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All-Ceramic Inlays, Onlays, Veneers and Crowns are the most esthetic restorations.
Because there is no metal to block light transmission, they resemble natural tooth
structure better in terms of colour and translucency than any other restorative option.
Composition of ceramic
products based on
Feldspar, Kaolin and
Quartz
ALL-CERAMIC: A ceramic restoration that restores a clinical crown without a
supporting metal substructure.
Indications:
1. High esthetic needs
2. Discoloured anterior teeth
3. Malformed anterior teeth
4. Fractured anterior teeth but with sufficient coronal tooth structure incisally
5. Because of the relative weakness of the restoration, the occlusal load should be
favourably distributed. Generally this means that centric contact must be in an area
where the porcelain is supported by tooth structure (e.g., in the middle third of the
lingual wall).
The occlusion on an all-ceramic crown is critical for
avoiding fracture. Centric contacts are best confined to
the middle third of the lingual surface. Anterior guidance
should be smooth and consistent with contact on the
adjacent teeth. Leaving the restoration out of contact is
not recommended. Future eruption may lead to protrusive
interferences, precipitating fracture.
Contraindications:
1. Unfavorable occlusion (edge to edge bite and deep bite)
2. When superior strength is needed
3. Reduced esthetic demands
4. Young patient (large pulp horns)
5. Thin teeth (facio-lingually)
6. Teeth with constricted cervical outline
7. Patients with bruxism
8. If a more conservative restoration is indicated
9. When it is not possible to provide adequate support at the incisal edge for porcelain
(in badly broken teeth).
10. In cases of uncontrolled caries and untreated periodontal problems.
Armamentarium:
Handpiece
Flat end tapered diamond
Small wheel diamond
Radial fissure bur
Binangle chisel
Recommended reduction for ALL-CERAMIC crown - Anterior and posterior
Step-by-step procedure
Adapt putty silicone on the tooth before tooth preparation to make an index. This will
act as a guide after the tooth is prepared.
To achieve adequate reduction without encroaching upon the pulp the facial surface is
prepared in two planes that correspond to the two planes present on the facial surface
of an uncut tooth.
Step no: 1 - Placement of depth orientation grooves - (1.2 mm deep)
The labial grooves are cut in two sets with flat end tapered diamond
One set parallel with the gingival 1/3rd of labial surface
One set parallel with the incisal 2/3rd of labial surface
What happens if you do not prepare the labial surface in 2 planes?
If the facial surface is prepared in one plane that is parallel to the gingival 1/3rd there
will be insufficient space for porcelain in the incisal area.
If the facial surface is prepared in one plane that is parallel to the incisal 2/3rd the
facial surface will be over prepared and too close to the pulp.
Step no: 2 - Incisal reduction - (2mm)
With flat end tapered diamond place 2 grooves on the incisal edge.
Step no: 3 - Labial reduction (Incisal 2/3 rd)
With flat end tapered diamond remove the tooth structure between the grooves.
Step no: 4 - Labial reduction (Gingival 1/3rd)
With flat end tapered diamond remove the tooth structure between the grooves. At the
same time shoulder margin is formed.
Step no: 5 - Proximal reduction
With a long needle diamond break the contact point mesially and distally.
Step no: 6 - Lingual reduction
With round diamond make depth orientation grooves of about 1.2 mm. Join these
grooves with small wheel diamond.
Step no: 7 - Prepare the mesial and distal wall and radial shoulder with radial fissure
bur.
Step no: 8 - Round off all line angles with a flame shaped bur.
Step no: 9 - Smoothen the radial shoulder with binangle chisel.
Occlusal reduction (1.5 to 2 mm): With a round end tapered diamond reduce the
occlusal surface and follow anatomic planes of the tooth and place the functional cusp
bevel.
Facial & Lingual reduction (1 to 1.5 mm): With a round end tapered diamond place
axial guiding grooves on the buccal and lingual surface. Join these grooves and at the
same time form a heavy chamfer margin.
Proximal reduction: Break the contact points with a small needle diamond. With a
round end tapered diamond form a heavy chamfer on the mesial and distal surfaces.
Round off all sharp angles on the tooth with a flame shaped bur.
Advantage:
The main advantage of facial veneers is that they are conservative of tooth structure.
Typically only about 0.5 mm of facial reduction is needed. Since this is confined to
the enamel layer, local anesthesia is not usually required.
Disadvantages:
1. Technique sensitive procedures
2. Shade matching is difficult
3. More time is required to fabricate the veneer in the laboratory
4. Difficult to repair the veneer
5. Fragile (easily breaks)
6. Cost is high
Indications:
1. Malformation of tooth (enamel hypoplasia, peg laterals)
2. Discolorations of tooth (tetracycline, old restorations, dark teeth, fluorosis) when
bleaching is insufficient
3. Minor mal positions or diastemas of the tooth
4. Abrasion, erosion or fracture (where sufficient enamel remains)
Contraindications:
1. Inability to isolate for cementation
2. Extensive loss of supporting enamel
3. Severe Abrasion/Erosion
4. Extensive existing restoration or caries
5. Severe bruxism
6. Moderate/severe malpositions
7. Unwillingness to wear night guard
Place 3 depth orientation grooves on the facial surface of the tooth with a depth
cutting diamond. The depth of the grooves should be 0.5 mm. Join these grooves with
a round end tapered diamond and form a chamfer finish line either at the gingiva or
sub gingivally.
First appointment:
Case history
Make primary impressions with alginate
Laboratory procedures:
Make diagnostic casts
Make stent in a clear poly vinyl material
Second appointment:
Tooth preparation
Make final impressions
Make provisional restorations using clear acrylic stent
Third appointment:
Remove provisional restorations
Do good moisture control
Etch the inner surface of veneer with hydro fluoric acid. Wash it with water and apply
a silane coupling agent.
Etch the tooth with phosphoric acid. Wash it with water and apply bonding agent on
the tooth. Light cure the bonding agent.
Mix resin cement and apply resin cement on the veneer and do cementation. Light
cure the resin cement and remove excess cement.
Conclusion
Dental ceramic technology is one of the fastest growing areas of dental material
research and development. The future of all ceramic restorations remains bright for
there is increased demand for tooth coloured restorations. All ceramic restorations
represent the most esthetically pleasing, but more fracture prone restorations.
However with adequate tooth reduction, an excellent quality impression, skilled
technician, high success can be achieved.
References:
1. PHILLIPS SCIENCE OF DENTAL MATERIALS Anusavice 11th edition
2. FUNDAMENTALS OF FIXED PROSTHODONTICS - Shillingburg
3rd edition
3. CONTEMPORARY FIXED PROSTHODONTICS Rosenstiel 3rd edition