1 The Metal-Free Practice Looks Longevity versus Common Public Perception of a Crown Sticks out like a headlight Doesn’t match Too opaque Black line at gum The All-Ceramic Restoration • Increased translucency and vitality • Supra-gingival margins possible • Does not contain metal • Potentially best esthetics All-Ceramic Restoration Advantages
20
Embed
Looks - d1ue90e5sp4tcv.cloudfront.netd1ue90e5sp4tcv.cloudfront.net/2855/images/Asset291188_v1.pdfClinical decisions for anterior restorations: the concept of restorative volume. J
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
The Metal-Free Practice
Looks
Longevity
versus
Common Public Perception of a Crown
Sticks out like a headlightDoesn’t matchToo opaqueBlack line at gum
The All-Ceramic Restoration
• Increased translucency and vitality
• Supra-gingival margins possible
• Does not contain metal
• Potentially best esthetics
All-Ceramic RestorationAdvantages
2
PFM vs All-Ceramic Crown
PFM Crown
All-Ceramic Crowns
• Exacting preparations
• Exacting cementation procedures
• Post-operative sensitivity
• Post-seating fractures
• Often higher lab bill (not pure Zr)
All-Ceramic RestorationChallengesChallenges
• Strength
• Esthetic expectations
• Specific tooth
• Occlusal habits and trauma
• Amount of tooth preparation
• Color of underlying tooth structure
• Periodontium biotype
• Type of core or post
• Bonding vs conventional cementation
• Patient cooperation
All-Ceramic Selection Factors
Cardoso JA, Almeida PJ, Fischer A, Phaxay SL. Clinical decisions for anterior restorations: the concept of restorative volume. J Esthet Restor Dent. 2012; 24:367-83
• All Zirconia
• High translucent Y-TZP
• Porcelain fused to Zirconia ?
• Monolithic Lithium Disilicate
• Lithium Disilicate w/ cutback
• Pressed Ceramic
• Feldspathic
All-Ceramic Restoration Materials-2016
• All Zirconia
• High translucent Y-TZP
• Porcelain fused to Zirconia
• Monolithic Lithium Disilicate
• Lithium Disilicate w/ cutback
• Pressed Ceramic
• Feldspathic
All-Ceramic Restoration Materials-2016
Monolithic
• Inherently Stronger
• Staining may wear off
• Posterior teeth
All-Ceramic RestorationsMonolithic vs Layered Core
Layered Core
• Weakest link is bond of overlaid porcelain to core
• Best esthetics
• Anterior teeth
3
Layered Zirconia RestorationsChipping of Layered Core
Technique Dependent
• Prep design
Sharp line angles
Uneven thickness of ceramic
Layered Zirconia RestorationsChipping of Layered Core
Technique Dependent
• Prep design
• Core design
Urapepon S, Taenguthai P. The effect of zirconia framework design on the failure of all-ceramic crown under static loading. J Adv Prosthodont. 2015 Apr; 7(2): 146–150
Even thickness 0.5mm Zr
Even thickness 0.8mm layering porcelain
Layered Zirconia RestorationsChipping of Layered Core
Technique Dependent
• Prep design
• Core design
• Decreased bond between porcelain and zirconia
Miyazaki T1, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res. 2013 Oct;57(4):236-61
Layered Zirconia RestorationsChipping of Layered Core
Miyazaki T1, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res. 2013 Oct;57(4):236-61
Occurs 10-19%
Solution
• Anterior-Lithium DiSilicate fused to Zr
• Posterior-Monolithic
Zirconia
• Stronger
• More opaque
• Conventional Cementation
• Posterior teeth
• Failure-Loose
All-Ceramic RestorationsZirconia vs Lithium DiSilicate
Lithium DiSilicate
• Weaker
• More Translucent
• Bonded Cementation Best
• Anterior teeth
• Failure-Fracture
All-Ceramic RestorationsLithium DiSilicate
• Anterior Teeth through Bicuspids
• Layered Incisors and Canine
• Monolithic bicuspids
• Bonded-anesthetize
4
All-Ceramic RestorationsZirconia
• Posterior molars
• Monolithic
• Anterior-blockoutdark tooth
• Li Disilicate to Zr
• Conventional cementation
• Bond w short or convergent preps
All-Ceramic RestorationsLithium DiSilicate bonded to Zirconia
Carefully adjust protrusive and lateral excursions
Smooth lingual with fine diamond football, white stone, successive points
Have patient return in 2 weeks for photos and to check occlusion
10
Before
After
Porcelain Laminate Veneers Seated
Laboratory prostheses fabricated by Valley Dental Arts Stillwater MN
Lithium Disilicate (E-Max)
• Strength and translucency
• Posterior crowns-monolithic
• Pressed or CAD produced
• Anterior crowns-w/ layered porcelain
• 360-400 MPA flexural strength
• Better to be bonded unless thick
• Best esthetics
Single Central Incisor Crown•2-5 Appointments•Higher Fee
Lithium Disilicate (E-Max)Endodontically Treated
Old Bonding
Lingual View
Remove facial compositeRemove AO compositeRemove most stainUse perio probe to remove subgingivalBond bleach white compositePrepare toothPhoto w/stump shade
Make custom temp for lab
•Make quick bis-acryl
•Laminate prep on facial
•Add composite and custom stains
Send photo and temp to lab
11
OR Make custom shade tab for lab
•Core Shade
•Add tints
•Overlay with Incisal Shade for value
Send photo and tab to lab
Pre Operative Smile
Post Operative Smile
Laboratory prosthesis fabricated by Valley Dental Arts Stillwater MN
Monolithic E Max CrownsLoad to Failure*
*Data from Ivoclar/Vivadent
Li2Si2O5
Dentin______
CoreResin Cement
Sila
ne
Bonding to Lithium Disilicate(Retentive)
15 MPa
Li2Si2O5
Dentin______
CoreResin Cement
Sila
ne
Adhesive
Bonding to Lithium Disilicate-(Non Retentive)
35 MPa
Duo-Link Universal
•Increased radiopacity
•2 shades‐milky white & translucent
•Dual curing
•Completely cures w/o light exposure
•Easier cleanup
12
Duo-Link Universal
•Usable with Universal, total etch, self‐etch bonding agents
e Cement•All‐inclusive kit
•Dual and light cure
Duo-Link used with All-Bond Universal vs. Primersfor Ceramics & Zirconia/Metals (Indirect Substrates)
*All Bond Universal can be used as a Universal Primer for Porcelain & Zirconia substrates , but it MUST BE LIGHT‐CURED prior to cementation of the restoration. Although the initial Shear Bond Strengths may be statistically similar, a separate pure Silane primer for lithium disilicate and separate Metal primer for Zirconia results in better long‐term durability of the bond.
Temporary Crown
Bonding Technique
Place Divots with 330 bur
Anesthetize if vital
Seat Pointed Forceps-Easy back and forth
Be gentle: slight rock, then pull straight up
(Optional) Roughen surface w diamond for immediate dentin sealing
GI Initial setting and early strength Fluoride release
Calcium Aluminate Long term-increased strength and retentionApatite formation Sealing at marginal interface Sustained long term properties w/o degradingHigher pH (not acidic)-virtually no sensitivity
Ceramir
Telio – Temporary Concept, Team IV Spain, Madrid, November 2009
Ceramir
Forms apatite crystals Powder and water are mixed Dissolution results in nano-crystal formation Gibbsite and Katoite forms Crystals form on tooth and restoration Long-term stable bond Ceramir Dentin
Physical Properties– Creates Apatite when in contact with phosphates– No shrinkage– Hydrophilic system with Alkaline pH– Thermal properties similar to tooth structure– Low film thickness -15 microns– 160 Mpa compressive strength– Anti-bacterial-inhibits caries– Gets stronger over time– Acid resistant– Bonds well to metal, porcelain, ceramics, zirconium
Ceramir
Telio – Temporary Concept, Team IV Spain, Madrid, November 2009
Ceramir
Jeffries SR, Fuller AE, Boston DE. Preliminary Evidence that Bioactive Cements Occlude Artificial Marginal Gaps. J Esthet Restor Dent. 2015.
Self Adhesive Resin Cement
Resin-Modified Glass Ionomer
Glass Ionomer
Calcium AluminateRMGI
Calcium Silicate
15
0:00
Ceramir
2:00
Ceramir
4:00
Ceramir
Calcium Aluminate/RMGI cement– Hybrid cement
– Forms apatite crystals
– Excellent physical properties
– Low film thickness-easy to use
– Virtually no sensitivity
Ceramir
ZrDentin______
CoreResin Cement
Z P
rime
Adhesive
Bonding to Zirconia
Short/Tapered, Non-retentive Zr Crown adhesively bond with Resin Cement
Universal Primer
• Can be used with Self-Etch, Total-Etch or Selective Etch techniques
• Compatible with Light-cured, Dual-cured & Self-cured resin cements, composites or core materials
• Universal adhesive for direct & indirect bonding procedures
16
Universal Primer
• Advantages– Contains MDP-long term stable bonds
– Does not need to be light cured-posts
– Low film thickness (5 microns)
– Excellent bond strengths
Universal Primer
Z-Prime Plus (Surface Primer)
• Phosphate Monomer (MDP), BPDM, Et OH
• Indications– Zirconia (LAVA, Cercon, Implant)
– Alumina (Procera)
– Metal (Titanium, Non-Precious, Semi-precious, High Noble)
– Composite Indirect
– Endodontic Posts (Zirconia, Fiber, Metal)
– Intra-oral repairs
Bonding Zirconia CrownsTreatment of Zirconia Surface
MDP to Zirconia
Addition Reaction
Zirconia
Bond Strengths to Intaglio Surface*
*Data from Bisco 96
Phosphates contaminate Zr surface
• Saliva contains phosphates that tie up receptor sites