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Ceramic veneers are one of thehottest topics in moderndentistry. The areas ofapplication are numerous, from pureaesthetics for front teeth - for exampleto close a diastema - passing by thepalatal parts to reconstruct a lostcanine guide, up to the occlusal parts
to restore or improve function andvertical dimension. In all casespreparation can be minimally invasive, making it possible to retainthe tooth substance and satisfy the
patient’s desire for treatment withoutcomplications and with little or nopain.
Our patient in this case happens to be one of my clients, a periodontist. From my own point of view, it is always gratifying to work on a dentist’s case. One of the reasons is because they provide me with whatever I need in terms of margin design and occlusion reduction. They understand what it takes to make the case look its best and they want to provide themselves with an esthetic restoration. They are, after all, advertising themselves as a dentist to their patients and this makes their own smile appearance important!
I’ve expanded my horizons lately when it comes to taking a patient’s shade. Rather than depending on traditional shade tabs, I have created other methods of matching the colors I record. This is because traditional shade tabs do not, in my opinion, equal natural teeth in color. They are simply a guide to the base shade we can start out with. The rest is up to me as a technician to document before I begin my work on the case.
One of the first things I noticed about this particular case was that the second premolar was tinted with blue, due to the amalgam filling inside. It did not match with the canine coloration which is white with a gray tinge. Also, the second premolar’s cervical 1/3 color is lighter than the cuspid’s. This meant that when blending the color with the adjacent teeth, I would have to consider the restoration’s position in the mouth and unify the color harmoniously to match with each of the neighboring teeth.
When working with natural teeth, the question of how penetrating light is altered inevitably arises. Light waves in and around natural teeth are physically influenced in different ways. The colour as well as the vital appearance of a tooth are the result of the volume of light which is reflected. This means that escaping light, after entering the body of the tooth, is partly thrown back, allowed to pass through, or reflected. It must be possible to use the light-optical variability which characterises natural teeth to contribute to our work in any way that it can.
A crown’s natural appearance can only be achieved from within, meaning that every nuance in colour must be integrated into the layering work. An appropriate layering technology in combination with a functional application technique opens up a whole new dimension to reconstructive porcelain work.
The Precision Build-up Technique was designed with three purposes in mind. The first, is to have a technique that would provide the ceramist with the ability to work to precise shape and contour with very little adjusting.
The second is to be able to control all the aspects of color regardless of the challenge. The third is to have a technique that is repeatable, and will fit all situations, thus making the fabrication of complex cases efficient and predictable. In order to do this, the ceramist must be in harmony with three very important concepts. The first comes from Albert Einstein and states that “ things should be made to be as simple as possible. But no simpler”. The second comes from Stephen Covey and states that we should always “ begin with the end in mind”. Donald Trump also said, “while you re focusing on the details, never lose sight of the big picture.” Although the last two may seem alike, they are very different. Stephen Covey’s quote is about how we should think when we begin our crown. In other words we need to define the result that we want before picking up a porcelain brush. Donald Trump’s quote reminds us that if we always keep the end in mind, we are more apt to keep our build-up in harmony with the end result. This quote has to do with the doing as opposed to the thought process. It actually ties the two together. When the ceramic technique is in harmony with these three statements and the techniques can be done repeatedly with precision, then it can be considered a viable technique.
One of the first things a technician must consider during custom shade matching is internal (prep) color. Dark color or a post core will especially need to be checked before making a material choice. Without this information we won’t be able to get a good custom shade match simply because we won’t know exactly what we are covering, and where. For instance, after preparation, the stump color may be variable at the gingival and incisal level, leading to different porcelain layering techniques for each segment of the crown.
Porcelain fused to metal (PFM) restorations are the most commonly used dental prosthetics. Other technologies, such as all-ceramic and CAD/CAM ceramics, are now finding increasing acceptance. However, their market share is still substantially less than PFM restorations. The technology for creating PFM restorations can be traced back to the pioneering work done by Widman in the 1830’s and subsequent major technological advances in the alloy and in the porcelain compositions beginning in the late 1960’s, have led to today’s modern restorations. The continued popularity of PFM restorations partially results from their ease of fabrication, their diversity of applications, their pleasing aesthetics, their renowned durability and their ease of installation by dentists using traditional cements, all without the need for expensive equipment or sophisticated technologies.
This clinical report demonstrates how a clinician can objectively overcome some of the barriers associated with providing patients with predictable esthetics, in a mutually satisfactory manner. Two such barriers are identified and discussed. The first is related to psychology and patient attitude to treatment. The second is related to the actual clinical procedure. A direct mock-up technique is described which serves as an effective communication tool between the dentist, patient, and the dental laboratory technician.
Historically, many authors have identified barriers for patients to receive and accept dental treatment.1-3 It has been suggested that the psychological status, as well as the patients’ attitude have bearing on the course of dental treatment.1-3 Recently, the American College of Prosthodontics (ACP) recommended the use of a classification system by McGarry et al4 for evaluating the difficulty in treating the dentate patient.4 In this classification system the occlusal scheme and state of the existing dentition have a bearing on perceived difficulty for dental treatment. A class I patient is ideal or minimally compromised in terms of difficulty to treat, while a class IV patient’s severely compromised. It is proposed that the psychological status of the patient can also affect perceived difficulty for dental treatment.
When discussing veneers, everyone understands that they are highly esthetic restorations. Ceramic veneers have become hugely popular in recent years and this is due, undoubtedly, to their excellent biochemical behavior and esthetics after bonding. With these traits and the minimal tooth preparation needed for success, it is no surprise that they are so popular. This article reviews the evolution of veneers and shows some first experiences with Empress Esthetic and e.max, new materials from Ivoclar.
For many years, teeth have been restored using the conventional refractory model technique. Without a doubt this technique has given, and does give great results. Yet, it still has its pros and cons:
• Length of time needed to prepare models.
• Slight loss of precision from duplicating methods.
• Precision loss from using removable models.
• Develops a highly esthetic and very thin restoration.
• Uses adhesive bonding technique.
• Controls shade and opacity of the teeth depending on the needs of each case.