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Dentist-time expenditure for two different adhesive all-ceramic systems
journal of dentistry 34 (2006) 450–453
available at www.sciencedirect.com
journal homepage: www.intl.elsevierhealth.com/journals/jden
"
Dentist-time expenditure for two different adhesive all-ceramic systems Matthias Wurbs a, James F. Simon b, Markus Troeltzsch a, Thomas Denekas a, Manfred Wichmann a, Sven Reich c,* a
Department of Prosthetic Dentistry of the University of Erlangen-Nuremberg, Glueckstrasse 11, D-91054 Erlangen, Germany Department of Restorative Dentistry, University of Tennessee, College of Dentistry, 875 Union Avenue, Memphis, TN 38163, USA c Department of Prosthetic Dentistry and Material Sciences, University of Leipzig, Nuernberger Strasse 57, D-04103 Leipzig, Germany b
article info
abstract
Article history:
Objectives: The purpose of this clinical investigation was to compare a chair-side adhesive
Received 27 June 2005
all-ceramic system to a laboratory processed adhesive all-ceramic system with respect to
Accepted 20 September 2005
quality and time expenditure for the dentist. Methods: The same dentist treated 10 patients, who were each to receive two large posterior single tooth restorations of similar location and extent. One restoration was made in the
Keywords:
laboratory by using the IPS EmpressTM system [LAB], the other one was done chair-side by
Time expenditure
utilizing the CerecTM system [CHAIR]. The time expenditure was measured for [LAB] and
All-ceramic restorations
[CHAIR] and compared by the Wilcoxon signed rank test. The restorations were also
Cerec
evaluated according to the USPHS criteria.
Empress
Results: The mean time expenditure for the dentist with low-level assistance was
USPHS criteria
111:03 min [S.D. 24:09 min] for [LAB] and 115:31 min [S.D. 15:54 min] for [CHAIR]. Time
CAD/CAM
expenditure with medium level assistance for the operator was 100:53 min [S.D. 23:59] for [LAB] and 105:50 [S.D. 15:28] for [CHAIR]. Assuming a high level of assistance, the mean time values were 53:11 min [S.D. 14:29] for [LAB] and 54:29 min [S.D. 09:21] for [CHAIR]. The baseline investigation according to the modified USPHS criteria did not reveal any differences between [CHAIR] and [LAB]. Conclusion: There were no statistical significant differences with respect to time expenditure or quality between [LAB] and [CHAIR] in this study. # 2005 Elsevier Ltd. All rights reserved.
1.
Introduction
Since the introduction of the modern dentine adhesive systems, all-ceramic single tooth restorations are an alternative to conventional gold cast restorations.1 Adhesively luted, single tooth all-ceramic restorations can be provided at the chair-side or in the laboratory. Currently, the only chairside system available is the CerecTM method (Sirona Dental System, Bensheim, Germany),2,3 and a well known laboratory system is the IPS EmpressTM system (Ivoclar Vivadent AG,
Schaan, Liechtenstein).4,5 Both systems are documented in detail by long-term clinical trials.2–5 The treatment procedure can be subdivided into several steps. Only the dentist can complete some of these steps while some of them can be delegated to the assistant. One purpose of this study was to consider several assistance concepts, in order to evaluate whether one of these concepts could offer decisive time advantages. There are three main concepts of assistance, called high, medium, and low level assistance, which were originally developed for the Cerec 2TM method.6
* Corresponding author. Tel.: +49 341 97 21 300; fax: +49 341 97 21 309. E-mail address: [email protected] (S. Reich). 0300-5712/$ – see front matter # 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.jdent.2005.09.005
journal of dentistry 34 (2006) 450–453
However, they can be adopted to other adhesive treatments. In Table 1, the single treatment steps are grey scale coded in order to indicate to which assistance level they belong. The major aim of the present investigation was to compare the two all-ceramic systems Cerec 3DTM and IPS EmpressTM with respect to the time expenditure during patient treatment and the quality of the restorations. The hypothesis of the present study was that the two all-ceramic systems were comparable with regard to time expenditure for the operator and quality.
2.
Method and materials
Seven male and three female patients who were to receive two all-ceramic inlays (at least half of the occlusal surface had to be replaced) or onlays of similar extension and location in posterior teeth were chosen from the Department of Prosthodontics of a University. Each patient was treated with one Cerec 3DTM and one IPS EmpressTM restoration by the same operator, who was an experienced prosthodontist with over 10 years clinical experience and 8 years clinical experience with the Cerec system and the adhesive luting technique. The respective system was chosen randomly. Every restoration was completely finished, before the next restoration was begun with the alternative system. The time measured in seconds was the time expenditure spent on the treatment procedure exclusively. The time measurement could be divided into three phases. Phase I comprised the general treatment steps ‘‘preparation and impression’’. Phase II included ‘‘providing the restoration’’ and phase III consisted of ‘‘pre-treatment and adhesive luting’’. The single treatment steps are listed in Table 1. The Cerec restorations were done in one single appointment according to the recommendations and guidelines of the University of Zurich7 using the Cerec 3DTM software, version V2.10 R1500. For every Cerec 3DTM restoration the functionally guided pathway (FGP) technique was applied: after preparation a FGP registration made of silicone material (R-SI-LineTM Metalbite, R-dental Dentalerzeugnisse GmbH, Hamburg, Germany) was generated. It was possible to acquire up to five optical impressions of the cavity and the FGP registration. The single optical impressions of the cavity are computed to a virtual 3D model on the computer screen. Due to the fact that the optical data of the FGP registration could be superimposed on the 3D model it was possible to take into account cuspal contact point placement during the virtual design of the restoration on the monitor, which was then milled from a feldspathic machinable block (Vitablocks Mark IITM, Vita Zahnfabrik). The fit of the freshly milled restoration was checked as well as the tightness of proximal contacts. The outer surface of the restoration was pre-polished with dark blue Sof-Lex disks (3M Espe, St. Paul, MN, USA). Then the restoration was glazed in an oven (Vita VacumatTM, Vita Zahnfabrik) at 950 8C. After adhesive luting according to the recommendations of the University of Zurich7 the occlusal relationships were checked, corrected, if necessary, and finally polished. The Empress restoration required two appointments. In the first appointment the cavity was prepared. The double mix technique served as impression technique (Silaplast FuturaTM
451
and Silasoft NTM, Detax GmbH & Co. KG, Ettlingen, Germany). As temporary restorative the provisional light curing composite Fermit-NTM (Ivoclar Vivadent AG) was used and additionally fixed with FreegenolTM (GC Europe N.V., Leuven, Belgium). For the opposite jaw a single stage technique with alginate was applied. In the laboratory the impressions were poured into casts made of Fuji rockTM (GC Europe N.V.) and mounted into a semi adjustable articulator (Protar evo 5TM, Kavo Dental GmbH, Biberach, Germany). The restoration then was modeled in wax, sprued and invested. After waxing out and preheating the heated, softened ceramic was pressed into the mould. The fit of the divested restoration was checked and improved with fine diamonds, if necessary. After carefully cleaning the restoration, the restoration was stained and glazed. In the second appointment the restoration was tried in and adhesively luted under rubber dam (Table 2). Two independent examiners assessed all restorations after initial insertion according to the USPHS criteria.4 The time expenditure for the two systems was compared by the application of the Wilcoxon signed rank test for pair-wise comparison at p < 0.05. The statistical program SPSS for Windows NTTM, Version 11.5 (SPSS, Chicago, IL, USA) was used. In order to get a better overview the time measured in seconds was transferred into units of minutes and seconds.
3.
Results
Table 1 shows the time expenditures for the single treatment steps and the total sums. Using the USPHS criteria there were not found any significant differences regarding marginal gap, proximal contact, or anatomic/functional form. The evaluation of occlusal contacts did not reveal any differences of the tested systems.
4.
Discussion
In order to be able to deal with a limited number of patients, a study design was chosen that only patients were included who showed two similar indications for all-ceramic restorations with regard to extension and location. This meant that a pairwise statistical comparison was possible. The similarity of the indications is confirmed by comparable time measurements for identical treatment procedures like ‘‘Filling and caries removal’’, ‘‘Cavity preparation’’, ‘‘Cleaning, etching and dentine bonding’’ (Table 1). Although the Cerec 3DTM treatment comprised additional steps like ‘‘CAD design’’, both systems showed total time values which did not differ significantly. The mean time expenditure for rubberdam insertion differed significantly for two systems. When applying the IPS EmpressTM system rubberdam was only put on for adhesive luting so that it was possible to tear down the rubberdam in interdental spaces by the help of matrix bands and wedges. If the Cerec 3DTM system was used, the rubber dam was inserted before the optical impression was done. But if there were deep boxes which were on gingival level or even below, it was more complicated to get the rubberdam down without the help of matrix bands, because these would have affected the optical impression. Therefore, it was sometimes
452
journal of dentistry 34 (2006) 450–453
Table 1 – Time expenditure of the single treatment steps
The manner of grey scale coding indicates which treatment step has to be done by the operator himself dependent on assistance level: lowlevel assistance comprises the white, slight grey and grey marked fields, medium-level treatment the white and slight grey indicated fields, for high-level assistance the dentist has to do the treatment steps mentioned in the white fields. The values marked with the superscript ‘‘1’’ within the same row indicate a significant difference at p < 0.05 according to Wilcoxon signed rank test. Time measurements in parentheses: not relevant for the operator’s attendance; **laboratory procedure including firing time in the oven.
journal of dentistry 34 (2006) 450–453
Table 2 – Results of the clinical investigation according to modified USPHS criteria4 at baseline (=1 week after insertion): 1, excellent; 2, good; 3, sufficient Empress restorations, N = 10
Criteria Surface Color matching Anatomic form Anatomic form (margin) Proximal contact Changes in sensitivity Complaints Subjective contentment a
1a
2a
6 7 8 7 9 10 10 10
4 2 2 3 1
3a
1
Cerec restoration, N = 10 1a
2a
5 7 6 6 10 10 10 10
5 3 4 3
453
Although the treatment was performed by a dentist who was experienced in the field of adhesive restorations, the results cannot be confidently extrapolated to other dentists. However, this study was the first attempt to measure the time expenditure of two different systems for the same indication under clinical conditions.
3a
5.
1
Conclusion
The present study revealed, that it was possible for a special dentist to achieve similar results regarding time aspects and initial quality according USPHS criteria with both systems.
references
Assessment.
necessary and thus more time consuming to apply electrosurgery and to separate the tooth carefully with dental floss. The firing time in the oven (‘‘Glazing’’) was not considered, because it did not occupy the operator’s time. One reason for similar total values was that the Cerec 3DTM treatment showed time advantages in the case of ‘‘Generating a FGP’’, ‘‘Powdering the cavity and optical impression’’ in comparison with the complementary steps of the IPS EmpressTM system (Table 1). Furthermore, treatment steps like ‘‘Manufacturing of a temporary restoration’’ and the ‘‘Removal of the temporary restoration, first fit adjustment’ and ’’Cleaning the cavity‘‘ were only required for the IPS EmpressTM method as well as the local anaesthesia for the second appointment. When considering the assistance concept, the mean time difference between the two systems was in a range of about 1 min (high-level assistance) and 4 min (low-level assistance). The time expenditure could be reduced more than half, if highlevel assistance was applied instead of low-level. It must be stressed that a high-level assistance concept requires a very skilled and highly trained dental assistant.
1. Kramer N, Lohbauer U, Frankenberger R. Adhesive luting of indirect restorations.. American Journal of Dentistry Special Issue 2000;13:60–76. 2. Otto T, De Nisco S. Computer-aided direct ceramic restorations: a 10-year prospective clinical study of cerec CAD/CAM inlays and onlays. International Journal Prosthodontics 2002;15:122–8. 3. Reiss B, Walther W. Clinical long-term results and 10-year Kaplan–Meier analysis of cerec restorations. International Journal of Computerized Dentistry 2000;3:9–23. 4. Frankenberger R, Petschelt A, Kramer N. Leucite-reinforced glass ceramic inlays and onlays after six years: clinical behaviour. Operative Dentistry 2000;25:459–65. 5. Blatz MB. Long-term clinical success of all-ceramic posterior restorations. Quintessence International 2002;33:415–26. 6. Bohrs R, Kablowski M, Backenkohler B, Wiedhahn KJ. The cerec assistance. In: Mormann WH, editor. CAD/CIM in aesthetic dentistry. 1st ed. Chicago: Quintessence Publishing; 1996. p. 277–91. 7. Richter B, Mormann WH. Adhesive luting. In: Richter B, Mormann WH, editors. Cerec 3 full-ceramic CAD/CAM inlays and partial crowns. 1st ed. Zurich: Foundation for the Advancement of Computer-assisted Dentistry Publishers; 2001. p. 10–3.
available at www.sciencedirect.com
journal homepage: www.intl.elsevierhealth.com/journals/jden
"
Dentist-time expenditure for two different adhesive all-ceramic systems Matthias Wurbs a, James F. Simon b, Markus Troeltzsch a, Thomas Denekas a, Manfred Wichmann a, Sven Reich c,* a
Department of Prosthetic Dentistry of the University of Erlangen-Nuremberg, Glueckstrasse 11, D-91054 Erlangen, Germany Department of Restorative Dentistry, University of Tennessee, College of Dentistry, 875 Union Avenue, Memphis, TN 38163, USA c Department of Prosthetic Dentistry and Material Sciences, University of Leipzig, Nuernberger Strasse 57, D-04103 Leipzig, Germany b
article info
abstract
Article history:
Objectives: The purpose of this clinical investigation was to compare a chair-side adhesive
Received 27 June 2005
all-ceramic system to a laboratory processed adhesive all-ceramic system with respect to
Accepted 20 September 2005
quality and time expenditure for the dentist. Methods: The same dentist treated 10 patients, who were each to receive two large posterior single tooth restorations of similar location and extent. One restoration was made in the
Keywords:
laboratory by using the IPS EmpressTM system [LAB], the other one was done chair-side by
Time expenditure
utilizing the CerecTM system [CHAIR]. The time expenditure was measured for [LAB] and
All-ceramic restorations
[CHAIR] and compared by the Wilcoxon signed rank test. The restorations were also
Cerec
evaluated according to the USPHS criteria.
Empress
Results: The mean time expenditure for the dentist with low-level assistance was
USPHS criteria
111:03 min [S.D. 24:09 min] for [LAB] and 115:31 min [S.D. 15:54 min] for [CHAIR]. Time
CAD/CAM
expenditure with medium level assistance for the operator was 100:53 min [S.D. 23:59] for [LAB] and 105:50 [S.D. 15:28] for [CHAIR]. Assuming a high level of assistance, the mean time values were 53:11 min [S.D. 14:29] for [LAB] and 54:29 min [S.D. 09:21] for [CHAIR]. The baseline investigation according to the modified USPHS criteria did not reveal any differences between [CHAIR] and [LAB]. Conclusion: There were no statistical significant differences with respect to time expenditure or quality between [LAB] and [CHAIR] in this study. # 2005 Elsevier Ltd. All rights reserved.
1.
Introduction
Since the introduction of the modern dentine adhesive systems, all-ceramic single tooth restorations are an alternative to conventional gold cast restorations.1 Adhesively luted, single tooth all-ceramic restorations can be provided at the chair-side or in the laboratory. Currently, the only chairside system available is the CerecTM method (Sirona Dental System, Bensheim, Germany),2,3 and a well known laboratory system is the IPS EmpressTM system (Ivoclar Vivadent AG,
Schaan, Liechtenstein).4,5 Both systems are documented in detail by long-term clinical trials.2–5 The treatment procedure can be subdivided into several steps. Only the dentist can complete some of these steps while some of them can be delegated to the assistant. One purpose of this study was to consider several assistance concepts, in order to evaluate whether one of these concepts could offer decisive time advantages. There are three main concepts of assistance, called high, medium, and low level assistance, which were originally developed for the Cerec 2TM method.6
* Corresponding author. Tel.: +49 341 97 21 300; fax: +49 341 97 21 309. E-mail address: [email protected] (S. Reich). 0300-5712/$ – see front matter # 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.jdent.2005.09.005
journal of dentistry 34 (2006) 450–453
However, they can be adopted to other adhesive treatments. In Table 1, the single treatment steps are grey scale coded in order to indicate to which assistance level they belong. The major aim of the present investigation was to compare the two all-ceramic systems Cerec 3DTM and IPS EmpressTM with respect to the time expenditure during patient treatment and the quality of the restorations. The hypothesis of the present study was that the two all-ceramic systems were comparable with regard to time expenditure for the operator and quality.
2.
Method and materials
Seven male and three female patients who were to receive two all-ceramic inlays (at least half of the occlusal surface had to be replaced) or onlays of similar extension and location in posterior teeth were chosen from the Department of Prosthodontics of a University. Each patient was treated with one Cerec 3DTM and one IPS EmpressTM restoration by the same operator, who was an experienced prosthodontist with over 10 years clinical experience and 8 years clinical experience with the Cerec system and the adhesive luting technique. The respective system was chosen randomly. Every restoration was completely finished, before the next restoration was begun with the alternative system. The time measured in seconds was the time expenditure spent on the treatment procedure exclusively. The time measurement could be divided into three phases. Phase I comprised the general treatment steps ‘‘preparation and impression’’. Phase II included ‘‘providing the restoration’’ and phase III consisted of ‘‘pre-treatment and adhesive luting’’. The single treatment steps are listed in Table 1. The Cerec restorations were done in one single appointment according to the recommendations and guidelines of the University of Zurich7 using the Cerec 3DTM software, version V2.10 R1500. For every Cerec 3DTM restoration the functionally guided pathway (FGP) technique was applied: after preparation a FGP registration made of silicone material (R-SI-LineTM Metalbite, R-dental Dentalerzeugnisse GmbH, Hamburg, Germany) was generated. It was possible to acquire up to five optical impressions of the cavity and the FGP registration. The single optical impressions of the cavity are computed to a virtual 3D model on the computer screen. Due to the fact that the optical data of the FGP registration could be superimposed on the 3D model it was possible to take into account cuspal contact point placement during the virtual design of the restoration on the monitor, which was then milled from a feldspathic machinable block (Vitablocks Mark IITM, Vita Zahnfabrik). The fit of the freshly milled restoration was checked as well as the tightness of proximal contacts. The outer surface of the restoration was pre-polished with dark blue Sof-Lex disks (3M Espe, St. Paul, MN, USA). Then the restoration was glazed in an oven (Vita VacumatTM, Vita Zahnfabrik) at 950 8C. After adhesive luting according to the recommendations of the University of Zurich7 the occlusal relationships were checked, corrected, if necessary, and finally polished. The Empress restoration required two appointments. In the first appointment the cavity was prepared. The double mix technique served as impression technique (Silaplast FuturaTM
451
and Silasoft NTM, Detax GmbH & Co. KG, Ettlingen, Germany). As temporary restorative the provisional light curing composite Fermit-NTM (Ivoclar Vivadent AG) was used and additionally fixed with FreegenolTM (GC Europe N.V., Leuven, Belgium). For the opposite jaw a single stage technique with alginate was applied. In the laboratory the impressions were poured into casts made of Fuji rockTM (GC Europe N.V.) and mounted into a semi adjustable articulator (Protar evo 5TM, Kavo Dental GmbH, Biberach, Germany). The restoration then was modeled in wax, sprued and invested. After waxing out and preheating the heated, softened ceramic was pressed into the mould. The fit of the divested restoration was checked and improved with fine diamonds, if necessary. After carefully cleaning the restoration, the restoration was stained and glazed. In the second appointment the restoration was tried in and adhesively luted under rubber dam (Table 2). Two independent examiners assessed all restorations after initial insertion according to the USPHS criteria.4 The time expenditure for the two systems was compared by the application of the Wilcoxon signed rank test for pair-wise comparison at p < 0.05. The statistical program SPSS for Windows NTTM, Version 11.5 (SPSS, Chicago, IL, USA) was used. In order to get a better overview the time measured in seconds was transferred into units of minutes and seconds.
3.
Results
Table 1 shows the time expenditures for the single treatment steps and the total sums. Using the USPHS criteria there were not found any significant differences regarding marginal gap, proximal contact, or anatomic/functional form. The evaluation of occlusal contacts did not reveal any differences of the tested systems.
4.
Discussion
In order to be able to deal with a limited number of patients, a study design was chosen that only patients were included who showed two similar indications for all-ceramic restorations with regard to extension and location. This meant that a pairwise statistical comparison was possible. The similarity of the indications is confirmed by comparable time measurements for identical treatment procedures like ‘‘Filling and caries removal’’, ‘‘Cavity preparation’’, ‘‘Cleaning, etching and dentine bonding’’ (Table 1). Although the Cerec 3DTM treatment comprised additional steps like ‘‘CAD design’’, both systems showed total time values which did not differ significantly. The mean time expenditure for rubberdam insertion differed significantly for two systems. When applying the IPS EmpressTM system rubberdam was only put on for adhesive luting so that it was possible to tear down the rubberdam in interdental spaces by the help of matrix bands and wedges. If the Cerec 3DTM system was used, the rubber dam was inserted before the optical impression was done. But if there were deep boxes which were on gingival level or even below, it was more complicated to get the rubberdam down without the help of matrix bands, because these would have affected the optical impression. Therefore, it was sometimes
452
journal of dentistry 34 (2006) 450–453
Table 1 – Time expenditure of the single treatment steps
The manner of grey scale coding indicates which treatment step has to be done by the operator himself dependent on assistance level: lowlevel assistance comprises the white, slight grey and grey marked fields, medium-level treatment the white and slight grey indicated fields, for high-level assistance the dentist has to do the treatment steps mentioned in the white fields. The values marked with the superscript ‘‘1’’ within the same row indicate a significant difference at p < 0.05 according to Wilcoxon signed rank test. Time measurements in parentheses: not relevant for the operator’s attendance; **laboratory procedure including firing time in the oven.
journal of dentistry 34 (2006) 450–453
Table 2 – Results of the clinical investigation according to modified USPHS criteria4 at baseline (=1 week after insertion): 1, excellent; 2, good; 3, sufficient Empress restorations, N = 10
Criteria Surface Color matching Anatomic form Anatomic form (margin) Proximal contact Changes in sensitivity Complaints Subjective contentment a
1a
2a
6 7 8 7 9 10 10 10
4 2 2 3 1
3a
1
Cerec restoration, N = 10 1a
2a
5 7 6 6 10 10 10 10
5 3 4 3
453
Although the treatment was performed by a dentist who was experienced in the field of adhesive restorations, the results cannot be confidently extrapolated to other dentists. However, this study was the first attempt to measure the time expenditure of two different systems for the same indication under clinical conditions.
3a
5.
1
Conclusion
The present study revealed, that it was possible for a special dentist to achieve similar results regarding time aspects and initial quality according USPHS criteria with both systems.
references
Assessment.
necessary and thus more time consuming to apply electrosurgery and to separate the tooth carefully with dental floss. The firing time in the oven (‘‘Glazing’’) was not considered, because it did not occupy the operator’s time. One reason for similar total values was that the Cerec 3DTM treatment showed time advantages in the case of ‘‘Generating a FGP’’, ‘‘Powdering the cavity and optical impression’’ in comparison with the complementary steps of the IPS EmpressTM system (Table 1). Furthermore, treatment steps like ‘‘Manufacturing of a temporary restoration’’ and the ‘‘Removal of the temporary restoration, first fit adjustment’ and ’’Cleaning the cavity‘‘ were only required for the IPS EmpressTM method as well as the local anaesthesia for the second appointment. When considering the assistance concept, the mean time difference between the two systems was in a range of about 1 min (high-level assistance) and 4 min (low-level assistance). The time expenditure could be reduced more than half, if highlevel assistance was applied instead of low-level. It must be stressed that a high-level assistance concept requires a very skilled and highly trained dental assistant.
1. Kramer N, Lohbauer U, Frankenberger R. Adhesive luting of indirect restorations.. American Journal of Dentistry Special Issue 2000;13:60–76. 2. Otto T, De Nisco S. Computer-aided direct ceramic restorations: a 10-year prospective clinical study of cerec CAD/CAM inlays and onlays. International Journal Prosthodontics 2002;15:122–8. 3. Reiss B, Walther W. Clinical long-term results and 10-year Kaplan–Meier analysis of cerec restorations. International Journal of Computerized Dentistry 2000;3:9–23. 4. Frankenberger R, Petschelt A, Kramer N. Leucite-reinforced glass ceramic inlays and onlays after six years: clinical behaviour. Operative Dentistry 2000;25:459–65. 5. Blatz MB. Long-term clinical success of all-ceramic posterior restorations. Quintessence International 2002;33:415–26. 6. Bohrs R, Kablowski M, Backenkohler B, Wiedhahn KJ. The cerec assistance. In: Mormann WH, editor. CAD/CIM in aesthetic dentistry. 1st ed. Chicago: Quintessence Publishing; 1996. p. 277–91. 7. Richter B, Mormann WH. Adhesive luting. In: Richter B, Mormann WH, editors. Cerec 3 full-ceramic CAD/CAM inlays and partial crowns. 1st ed. Zurich: Foundation for the Advancement of Computer-assisted Dentistry Publishers; 2001. p. 10–3.