Over the last few decades, porcelain-fused to-metal has been a proven choice of restorative material in
dentistry. Correctly produced restorations have been in the mouth for over 20-30 years and improved
materials and techniques could produce a restoration as natural as any other material on the market today.
Pressable Ceramics have long been a favorite choice ofcosmetic application, first with Procera and now with
Zirconia.

Although some materials have inherent advantages overothers, right techniques and proper communication
between clinician, patient and technician are the most important ingredients forachieving aesthetic excellence.

Modern dentistry requires not only new technologies and treatment methods but also modern products that are geared towards the needs of today’s market. Products that have been utilized to meet the same demands for many years have to be assessed according to new criteria.

Pre-fabricated denture teeth, for example, are used for new fields of application, eg in implantology. Pre-fabricated composite teeth are basically divided into two categories: PMMA-based pre-fabricated denture teeth have been available for many years and mainly cover the market for removable dental prosthetics. With the arrival of Condyloform® II NFC from Candulor (Wangen, Switzerland) and SR Phonares NHC from Ivoclar Vivadent (Schaan, Liechtenstein), the second generation of compositebased teeth has been launched.

If a close look at the requirements of dental implant prosthetics is taken, the differences to conventional tooth
replacements are clearly evident. The chewing forces measured in implant-borne dental prostheses are eight to ten times higher than those recorded in tooth-supported restorations.

In my first article, The Beauty of Simplicity-Part 1, I discussed the techniques of laminate veneers. As a continuation I will now discuss more complex cases that combine crowns and laminates. As dental technicians, we routinely encounter cases that include crowns and laminates in the same mouth—these are the most challenging cases. They require working with two different preparations, often a laminate and a crown, next to each other.

In this article, I will discuss two different cases: the first, involves the two upper central incisors (#9 an existing crown), the second case involves four upper incisors and a lower single crown, for a patient who was demanding a more beautiful smile. Over the years I have explored numerous techniques. The most valuable lesson that I have learned is to always use the same porcelain material. Using the same material will provide you with the freedom and flexibility to build-up a beautiful restoration working with the same model. For example, if I build a laminate of a refractory model it would be time consuming and much more labor intensive. The techniques that I employ, only require pouring the model once. There are no extra steps, for example, such as duplicating models or pouring refractory materials.

Possibilities Today s world of dental ceramics is filled with ceramic systems, each seeming to have a place in the industry, and each enjoying a certain degree of success. Although they all claim to be organized systems, only one truly is.

The VM System from Vita is the only system that is organized with equally spaced shades based on actual dental color space (3D Master System) (Figs. A & B), and is accurately and consistently supported by all VM materials. Regardless of the VM material used,the results are consistent, and throughout the VM System when two shades are mixed in equal amounts it always results in a shade predictably and exactly between the two original shades (3D shades only).

The fact that the VM System is the only ceramic system that is accurately based on the 3D Shade system, the logical conclusion is that the VM System is the only ceramic system that is actually a system. All of the other so called systems have never proven themselves to be logical systems at all. The VM System offers complete measurable shade predictability. When one considers the wide assortment of specialty powders that support the system, the aesthetic possibilities are unlimited.

Introduction

Today minimally invasive restorations are increasingly used in both the anterior and posterior sectors, and so with great respect for the dental substance that has been lost (Fig. 1). Thanks to our knowledge of tooth anatomy (Fig. 2) and of the materials that companies supply us with, we manage to correct and restore enamel and dentin parts so that they look like natural teeth. In our daily practice we try to treat each patient individually, seeking to harmonize the balance between face, lips, and teeth [1][2].

Treatment plan

The patient was a young woman (Fig. 3) who when she presented at the dental practice was dissatisfied with her old composite restorations on elements 11-12 as they were infiltrated and discolored, and she wanted to correct the diastemas in the anterior sectors (Figs. 4 and 5). After a careful clinical anamnesis of the patient had found a generally positive situation, Dr. Marco Furri (Lazise, Verona) suggested orthodontic treatment to close the spaces between elements 11-21, 11-12, 12-13 and 12-22, 22-23, and following the conclusion of the orthodontic treatment, two indirect restorations on elements 11-21 [3].

In the author’s opinion the involvement of the dental technician is indispensable in the management of both simple and complex cases since dental technicians have experience of using systems and materials that will help the therapy be successful.

With all the great systems available for high strength ceramic production, today’s challenge is to choose the one that fits our needs best.

I selected a system that can supply the majority of my all-ceramic coping and framework needs simply and cost effectively in my own lab. The ELC-One electrophoresis processor provides a great alternative for high strength ceramic production (Fig. 1). This direct layering system can produce Vita InCeram Alumina and Zirconia Hybrid ceramic single and 3-unit bridge copings and frameworks for a fraction of the cost of milling, 3D printing, or rapid prototyping. Computer aided design (CAD) excels when we want to make an item hundreds or thousands of times as we can use one set of parameters over and over. In dentistry every die is different and needs individual parameters, which requires scanning. A positive build-up process like electrophoresis layering forms restorative material onto the actual die; instantly producing individual custom forms without the time and cost of scanning.

Introduction

The development of a unique integrated ceramic system (Ceramco iC, Dentsply Prosthetics, York PA) offers a single set of materials to fabricate porcelain fused-to-metal, press-to-metal and all-ceramic restorations. However, few restoration types are as challengingor as rewarding – as pressed and veneered anterior all-ceramics. In this case, Juergen Gebhardt, MDT, discusses a natural restoration using Ceramco iC pressable all-ceramics.

Introduction

Zirconia made a significant appearance on the dental horizon about 5 years ago. It provided an alternative for all ceramic crowns and bridges. Today, a milling procedure is the only reliable way to create zirconia restorative components for dental use. The availability of computer numerical controlled machines (CNC) allows for highly automated end-to-end component design using computer aided design and computer aided manufacture (CAD/CAM) programs. The programs produce a computer file that is interpreted to extract the commands needed to operate a particular machine, and then loaded into the CNC machines for production of the restoration coping or framework. There is also the possibility of producing the same results with an analogue copy-mill system. CNC manufacturing processes still have certain limitations with regards to all the possible ways that zirconia can be used for dental restorations. However, in the near future these limitations will disappear due the advancement of digital technologies and zirconia materials.

The innumerable technologies providing prosthetic solutions available on the market that can now be offered to patients as a matter of routine greatly increase the range of successful large and small prosthetic reconstructions. In our opinion, however, standardized and repeatable “planning” of an operational prosthetic protocol remains fundamental, with the main aim being a treatment that is predictable, aesthetic, and functional.

This article explains the main phases in a dental technique for manufacturing esthetic reconstructions that integrate with the natural dental elements, a technique supported by an effective universally applicable schematized protocol. The marriage of the ceramic material and the technique used by the dental technician to apply the ceramic is clearly fundamentally important to achieving a successful reconstruction (that is, knowledge of the ceramic material used combined with the standardized and repeatable stratification technique illustrated).

Ceramic glass is a new esthetic material in which a larger amount of dispersion of light takes place inside the ceramic even in the presence of a metallic substructure. The esthetics of prosthetic restorations has improved considerably thanks to these materials. The author illustrates his results in three case studies.

Introduction

The perfect chromatic integration of a ceramic prosthetic restoration is one of the most difficult projects undertaken by dentists and dental technicians, especially if restoring individual elements. There is often the impression of a certain amount of “static chromaticity” when a ceramic tooth is positioned between two natural teeth that reveals the difference between the esthetic dental material and the natural tooth.

The internal structure of teeth permits the diffusion and dispersion of light inside them, and this characteristic gives a tooth subject to a source of illumination innumerable nuances and colors thereby generating the typical optical phenomena of natural teeth such as opalescence, transparency, and fluorescence (Figs. 1 to 3).

The highly demanding and manually skilled casting procedure is still the most widely-used forming process for metal and ceramic used in dental technology, due to its individuality and range of materials. The investments are the key material in this dental technology manufacturing process, and the process of managing their expansion is highly complex.

Every user has his own experiences of working with investments as a material, and develops a functioning laboratory process by means of which acceptable results are maintained. Unsatisfactory quality of casting is a repeated occurrence, however, since the requirements specified by the investment manufacturers cannot always be maintained consistently in the dental laboratory. These requirements are:
• dry and vibration-free storage of the investment powder
• controlling the temperature of water/ liquid and/or investment powder
• constant processing temperature
• precise dosing of all components.

All-ceramic restorations have become an indispensable part of the dental repertoire for sophisticated and aesthetic dental restorations. All-ceramic materials help realize the promise of aesthetic dentistry. All-ceramic abutments are the next step toward perfection in this area. In this article, the author presents an anterior reconstruction using an all-ceramic crown on a custom-milled Straumann CARES abutment, demonstrating the aesthetic potential of these materials.