Use of CEREC Composite Restorations in Primary Dentition

Objectives: The objective of this study is to determine if a CEREC composite restoration could be used as a pediatric posterior restoration where a stainless steel crown would have been the conventional restorative method. While CEREC is becoming a popular restorative technique for permanent dentition, there has not been use of the technology for primary dentition. Methods: It must be determined if primary teeth are candidates for CEREC restorations. Ideal stainless steel crown preparations in artificial mandibular primary first molars both with and without pulpotomies were cut with little occlusal reduction while maintaining the buccal/lingual height of contour. The preparation was then altered until a suitable restoration could be milled with adequate thickness of composite. Once a successful preparation was designed, the preparation procedure was duplicated for eight additional samples. Second, the optimal procedure for milling a CEREC restoration was needed since no primary tooth catalog exists. A mandibular permanent first molar (#30) was selected for a full crown restoration using a bite material scan followed by standard CEREC milling procedures. Results: In order to successfully mill a pediatric restoration, the standard preparation must be altered by the incorporation of a second plane reduction of the occlusal surface in order to get a minimal 1.0mm thickness of composite. Conclusions: Teeth with pulpotomies were found to be the best candidates for CEREC restorations because they typically have the sufficient occlusal reduction and additional retention due to the nature of the pulpotomy preparation design. The advantage of using CEREC restorations over stainless steel crowns in a pediatric population would include esthetics and patient compliance during the placement of these restorations. In addition, gingival damage that often occurs with stainless steel crowns can be eliminated with the use of CEREC technology thus providing the pediatric patient with a more pleasurable dental experience.