Adhesive Partial-Coverage Ceramic Restorations

What are some examples of adhesive partial-cvoerage ceramic restorations?

1. Ceramic veneers

2. Ceramic inlays / onlays

3. Ceramic resin-bonded bridge

What are ceramic veneers?

A thin bonded ceramic restorations that restores the facial, incisal and part of the proximal surfaces of teeth requeing esthetic restoration

Which tooth surface is not worked on regarding ceramic veneers

Lingual

The success of veneers is determined by what 3 stages?

1. Pre-operative phase

2. Operative phase

3. Post-operative phase

The pre-operative phase includes

1. Proper treatment planning

2. Proper selection of ceramics

The operative phase includes:

1. Proper preparation of teeth

2. Proper selection of the materials

3. Methods of cementation

The post-operative phase includes:

1. Proper finishing and polishing of the restorations

2. Proper planning for the continued maintenance of the restorations

What are the 4 indications for veneers?

1. Modify tooth color

2. Modify tooth shape / length

3. Close diastema

4. Correct mild misaligned teeth

What are some reasons why you’d want to modify the tooth color?

1. Fix endodontically treated teeth

2. Tetracycline discolored teeth

3. Enhance existing tooth color

What are some reasons why a patient would want to modify their rooth shape or length?

1. Congenital malformation - peg laterla

2. Fractured teeth

3. Tooth wear

What are some reasons why you’d want to close the diastema?

To fix the contour

What are some contraindications for veneers?

1. Pronounced enamel defects

2. Severe malformations

3. Severe malalignment

4. Poor oral hygiene

What are the two components of an esthetic analysis?

1. Gingival display at smile

2. Tooth display at rest

What is gingival display?

How much of your gums show compared to your upper lip

A low smile line is when you smile and you don’t see any gums. What % of your anterior teeth are shown?

Displays less than 75% of anterior teeth

How common is a low smile line?

Seen in about 20.5% of the population

An average smile reveals 75% to 100% of anterior teeth and interproximal gingival only. How common is an average smile?

Seen in 68.94% of the population

A high smile line is present in 10.57% of the population. What does it reveal?

A continuous band of gingiva and the total cervico-incisal length of the maxillary anterior teeth

Pressable ceramics include

1. Leucite reinforced glass (IPS Empress)

2. Lithium disilicate glass (IPS e.max Press)

Milled ceramics include

1. Leucite reinforced glass (IPS Empress CAD)

2. Lithium disilicate glass (IPS e.max CAD)

What are the 3 main ways dental ceramics are fabricated?

• Feldspathic → layered (hand-built)

• Pressable → heat + pressed into mold

• Milled → CAD/CAM (cut from block)

Two techniques used for feldspathic porcelain?

• Platinum foil technique

• Refractory die technique

Advantages of feldspathic porcelain?

1. Highly translucent

2. Highly esthetic

3. Minimal tooth prep needed

4. Long term clinical history

Disadvantage of feldspathic porcelain?

1. Very weak → low flexural strength (110-150 MPa)

2. technique sensitive

3. Time consuming

4. Shrinkage / fit

5. Difficult to mask heavy discolored teeth

The clinical success rate for feldspathic porcelain has grown from 1998 to 2002 by what?

93 —> 98%

IPS Empress has a fracture strength of 200 MPa. What is it made of?

Leucite reinforced class

IPS e.max has a flexural strength of 300-500 MPa fracture strength. What is it made of?

Lithium disilicate glass

What are some benefits to using IPS e.max (lithium disilicate)?

1. Improve physical properties

2. Improve translucency

What are some advantages of pressable ceramics?

1. Less technique sensitive

2. Acceptable esthetics

3. Firm fit

4. High flexural strength

What are some disadvantages to pressable ceramics?

1. Monolithic color

2. Layered feldspathic porcelain often required

What is the difference between the clinical survival rates of pressable ceramics vs. feldspathic porcelain?

They are relatively the same

Clinical complications are significantly associated with a larger amount of

Exposed dentin; meaning its not about your material, it is about your prep and treatment planning

When bonded to enamel, porcelain veneers have a very

High clinical success rate

How much enamel do you have apically?

0.3-0.5mm

How much enamel do you have in the middle 1/3 of the tooth?

0.6 - 1.0mm

How much enamel do you have incisally?

1.0mm - 2.1mm

What are some advantages of a supragingival finish line?

1. Establish distinct and visible finish line

2. Reduce the risk of dentin exposure

3. Eliminate the chances of gingival injury

4. Likelihood to obtain a good quality impression

5. Facilitate bonding procedure

6. Convenience to maintain good OH

What is a disadvantage of a supragingival finish line?

Tooth / restoration interface might be visible

What is the contact lens effect

Very thin, highly translucent veneer (usually feldspathic) that allows the underlying tooth color to show through and influence the final appearance

What are some indications for subgingival finish lines?

1. Major tooth color change

2. Create smooth emergence profile while closing diastema

If a patient has an existing Class III composite, how should you prep the interproximal for a veneer?

Extend the prep through

What are the 3 indications for extending the interproximal preparation through the contact area?

1. Major tooth color change

2. Existing interproximal restorations

3. Closing a diastema

What kind of incisal reduction is this

No incisal reduction

What kind of incisal reduction is this

Palatal chamfer

What kind of incisal reduction is this

Butt joint

Which incisal preparation is best?

Ceramic veneers have shown no relation between survival rates due to incisal preparation design