Acrylic, temporary cement, over-prepping for retention, waiting for PVS to set up was the normal day in the office, the emergency phone call from the patient saying that the temp came loose requiring re-cementing, a minor inconvenience that did nothing to build the confidence of the patient, did nothing to build the confidence of the patient in the abilities of your office that is! The crown delivered and the patient is happy, in the majority of cases, though sometimes the situation starts in a downward slide and only a root canal can calm things down...just what the patient likes, a nice hole in a new crown. This lead to condemning of the nerve in certain cases, better to be proactive than reactive, avoided a possible uncomfortable conversation after the fact. 

After incorporating Cerec into the practice it did lead to some changes with experiences previously mentioned. The immediate sealing of the dentin, prior to it having a chance to be contaminated which could lead to pulpal irritation or worse death, has been a great benefit for my patients. Fresh cut enamel and dentin allows for the best adhesion and the best seal, no debating or arguing this. A single insult to the nerve, even a significant one, is far better than a long term constant moderate irritation. As long as the occlusion was managed correctly teeth that I expected to act up didn’t.

I do almost all my own endo so having a decrease in the number of cases might be seen by some as not a good thing, but I am OK with that. The confidence I instill in my patients by treating them the first time and the only time more than makes up for it.

Pete, can you go over your protocol for Immediate Dentin Sealing with Scotchbond Universal? Do you seal prior to powdering? (still a blue am user) and do you leave the isolite in the mouth after sealing to prevent moisture contamination?

Fran
I do not do IDS. After I prep and image I remove the isolite to minimize desiccation
For IDS I would finish prep, apply Scotchbond, powder image. After imaging is approved and you go forward with design clean the powder off with alcohol. When bonding I would apply a fresh coat of scotch bond then insert crown loaded with RelyX

Same here as I would guess 8-12% of the endo I did was on or just prior to cementation after the patient had worn a temporary for 2-3 weeks. Over a year now with hundreds of CEREC crowns and only 2 needing root canals @10-12 months post placement, none within 6 months of placement. I too do not miss the endo, esp immediately after placement of a new crown, it's gonna happen again but should be a rare case. No pre powder treatment, I just scrub etch (to remove powder), Gluma or Hema twice (20 seconds) then bonding agent twice then resin cementation, rarely RMGI cementation, ZERO dental sensativity. Imagine the results should be similar between the two?