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Esthetic Dental Materials

Esthetic Dental Materials. Joseph W. Parkinson, DDS. Esthetic Dental Materials. Single -Component Systems-Homogeneous material Feldspathic Porcelain Reinforced glass ceramics Pressed Ceramics Structural Limitations Need support from tooth structure Restricts to veneers, inlays, onlays.

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Esthetic Dental Materials

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  1. Esthetic Dental Materials Joseph W. Parkinson, DDS

  2. Esthetic Dental Materials • Single -Component Systems-Homogeneous material • Feldspathic Porcelain • Reinforced glass ceramics • Pressed Ceramics • Structural Limitations • Need support from tooth structure • Restricts to veneers, inlays, onlays

  3. Esthetic Dental Materials • Single-Component Systems (con’t) • CAD/CAM (CEREC) • Esthetic restorations • Good marginal fit • Brittle • Need adequate tooth structure • Meticulous bonding • Single appt- good for patients, practitioners • High initial investment- affect treatment decisions?

  4. Esthetic Dental Materials • iTERO • Similar to CAD/CAM • Prep design critical

  5. Two-Component Ceramic Systems • Pressed Ceramic Restorations • Exceptional Esthetics • Very good marginal fit • Leucite-reinforced pressed ceramics (IPS Empress, Finesse) • Flexural strength of 140-180MPa, Feldspathic Porcelain 80 MPa • Should be restricted to single units in anterior, partial coverage restorations in posterior

  6. Two Component Ceramic Systems • Pressed Ceramic Restorations-con’t. • Lithium Disilicate-Reinforced Pressed Ceramics (IPS Empress 2, Eris. e. Max Press) • Flexural Strenghth 300 MPa • Short span bridges anterior to second premolar

  7. Two Component Ceramic Systems • Adhesively bonded resin cements required for cementing pressed ceramics • Maintain their translucency • Shade of cement can affect final shade • Glass component in pressed ceramics susceptible to etching with HF acid • Etching and silanization form bond with cement, tooth, restoration • Leucite and Lithium Disilicate in pressed ceramics can be used with CAD/CAM

  8. Two Component Ceramic Systems • Glass- Infiltrated Ceramics • Zirconia, Alumina, Spinel • Flexural Strength-350MPa for Spinel, 500MPa for Alumina, 700 MPa for Zirconia • Prep similar to pressed ceramics • Even circumferential reduction • Deep chamfer reduction recommended • Moderate taper, no sharp line angles

  9. Two Component Ceramic Systems • Glass- Infiltrated Ceramics- con’t. • Frameworks for full coverage crowns in Anterior • Short span bridges replacing premolars or anterior teeth • Conventional Cementation Techniques (GI or Zn Phosphate)

  10. Two Component Ceramic Systems • Fully Sintered Ceramics • Based on pure crystalline ceramic copings • Stronger than pressed or glass-infused ceramic- e.g. Procera All-Ceram, Procera All-Zircon, Lava • Lava-Flexural Strength of 1,100 MPa- can be as thin as 0.3mm

  11. Two Component Ceramic Systems • Pressed to Zirconium • Feldspathic Porcelain veneered over fully sintered zirconium • Chipping of porcelain similar to metal ceramic

  12. Selecting The Right One • Meeting the patient’s restorative needs -#1 • Look at patient’s smile line • If gingival margin exposed during smiling, then metal should not show • Opaque copings of alumina or zirconia may look unnatural if extended to facial margin • Glass ceramic facial margin(pressed or stacked) is only option for patient with high smile line • Can use metal ceramic w/all porcelain margin or pressed all ceramic or pressed to Zn

  13. Selecting The Right One • Shade matching- #2 • All systems can block out unwanted background color either intrinsically or with opaque modifiers • Matching existing teeth or recreating imperfect natural is a greater challenge-pressed ceramic the best • Posterior teeth-structural implications • Multiple cusps-splitting forces\ • Pressed ceramics-bad • Crystalline ceramics-glass infiltrated or fully sintered –better • Primary drawback to Zn is cost

  14. Selecting The Right One • Bridges • Need for strength greater • Lithium Disilicate-based pressed ceramics can be used for short spans in anterior and premolar-not molar abutments or pontics • Glass infiltrated ceramic frameworks-similar indications-less natural appearance • Zirconia frameworks-first choice for long span posterior bridges

  15. In The Future • Zirconia-material of present and near future • Maryland bridges, inlay/onlay retained bridges • Abutments for implant retained restorations IntraOral Scanning devices-CAD/CAM, iTero

  16. In The Future • Overlooked Problem-Replacement • More likely to result in fractured or grossly over-reduced tooth than metal ceramic due to visual similarity and tenacious grip on tooth structure

  17. Dental Cements • Zinc Phosphate • Advantages • Easy to mix • Well-defined setting time • Working time that can be prolonged by adjusting mixing technique • Low cost

  18. Disadvantages • Potential for pulpal irritation due to low pH (2) • No antibacterial function • Brittle • No adhesive qualities • More soluble than most cements • Opaque • Exothermic reaction

  19. Polycarboxylate Cement • Advantages • They bond to enamel and dentin with a similar mechanism found in glass-ionomer cements • Low pulpal irritation • Strength, solubility, and film thickness comparable to zinc phosphate • Antibacterial action

  20. Disadvantages • Properties highly dependent on mixing procedure • Short working time • Longer setting time • Clean up difficult if excess is allowed to harden

  21. Glass ionomers • Advantages • Fluoride release • Cariostatic potential • Similar coefficient of thermal expansion when compared to hard tissue • Chemical adhesion to dentin and enamel • Capsules for consistent powder-to-liquid ratio • Lower opacity than zinc phosphate

  22. Disadvantages • Lower than resin cements in fracture toughness, brittleness, higher solubility and wear • Absorb moisture during initial setting phase

  23. Resin Modified Glass Ionomers • Advantages • Less sensitivity to moisture during initial setting phase • Capable of bonding to composites • Some fluoride release

  24. Disadvantages • Hydrophilic behavior • Water absorption and hygroscopic expansion—not recommended for all ceramic crowns or veneers • More leakage than resin-based materials

  25. Resin-based Cements • Advantages • High compressive and tensile strength • Good biocompatibility • Intra-oral solubility is lowest • Good adhesion • Reach maximum strength in a short time

  26. Disadvantages • Higher film thickness than RMGI or GI • Much more difficult to remove excess once cured • When used with acid-etching techniques, can cause post-operative sensitivity

  27. The Use of Luting Materials Classified by Type of Restoration 1. Low-Strength Ceramic Restorations A. Veneers (IPS Empress) Recommended Material: Light or Dual-Cured Cement (Variolink II, Calibra) B. Inlay, Onlay, Full Crown (IPS Empress, VITA PM) Recommended Material: Dual or Self-Cure Cement (Variolink II, Panavia 21)

  28. 2. High-Strength Ceramic Restorations (Lava, ProCeraZirconia) A. Core Reinforced Full Ceramic Crowns, FPDs, Posts and Cores Recommended Material: Conventional Cement (Zinc Phosphate or GI) or a dual or self-cured resin cement for adhesive cementation (RelyXUnicemMaxcem, Multilink Sprint, Panavia F 2.0)

  29. References • Esthetic Dentistry in Clinical Practice • Mark Geissberger/1sted, 2010, Blackwell Publishing • Bay View Dental lab

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