Professional Documents
Culture Documents
Piis0002817714634644 PDF
Piis0002817714634644 PDF
crown or bridge restorations, while they can use highly translucent ceramic that makes changing
translucent materials for full-coverage or more color difficult with these restorations also allows
conservative partial-coverage bonded restora- them to have invisible supragingival margins.15,18
tions. We can best summarize these differences as This allows conservative margin preparation
esthetic but weaker versus stronger but more short of the proximal contact or incisal edge and
opaque, a dichotomy that drives the process of helps maintain gingival health.
selecting all-ceramic materials.12
Restorative needs. Dentists should base DENTIN AND ENAMEL REPLACEMENT
their choice of material on the requirements of As desirable as the conservative nature of enamel
the tooth being restored. For purposes of sim- replacement restorations may be, many teeth
plicity, we can group restorations into four major simply cannot be treated minimally. Situations
categories: porcelain laminate veneer restorations involving large interproximal restorations, tooth
that replace primarily enamel, partial-coverage malposition, tooth discoloration, wear or fractures
restorations that replace enamel and dentin, con- may require a restoration that involves the
ventional complete crowns that cover acceptably removal of more tooth structure but does not
colored dentin, and complete crowns that cover necessitate a conventional complete-coverage
discolored dentin or metal posts that must be crown. When the clinician must replace both
masked. dentin and enamel but will not alter the occlusion
or color, translucent ceramics still are the
PARTIAL ENAMEL REPLACEMENT materials of choice, because of their excellent
The most conservative of all indirect restorations enamellike appearance and ability to be bonded to
essentially replace enamel with minimal, if any, natural tooth structure.
preparation into dentin. These restorations are
useful when the overall tooth color is pleasing COMPLETE CROWN AND ACCEPTABLY
COLORED DENTIN
and the restorative goal is to place a new, more
pleasing external surface on the tooth without In general, the reasons to use an all-ceramic,
changing the tooth color significantly.13,14 Because complete-coverage crown for an anterior tooth
the enamel thickness of a natural tooth varies include replacement of an existing crown; the
from 0.4 millimeters on the facial aspect in the tooth structurally requires that the lingual sur-
cervical one-third to 0.8 to 1.0 mm on the facial face be prepared; the occlusion requires a signifi-
aspect in the incisal one-third, true enamel cant change so that lingual coverage is needed;
replacement restorations typically are 0.3 to and large proximal areas of decay are present or
0.5 mm thick and require minimal preparation.15 the patient has pre-existing restorations. This is
In general, some tooth preparation is desirable to the one restoration for which clinicians may find
allow for ideal cervical emergence contours.16,17 it difficult to decide whether to use translucent
Because of the ceramic thickness needed for materials or opaque, layered materials, because
enamel replacement restorations, dentists should both may work equally well. In general, the deci-
use only translucent unlayered materials. sion will be based on the need for high strength
In addition to the low possibility of pulpal irri- owing to the lack of anterior guidance or the pres-
tation, margin placement is another advantage of ence of parafunctional habits, the amount of tooth
enamel replacement restorations. The ultrathin, reduction required, the laboratory’s preference