technology. Congratulations to Dr. Richard Masek who had
the vision and dedication to incorporate the technology into his
practice in the early days.
Dr. Masek has produced an atlas showing patients what can
be done clinically with CEREC technology. It shows several
common dental clinical situations and CEREC Solutions. The
book is a simple and straight forward show and tell for patients
from a dentist who has been a pioneer user of CEREC in the LIS.
Dr. Gordon Christensen
Dr. Rella Christensen
 The difference between
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the ordinary and the

extraordinary is that
little extra
11

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Highly Esthetic

CEREC So utions
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 Contents
Introduction 16
The Patients 19

Kathleen - Inlay 21 4 Nicole - Inlay & Onlay 43

_

2 Norman - Inlay/ Onlay 25 5 Shannon - Crown 47

3 Tom - Onlay 31 6 Sarah - Crown-Lay & Post 59

 Contents

* ** ,

7 David - Multiple Crowns 63 10 Keandre -Veneers 75

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8 Carole - Front Crown 67 11 Paulette -Veneers 79
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9 Greg - Front Crown 71

T7TTT 1 2Kristin -Veneers 87

Glossary 92
About the Author 96
Credits 96
 Introduction

Ihe world of dentistry has changed remarkably sinceIbegan my practice in 1976.

Computers were monstrous and filled a room. Cosmetic dentistry consisted of '‘not too much
gold showing”. In 1985, Dr. Werner Mormann, teaching at the University of Zurich, brought
an amazing product to the dental community, the CEREC CAD/ CAM computer.

Since that meager beginning, CEREC has grown to a world wide phenomenon and has spread
throughout. Not only does the technology fascinate all who see it, it provides an outstanding
treatment solution for many clinical problems that patients face,

Single visit treatment with laboratory quality restorations gives the patient a completed, fully
restored tooth with only one episode of numbing and the least number of appointments
possible, ONE! There is no bother with a temporary crown that sometimes comes off at the
most inconvenient of times. The restorations are tooth colored with no metal, and that appeals
to many doctors and patients alike. There is usually no need for those messy molds that more
traditional techniques require. Best of all, this superb treatment method is generally no more
cosdy than traditional methods that can take 2-3 weeks to complete!

16
CEREC restorations are intrinsically esthetic, but in this bookIwanted to show what happens with
that little “extra”. After nearly 15 years spent providing CEREC treatment,Iwanted to bring together
this collection, highlighting the amazing capabilities of the CEREC system.

This book is arranged to show treatment possibilities for a variety of dental conditions. All of
the restorative patient care was performed utilizing CEREC CAD/CAM technology in single visit
treatment episodes. Each patient case has a narrative to provide the reader information including
an explanation of the situation, diagnosis, materials used and techniques employed. Some case
presentations include step-by-step visual explanations of the treatment process.

Join me in this exciting exploration of CEREC dental treatment. Get to know some patients who may
share the same situation as you, and see how their dental needs were solved. Simple replacement of
defective fillings to complete “Extreme Makeovers”, are within the capabilities of the CEREC system.
Understanding and awareness of those possibilities is a crucial part of good decision making. Every
patient must explore their own needs with their dentist and make their own decisions for treatment.
This book will help you learn more about what might be accomplished for you.

Welcome to the world of ‘Highly Esthetic CEREC Solutions.”

Dr. Rich Masek

17
The Patients

19
 I
KATHLEEN
The Inlay
11

21
 The Inlay
Kathleen is 38 years old and works for
A
a major
computer hardware and software company, A defective
filling (mercury-silver amalgam shown below), was %

discovered by her dentist who recommended correction

with a crown. She was warned not leave the country
between the “temporary”and the “final”just in case
she had trouble or it fell out. She was concerned with
the warning because she frequently left the country to
Germany, France and Korea on business trips. She began
to research other treatment options on the Internet and
located the web site of a CEREC dentist.

s he was impressed with the explanation of the CEREC

system. She found there were options other than a
crown. She also discovered that with CEREC, the
* entire procedure could be done in one visit - no concern
T
with needing an emergency dental visit while overseas,
*
She contacted the new CEREC dentist for a second
opinion. The options for care were reviewed during the
j > •
consultation which included replacement with another
silver-mercury filling, a composite resin filling (tooth
colored plastic), a crown or a tooth colored porcelain
. : *‘1. # CEREC restoration that is called a Porcelain Inlay.
%
i

22
 Kathleen scheduled an appointment for treatment and
returned for a single visit to prepare and insert the final,
m beautiful CEREC restoration. She avoided placement of
a temporary restoration, an impression and a return visit
with additional numbing that would have been required

i V- with more traditional dental methods,

'• CEREC was the perfect solution for Kathleen. Both

m Sc v L. * Kathleen and her new CEREC dentist were very pleased
with her non-metal, visually appealing end result,

Kathleen CEREC dentist explained that the Porcelain

s
Inlay would be a much stronger and longer lasting option
and that it was far more conservative than a crown. The
mercury-silver amalgam filling was cracked on the chewing
surface and was creating occasional discomfort to hot
and cold as well as sweet sensitivity. Kathleen learned
that the CEREC Inlay option would strengthen the tooth
structure remaining after the removal of the mercury
filling, saving more of her natural tooth. She found it
would also provide a beautiful, esthetic result that would
blend into her existing tooth. Kathleen chose the CEREC
*%
Inlay option. '

*
23
 2
NORMAN
The Inlay/Onlay
11

25
 N orman was having sensitivity in a moderate
sized mercury amalgam filling. There was significant
darkening around the borders of the filling, A deep
I crack had also developed on the tongue side of the
tooth. Decay was also present in between the teeth.
m

The Inlay/Onlay
N orman is a 34 year old engineer who works for an
industrial products distributor. He has a keen sense for
technology and seeks out health care that uses the most W
current available technology.
ft
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26
Mercury fillings can hide significant damage within
the tooth because of the already dark color of the filling. 1

Blackened and discolored areas frequently mean that decay

is progressing underneath the filling. Weakened areas of
the tooth from decay or stress can fracture, leading to
surface cracks that can become stained.

i ’I.

A porcelain Inlay/Onlay was created with

CEREC to repair the extensive hidden damage in
Normans tooth. Colored stains and a glaze were
applied to provide a natural appearance.

27
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* * **
*

N orman was fascinated with the entire process of creating

the restoration for his tooth. He enjoyed seeing his dentist take
the image of his tooth, design a computer “ pattern”and watch
while his new CEREC restoration was being made. I

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28
 N orman was even more excited when he saw the completed
restoration placed into his tooth* It completely disappeared! Not only
did the new CEREC restoration look just like the surrounding teeth,
the unattractive black spot on the side of the tooth was gone.

A This beautiful CEREC Solution made Normans tooth as good as new,

and in just one appointment!

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29
 3
TOM
11
The Onlay

31
 The Onlay
T om is a 38 year old technician with a large gas & electric company. He has a great personality and an
attractive smile that he loves to share with his wife and 2 young boys. The only problem was that there was a big,
black tooth that showed. He was very self conscious when he smiled and wanted to get the black spot removed.

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32
Examination of the area revealed a very large mercury
amalgam filling that covered the chewing surface
and the cheek side of his molar tooth. Although Tom wanted to improve the appearance of his smile* he
was also concerned about having a crown on his tooth and losing more of his natural tooth than necessary.

'
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33
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k , d fvather than destroy a large amount of tooth

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iidi, for a crown, his dentist was able to remove the old
amalgam filling and decay. He then took a computer
picture, an “optical impression", of his tooth after
applying a reflective powder.

T -
4*
dentist discussed the treatment options
JL oms
and explained the differences between a crown and
a CEREC Porcelain Onlay. The Onlay would allow

A
Tom to keep a significant amount of his healthy
tooth structure and still provide a long lasting,
visually pleasing result.
1
34
The CEREC Process u
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The Optical “Impression”

The CEREC camera is placed over the tooth to
capture an “impression”of the powdered tooth*

* J
The Image
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Th,image is then processed by the computer to create a

i 3 dimensional model of the tooth. This extremely accurate

image of the tooth is used to create the new restoration.
«•
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The Design
Th,restoration is then designed on the
CEREC
computer and the shape of the new restoration is refined,

35
 The Computerized Pattern
Th, computer generates a pattern that contains all of
4
*

the data needed to create the porcelain restoration. The i

information is transferred to the Milling Chamber for
processing.
* i

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*

Choosing The Color

A porcelain blank is selected in that closely
a color
resembles the color of the tooth. The blank is then
placed into the Milling Chamber.

36
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The Milling Chamber

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JL he Milling Chamber receives the data from the computer and mills the porcelain blank.
The transfer is wireless and the process only takes about 10 to 15 minutes in most cases,
37
 The Milling
Process *

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he selected porcelain blank is
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placed on the milling spindle and
the process is started* Two burs
act on the blank* slowly removing
4
the excess material* much the way
a sculptor fashions a piece of art
from a block of stone* Water jets
spray on the burs and the porcelain
to facilitate the milling process.
When completed, the milling
chamber signals the computer that
the restoration is finished* *y,

38
 1

X he milled Porcelain Onlay resembles a “puzzle”

piece. It was then placed into Toms tooth
preparation to check the accuracy of the fit,
1

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1he initial appearance of the CEREC Onlay was
opaque and “chalky”* It did not achieve the level of

d appearance desired* The tooth and porcelain colors

were compared* The new Porcelain Onlay was then
“characterized”with appropriate porcelain “stains”
to match the coloring of the natural tooth*

39
This style of tooth restoration is traditionally created over a period of 2 or more weeks and
two patient visits. The patient would have an impression of the prepared tooth and a temporary
restoration placed. Also, this type of porcelain “characterization”is generally done in the laboratory.

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 H owever, for Tom, the CEREC system allowed his dentist to create this final result in just one
visit, Tom can now beam with confidence, knowing that the big black spot is no longer there to
compromise his handsome smile!

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 4
NICOLE
* tilay & Onlay
11

43
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Nicole is »\
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old college student working
a 22 year
as a new account representative for a large financial
institution. She had several teeth restored with mercury
amalgam fillings.
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Nicole previous dentist had
s
diagnosed several traditional crowns
to repair the defective fillings. Nicole
wanted to find a different restorative
option because she did not want
to lose all of the tooth structure
necessary to place crowns. She
sought a second opinion and her
v new dentist offered her the option
/ of conservative and esthetic CEREC
t
i restorations. This was exactly the
option that she was looking for.

44
 '
X hese twoteeth were restored to “like new”
condition using CEREC in just one visit The front
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tooth was “characterized”with natural appearing colors.

£ The back tooth was placed with no addition of color.

j Nicole and her dentist were both very pleased with

the results of her new CEREC restorations and she
*
continued to have the rest of her defective restorations
replaced using the CEREC method.

An appointment was made to

replace the two mercury-amalgam
fillings with CEREC restorations.
\ 7-\7
The appearance of the two teeth
was considered and it was decided
to “characterize”the more forward
tooth but not the back one. All
V- - s
restorations do not require coloration
to achieve a good esthetic result. A
tooth that is not visible can have
a restoration placed without the 0

addition of porcelain stains. \

45
 5
Hannon
The Crown11

47
 She had moved more than i 500 miles
\ away and was understandably very nervous
about having the tooth treated again. She
wanted to get the broken crown fixed but
* i
she also wanted a more natural looking
crown. Her new dentist discussed the
benefits of a full porcelain, CEREC crown,
and she decided to proceed with treatment.

The Crown
Shannon is a Registered Nurse with a
bachelors degree. At 33 years old, her upper
left first molar tooth required a root canal and
a crown. The end result was intended to be JC:
an esthetic, porcelain-fused-to-gold crown. ;
However, the gold was visible at the gum
line and just ten months later, the porcelain *
fractured from the gold, leaving her with food
trapping and a very rough surface.

48
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X he old crown was removed and the tooth was prepared receive the new CEREC crown. The
to
correct colored porcelain blank was selected and placed into the milling chamber. Shannon got a
chance to see the milling in action.
49
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1he milled crown was removed from the milling stub when
the process was complete. The crown was placed on Shannons
tooth. The extremely accurate fit was verified.
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1he milled crown then required esthetic 2*

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modifications to achieve the desired result. A palette

of colors was compared to the surrounding teeth.
Specific colors were determined to achieve the closest
color match to the surrounding teeth.
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TH, specific colors of porcelain stains are collected from the stain palette and placed on a glass
slab for easy identification and access. The wide range of colors allows the dentist or technician
to very closely match the subtleties and nuances of color seen in the surrounding natural teeth.

53
 4
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I orcelain stain is applied as appropriate and blended across the

surface of the crown. A porcelain glaze is also incorporated to give
the completed crown a smooth* natural feel.

54
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n

A natural chewing surface also has some color. The

glaze surface is applied with shadowing effects that
bring out the intricate beauty of a natural tooth.

55 -
T:„completed, crown is compared to Shannons
.
tooth to verify the match and is then inserted* v 1

Instead of the two

* visits needed to create
the original, marginally
I esthetic crown, her CEREC
dentist was able to create
a masterpiece in just one
appointment*

*4

56
 '
1 he final result no longer showed an

r
unsightly dark line at the gum and blended
perfectly with the surrounding natural
teeth. After completing this crown, Shannon
requested that another tooth on the lower right
be treated with the same technique.
A beautiful work of art created with CEREC.
A Highly Esthetic CEREC Solution!

N o temporary crown \j
was required (which is a
wonderful thing as they
'
sometimes come off atthe
worst times). And Shannon
had her new tooth in less
than 2 hours!
2

57
 6
SARAH
The Crown-Lay & Pose
11

59
 *
X he decay was removed, but had penetrated into
the pulp, causing an infection. The tooth required
\ I

i T root canal therapy to be saved. The deep decay

k\ weakened the interior of the tooth and caused a

•» crack in one of the chewing “cusps”,
* +

:x..

The
Crown-Lay & Post
Sarah, a 21 year old student, had been experiencing
a tooth ache in her upper right molar.There was
very deep decay that grew in a very small hole in the
center of her tooth,

60
 Appiication of porcelain stains allowed the
crown tocompletely mimic the appearance of the
i«- 4

surrounding teeth for a beautiful end result.

1

Sarah was very comfortable with the smooth feeling

of her new crown and was especially pleased with
the appearance of her new tooth.
CEREC proved to be an excellent Solution to
restore her root canal treated tooth.

Jl he tooth was protected from breakage since

Sarah was wearing braces at the time. Some of
the cement from the braces still remained on the
tooth after the braces were removed.
Considering the broken cusp and deep decay,
restoration with a crown and “post”was
indicated. The post was made to help hold the
crown on and reinforce the weakened tooth. The
new CEREC crown was created with the post and
crown milled as one complete piece.
-"
i
61
 7
DAVID
yy

Multiple Crowns

63
 y V* • .•
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!
Multiple Crowns
David is old business executive for a computer software company. He was referred to his dentist
a 59 year
specifically for the benefits of the CERHC restoration. David was concerned about mercury fillings as well as
metallic crowns in general. The existing gold crowns that he had served him very well for many years, but were
showing a great deal of wear and some decay around the margins (edges). Mercury filling material and decay were
also found underneath the gold crowns.
64
 *
*
*
*
*

< <

{
'

In just a few hours Davids dentist removed, created and replaced all three of his unsightly gold crowns with very
attractive, all porcelain restorations. He was very happy that temporary crowns and impressions were not necessary.
He also loved the fact that he would not have to have another episode of numbing for these teeth. David has
already enjoyed the benefits of several CEREC restorations and he is excited about getting his remaining restorations
completed at his next CEREC visit!
65
 8
CAROLE
11
The Front Crown

67
 Th, crown had been placed many years ago and the gum tissue
receded* exposing the metal portion of the porcelain/metal crown.
Additionally the original crown was the wrong color and did not
I match her natural teeth.

ys Carole was also concerned about having the crown replaced since
she experienced difficulties with previous crowns. A temporary
crown that she had to keep for three weeks came off over a
weekend!

The Front Crown

Carole is a 56 year old homemaker
*
that was self-conscious about her
smile. She has a very outgoing
personality but she tried to hide the
dark line around the crown on her
upper left tooth by not smiling widely '

68
 *
*

She heard about the CEREC system on a news program

and found her new dentist by doing an Internet search. She
was very pleased when her dentist told her that the new
crown could be made with CEREC in a single visit.

>
*
*

ot only that, but her dentist was

able to customize the color of the
tooth immediately to be sure that it
matched properly,

i *
Carole is very pleased with her
new, CEREC crown and no longer
hesitates to give a big smile!
A
i

69
\
 9
GREG
yy
The Front Crown

71
 ,
T j 1

i.
il,

The Front Crown

Greg sustained an injury to his mouth in earlyadolescence. The nerve inside the tooth died and he needed a root canal
procedure performed to save the tooth. Slowly, over the years, his left front tooth got darker and darker.
He attempted bleaching the tooth several times. Unfortunately, none of these measures were effective. Although he was
embarrassed by it, Greg resigned himself to a dark tooth and simply tolerated it. Greg is now 30 and a claims adjuster
for a large insurance company. He loves to smile and is very extroverted but knows that his smile is unattractive. He no
longer wanted to tolerate the unsightly tooth and sought out a CEREC dentist to solve his problem.
72
 A

Greg s CEREC dentist analyzed his smile and noted that his right center tooth was leaning to the left and the edge
was tilted. The dark tooth was quite a lot shorter and needed to be lengthened to achieve the best appearance. These
esthetic enhancements were incorporated into the new crown to create a much more pleasing, harmonious smile.

Greg s new tooth brightened his smile and restored his confidence. He was thrilled and amazed with his new
CEREC Solution!

73
 10
KEANDRE
11
Veneers

75
 Porcelain Veneers

JCeandre is now 31 years old and is a Systems Support Analyst for a large city
newspaper. Five years ago, he was completing orthodontic treatment (braces),
but was going to be left with unsightly spaces between his front four teeth. This
condition is sometimes referred to as ‘Peg Laterals”because two of his front
teeth were too small and pointed.

* -•!*

It* r
j

' w
'
J[ he alignment of his teeth was otherwise excellent,
but he did not like the appearance of the two
pointed teeth. So, before the braces were removed,
he researched options on the Internet and found a
cosmetic CEREC dentist. He learned about the
possibilities that CEREC offered. He discovered
that he could have Veneers made to correct the two
pointed teeth in one day, right after his braces were
removed!
76
 tveandre enjoyed watching while his CEREC dentist
created his new smile on the computer. Within a few
minutes, the new porcelain veneers were made. His dentist
I r
. ,
fit them and added just the right color to make them match.

Five years later, Keandre is still sporting his handsome

CEREC smile. He is still very pleased with his great smile
and his highly esthetic CEREC Solution!

He also learned that CEREC Veneers are very thin

pieces of porcelain that are individually ‘bonded* on
to each of the pointed teeth. The CEREC dentist
then changes the shape to make his pointed teeth
look “normal**. The color would match that of the
rest of his teeth. Keandre was very excited about the
prospect of his smile being perfect after four years of r
braces. He made his appointment the next day, right r
after his braces were removed.
«
*

L .
77
 II
PAULETTE
11
Veneers

79
 Porcelain Veneers
Jr aulette did not like the alignment of her front teeth. She was very reluctant to smile wide because she did not like
the large spaces between her lower teeth. The misalignment of the center line of her top front two teeth was also a
constant distraction to her. Additionally* she wanted to correct the discoloration of the fillings in her front teeth.

ii

. .,
rn i fe¬

«
«

.
*

* *V '~ e *

' 1

80
1

\
I
m

She is a substitute school teacher, volunteer

worker at her church, a homemaker and a very active
mother taking care of her three young boys. As happens with self-sacrificing parents, her needs and
desires were put ‘An hold”for several years while her family and childrens needs were attended to.

81
 Ill
A
A \
:A

She had discussed the possibilities of a smile makeover with her CEREC dentist for several years.

Her dentist discussed a plan for her that called for ten veneers on the top and four on the bottom.
This allowed for the correction of the center line of her teeth, expansion of the width of her back
teeth and closure of the gaps between her lower teeth.

Finally, the time was right. It was her turn and she was ready to proceed!

ri .
/
82
 «

#. •

ill ,

mI

Paulette was very excited about the prospects of getting the smile that she always wanted. She wanted to get started
rightaway and was happy that her CEREC dentist could do the treatment in single visit sessions without having to
do temporaries. Her treatment was planned for two separate appointments. The four lower veneers were prepared
and placed on the first visit. One week later* she returned to have the ten top veneers completed.

83
Paulette was able to work with her dentist
to create the shape that she wanted for her
teeth. At the end of each of her two visits* she
was able to enjoy her completed veneers* not
worrying about having temporaries coming off.
She also liked only being numb once to get her
f
completed veneers. *
*

\
i

P
xvy v
84
 M

/: V

k
She was thrilled with the shape and color
of her new teeth. Her husband was also very
excited about the result. Paulette s face “lights
up”with joy and now she smiles with great
confidence.

Paulette s CEREC Solution gave her a radiant

new smile!
r

1
*i *

A
85
 12
KRISTIN
11
Veneers

87
 Porcelain Veneers
Kristin suffered from
m
a worn and uneven smile. She
had adult orthodontic care, with 2 years of braces.
She then changed her career and entered the dental
profession as a Registered Dental Assistant, / \
t.
The dentist that Kristin works for is a Computerized f. A
Cosmetic Dentist, a CEREC dentist. He replaced all \
of her mercury-silver fillings with beautiful porcelain
CEREC restorations. Kristin was soon anxious and
excited about the prospects of getting her front teeth
done,
y

Kristin had the advantage of seeing and helping her

dentist provide cosmetic makeovers. She analyzed the
smiles of the patients that she worked with and had a i i Vx'i *
clear plan for the appearance of her new smile. r'
y . » 7 i,
1

88
 She wanted towhiten and lengthen her teeth as well as
change the way her gumline looked* The first step was to do
*
teeth whitening* Once the color of her teeth was as white as
she wanted, the big day arrived to get her perfect, new smile
* /
/ with CEREC Veneers.
/ fdA &

Kristin received eight porcelain veneers, crafted to fit her

/
\ beautiful smile, in just one visit! Detailed characterization of
the veneers enhanced the natural look of her smile.

Shortly after Kristin began to sport her new smile, she added
a regular health club routine to her marathon running and
training. Her magnetic smile attracted some attention and
she struck up a new friendship at the gym.

m <1
Just one year later* Kristin married the “cute boy at the gym“*

: A wonderfully successful CEREC Solution!

JQ
\ 1

89
ilS o
What Win The Story
Of Your
CEREC Solution
Be J
 Glossary
AcquisitionTower (akVl-zlsh *Wn) (tourer) The
part of the CEREC’system that houses the computer
processor, monitor, keyboard, trackball and camera. The
dentist or assistant uses this device to capture the image
of the tooth, design the restoration and control the
milling chamber’.
CAD/CAM (kad)/(kam) Computer Aided Design
/ Computer Assisted Manufacturing. The industrial
process of designing objects by computer combined with
the creation of the object through computer control,
Ceramic (serram tik ) A glass like material with special
characteristics suitable for use in dental restorations .
Mimics tooth colors and can be fashioned to fit a tooth
with a CAD/CAM’device. It is very durable and wear
resistant.
CEREC (serixk) An acronym for CEramic
REConstruction. A computerized device that assists a
dentist in the process of creating tooth colored inlays ,
onlays’, ’crowns’and veneers’for patients in single visit
treatment appointments.
92
Characterize (kar *ak*turfz) The process of altering the
coloring of a ceramic’or porcelain tooth restoration
to improve die blend of the restoration with the tooth.
Effects are created using porcelain stains and powders.
Composite Bonding (bond *ing) A process in which
Composite Resin or Porcelain’is attached to a tooth.
The surface of the tooth is chemically roughened then
coated with an adhesive material.
Composite Resin (konrpo zlt) (rezdn) A polymer,
plastic type material that resembles tooth structure. It is
generally placed into a tooth and cured, or hardened, and
then polished. This tooth colored material has limited
wear characteristics and is less durable than ceramics’or
porcelain.
Computer Pattern (konrputer) (pa*turn) The result of
die CAM design process. Various design lines are created
by the CEREC’software program that are controlled by
the operator. The shape of the new restoration can be
altered to the best configuration for die tooth in question.
This information is then calculated by the computer to
create a three dimensional computer object that has all of
the data necessary to instruct die Milling Chamber’to
create the ‘restoration ,
Crown (kroun) Refers to a type of tooth restoration that
covers the entire tooth all the way to the gumline or below.
Frequently placed when a tooth is broken, severely decayed
or a cusp’is lost. The most aggressive of tooth restoration
types which sometimes can be avoided by using an Onlay
type restoration.
Cusp (kusp) Pointed areas on the chewing surface of a
tooth responsible for vigorously grinding food. Various teeth
have two, three, four or five of these chewing and grinding
surfaces. When a tooth is damaged from decay or a defective
filling , these areas of high stress in the tooth are frequently
damaged with cracks or are broken off entirely.
Filling (fl ding) A simple placement of a material into a
hole in a tooth which has been destroyed by decay. Usually
made from Mercury-Silver Amalgam’or Composite Resin
materials, these perform best in situations that do not involve
a large area of the chewing surface of the tooth.
Inlay (In da) A conservative, yet very durable, alternative to
a routine dental filling’. Made from gold, composite resin
or porcelain/ceramic’, these restorations’resist chewing
wear, yielding longer lasting results than typical fillings .
When made from CEREC’‘porcelain/ ceramic’materials, a
strong, durable and esthetic combination is achieved.
93
Mercury-Silver Amalgam (mur'-kiire) — (slF'vUr)
(a’mal gam) A combination of metallic materials that
include Mercury, Silver, Copper, Tin, Zinc and other
possible materials. Has been the standard of care for
dental fillings for over 100 years. Referred to as silver
‘fillings , they become unsightly as they age and corrode.
Milling Machine (minding) (ma*shen/) The ‘CAM’
portion of the CEREC CAD/CAM’system. This device
accepts the Porcelain Blank and mills, or grinds, the excess
material away as instructed by the Acquisition Tower. A
combination of diamond tools hone the Porcelain Blank
to very precise tolerances while a cooling and lubricating
water jet irrigates the field. Notifies the Acquisition
Tower’when the process is completed, usually between
twelve and twenty minutes.
Onlay (*6n da) A type of tooth restoration that replaces
of the chewing surface, i.e. a cusp, of
a missing section
a damaged tooth. It is much more conservative than a
crown and helps to reinforce and strengthen a damaged
tooth.
Optical Impression (op'trkal) (im-presh'wn) The process
of capturing the shape of the tooth following the removal
of decay, old filling materials and defective portions of
the tooth. Obtained by the CEREC camera, it begins
the design process for the new restoration. Unlike the
standard, mushy impression material, this impression is
simply a picture made possible by the application of a
reflective Powder*.
Porcelain (pOrsedln) See Ceramic*
Porcelain Blank (pOrCd'lin ) (blank) A glass type block
material that is fashioned and colored in an industrial
process to maximize the strength and esthetic properties.
Created in different materials, several sizes, shapes and
colors, these objects are milled to yield the final form that
will be placed into the patients tooth.
Porcelain Glaze (pOr seHln) (glaz) A glass type powder
that is mixed widi glycerin and applied to die restoration
surface. Once fused widi high heat, it develops a very-
smooth, polished appearance. Can be mixed with
‘porcelain stains* to characterize die restoration*.
94
Porcelain Stain (pOrCeriln) (stan) Glass type powders of
various colors that are mixed with glycerin and applied to
the restoration. They are fused to the porcelain/ceramic*
restoration by heating to high temperatures. Very useful
to help the new Restoration blend with the remaining
tooth structure.
Post (post) An extension of a restoration into the root,
or center, portion of a tooth that has been treated with
root canal therapy. It is used to help bond, or affix, the
restoration to the toodi to prevent loss during chewing.
Can reinforce the inside of a weakened toodi,
Powder (pouder; A biocompatible material diat is
infrared light reflective in nature. Allows die image of the
tooth preparation to be captured by the CEREC* camera.
It is an essential component of die Optical Impression
process,
Restoration (resRoua shi/n) A replacement part of
a tooth fabricated from any of a variety of materials
including mercury-silver*, gold, ‘composite resin or
porcelain, A filling* is considered a restoration, however,
for this book, a Restoration* is considered a longer lasting
type of tooth repair than a standard filling . Refers to
CEREC* porcelain/ceramic* tooth replacement objects,
Temporary Restoration (ternpO-rer'l) (res'to-ra'shuii) A
crown or other type of tooth replacement made from a
material intended to protect the prepared tooth between
dental visits. Usually made from composite resin or
aluminum materials. It is placed on the tooth with a
cement that is easily removed. Sometimes comes off when
least desired.

Veneer (vemer) A tooth restoration usually created

from porcelain or ceramic that involves removing the
most minimal amount of tooth necessary to correct a
damaged tooth. It is generally used for front teeth to close
spaces, change color, lengthen teeth and correct twisted
teeth. Sometimes referred to as bonding. Used for smile
“makeovers”.

95
 About The Author
Dr. Rich Masek lives in San Diego,
California with his beautiful wife, Sheri,
of 30 years and their two Yorkies, Amy &
m T
Molly. He enjoys spending time with his 3
daughters and 4 grandchildren, ages newborn
to 23, especially on snowboarding outings.
He has been practicing dentistry in San
Diego since his 1976 graduation from USC Dental School.
Dental Expressions, his private, fee-for-ser vice practice, is
focused on Cosmetic and CEREC CAD/CAM dentistry.
His use of CEREC technology began in 1990. Since that
time he has pioneered many innovative techniques, spoken
internationally on Computerized Cosmetic Dentistry, and has
published numerous articles.
Dr. Masek is the Vice President of the International Society
of Computerized Dentistry (ISCD) and past President of
the Academy of Computerized Dentistry of North America.
Certified as a trainer by the ISCD, Dr. Masek is a world
recognized authority on the CEREC system.
He is an Accredited member of the American Academy of
Cosmetic Dentistry and is the CE Director and Founding
Faculty Member of Dentistry by Design, Inc. Established in
1993, Dentistry by Design provides hands-on post graduate
training to the professional dental community including
CEREC and CAD /CAM education.
Additional information is available through Dr. Masek s website
at http:// www.mysmile.com

Credits
The patients depicted in this book were treated by Dr. Rich Masek using the Sirona CEREC 3 or 3D CAD/CAM system. The
treatment was performed in single visit appointments. All restorations shown were fabricated from Vita Mark II porcelain materials.
They have been characterized using Vita Akzent Stains and selected cases with VM7 or VM9 porcelains. Restorations were placed
using Ivoclar-Vivadent Excite and Variolink luting agent. Other materials are available and that can accomplish similar results.
Ivoclar-Vivadent provides ProCAD porcelain materials and 3M provides Paradigm composite resin based materials for the CEREC
system. The dioice of materials to be used is based on the clinical judgement of the dentist and discussion with the patient. Thanks
to Sirona Dental, Vident and Vita Zahnfabrik for their support of this work,

96