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An Esthetic Alternative in Full-Coverage Restorations An Esthetic Alternative in Full-Coverage Restorations

Author(s):

Sergio Rubinstein, DDS;Alan J. Nidetz, DDS

Date Added:

1/11/2004


Summary:

All too often, restorative dentists are faced with the dilemma of not being able to provide the ceramist the optimal space for maximum esthetics. The reasons are numerous, yet the problem still remains. The dental industry, along with the dental laboratory industry, has developed numerous full-coverage restorative options to obtain maximum esthetics. These include, but are not limited to, feldsphatic porcelain crowns or porcelain jacket crowns, In-Ceram (Vita Zahnfabrik; Distributor, Vident) and its derivatives, Procera (Nobel Biocare USA, Inc), IPS Empress I & II (Ivoclar Vivadent, Inc), and the old standard, porcelain-fused-tometal. Understanding the advantages and disadvantages of each product or technique intertwined with the patient’s esthetic dilemma and desires will help the dentist make the correct decision to achieve the desired goal. Regardless of the technique or materials used, an evaluation of the patient’s occlusion can help determine the restoration’s success or failure. Two main techniques are available to retain full-coverage restorations (ie, cemented or bonded). Each one has inherent advantages and disadvantages such as ease of cementation and/or retentive strength. The Captek (Captek: A Division of Precious Chemicals, Inc) crown has emerged as a unique porcelain-fused-to-highgold restoration, which enhances the vitality of baked-on porcelains yielding a pleasant esthetic result. These restorations do not require as much tooth reduction as is necessary for all-ceramic restorations. Additionally, it is important to note the Captek crown offers favorable biocompatibility for the soft tissue as well as a reinforced gold-platinum-palladium coping for strength, while using conventional cementation techniques. Ceramic systems offer esthetic advantages such as a nonmetal substructure coping and display and an excellent marginal fit. However, a core with sufficient strength requires a more aggressive tooth preparation than is necessary for a conventional crown, beginning with a tooth with no sharp edges. Empress can be too translucent of a choice because of susceptibility to chemically assisted, slow-crack growth induced by moisture, thus making the system strength insufficient to resist high-occlusal stresses occurring in cyclic fatigue loading in the molar region. The Zirconia-based systems offer exceptional strength, but its opacity can create some masking problems in attempting to achieve the desired esthetics and translucency, especially when space is limited. Although porcelain laminates are significantly more conservative and reinforce the tooth, the quality and quantity of the remaining enamel and dentin that will support these restorations and the occlusal loading forces they will be under must be considered in determining if they are to withstand them long term.

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