34
35
Toward Reconciling the
Esthetic Potential of
Ceramo-Metal Restorations
with Established Criteria for
Soft Tissue Management
Pe(erA Weiss,
DMD.,
1353 HigWond Avenue
Needfiom, MA. 01293
To many practioners the terms
"biocompatible" and "esthetic" in
reference to ceramo-metal morgins
are mutually exclusive. With their
patient's non-negotionable demond
to "show no metal" still fresh in their
memory, restorative dentists regard
the periodontist's prescription for
supragingival morgins with puzzle-
ment, and pay lip service rather than
risk a confrontation with their patient.
Periodontists are understandably
frustrated when the tissue they have
nurtured and brought to perfection is
taken back to square one by retrac-
tion techniques and subgingivally
placed collars.
Metol ceramics has come of age. As
for OS esthetics are concerned, it
stands alone in tbe milieu of restora-
tive materials. The time has come to
make ceramo-metal restorotions far
more biocompatible both in execu-
tion and in situ, without sacrificing
their esthetic superiority. This task of
coinciding the esthetic potential of
porcelain with the established
requirements af the periodontal tis-
sues will be multifaceted, drawing
together innovative techniques and
ormamentaria from diverse areas.
Here is a preview of subjects we
shall cover in this series:
a) Routine fabrication of porcelain
margins.
bj Rendering electrosurgicol
retraction innocuous with a new tip
(Periotome regTM) which spares the
attachment and cementum.
c) Correcting margins on existing
ceramo-metal frameworks.
d) Biocompatible preparation and
impression techniques.
e) The role of temporization in
biocompatible metal ceramics.
36
f) Maintenonce form: an impot^ant
criterion for insuring long term home
core cooperation.
g) Retractionless reconstruction.
Parti
The Porceloin Margin
Perhaps nothing disappoints a pa-
tient more than to be presented with
an anterior bridge whose facial col-
lars are in full view, and whose
cervical areas exhibit a garish opa-
que show-through. It matters not
whether the collar is in a gold, semi-
precious or non-precious oiloy or
thot it is highly polished or 24K gold
plated. The angulotion and ovailable
light render it black in appeorance
and thoroughly obiectianable. Since
the errors which produce such a
result are cumulotive and originate
with the preparation, the "fix" is
rarely the correct one but frequently
consists of covering the collor with
porcelain. This creates an overcon-
tour in the worst possible place. It is
fig, I 7heprenirernicfel-
cfiramium olloy ollowed
O.I mm collars (o be fabrica-
axiomatic thot the collor cannot be
covered with porceloin.
Some practitioners, noting that mony
of their efforts toke this route, legiti-
mize it by octually prescribing these
"porcelain margins" on a routine
basis. Finally, some labarotories, eo-
ger to ovoid remakes, have institu-
tionolized a very unsound design,
A second common method of elimi-
nating the fociol collor from the pa-
tient's view is ta have it, but bury it in
tissue. Although biologically un-
sound, this misguided opprooch
forms the rationale for many dentists
to avoid periodontol referral in the
first place.
There have olso been many attempts
by conscientious operators to
address the problem ayer the years.
These legitimate attempts center
around various ways of producing a
porceloin margin. There are several
approaches, some dating back
twenty years and more. In the eor-
liest and still most frequently used
techniques, a hybrid design results.
ted routinely.
with a conventional lingual and
proximal configuration and the facial
margin rendered in porcelain, using
the porcelain ¡ocket fabrication tech-
niques. The separating medium con
be thin (0,0005"| platinum foil or gold
foil. Some technicians prefer a mare
direct appraoch, using only a sea-
lant and die lubricant. Lately, vorious
attempts to use refractory dies, thus
eliminating the need for removing
the restoration for firing, have been
described. All these methods require
extra steps and/or allow additional
entry points for errors.
Until two years ago we hod settled
upon a very simple solution: sub-
stituting a premier nickel-chromium
alloy* for gold we were able to
reduce the width of the collar to
0.1 mm (Fig. 1). Such G narrow collar
was quite easy to hide by insertion to
o depth of 0,5 mm in a healthy
sulcus. There was no question, how-
ever, that the ideal situation was a
porcelain morgin. Utilizing the
strength-at.'temperoture properties
 37

Figs. 2ond3 Bulletshaped

rote ry ins fiu rn e nis gsnero'e a
"deep chamfer' preparation

of the premier nickel-chramium oiloy,

we devised the following technique,
which has been in routine use in our
laboratory for two years.

Technique
1. A deep chomfer preparotion is
provided such as that produced with Fig. 4 The faciol margins
the Brassier RCB instrumentation aie woxed lo 0 I mm. A
bright, reHeclive die slone
(Figs. 2 and 3). helps to gauge Ihe wax thick-
lV
2. The lost 0.5 mm of fhe facial
margins are waxed to 0.1 mm. Use
of a reflective die stone (Super Die,
Whip Mix Co.) aids in gauging wax
thickness (Fig. A).
38

3. The cosf 0.1 mm margin ¡Figs. 5

ond 6) is reduced in thickness to
0.05 mm with a #8 carbide bur in an
oir turbine ¡Fig. 7|. A small disc is
then used to feather the end of the
margin to a knife edge ¡Fig. 8). This
procedure is best carried out with the
aid of magnificotion. A good pair of
3 diopter loupes is minimol Prefer-
red is a stereo working microscope
ot lOx t o 2 5 x ¡Fig. 9}.

Frg. 5 Mo'gms o/e cost to

Rg, 6 There is no limllalion

lo the number ol porcelain
morgin unils, since there is no
unsuQporled çorceloin
 39

Figure 7

figs. 7 (o 9 feathering (he

focról margrns is done under
magniricallon.

fulgure 9
40

Figure II figure 12

fios. ID (o 12 Thelîrttloyer
ofopoqus iS opplied so thai
(fie (hictnes! alter firing is 5ft.

figs. 13 and W The second

layer of opopje is applied
 41

4. The first loyer of opoque is 5. The second or covering coat of 6. The secand coat of opaque is
applied so that fhe thickness after opaque is applied (Figs. 13 and 14). beveled at the margin before firing
firing is 5 M (Figs. 10 to 12). An airbrush is preferred, but the (Figs. 15 and 16).
application can be done monually.

Figs. 15 ond )ó Before ínng

Jhe second opaque loyer, the
molen"a( isfeaWieredo( o 45°
ong(e (o Jhe margin.
42

7. The second opoque loyer is Fig. ?7 Alter ("ing, (he opo-

que thickness is O.I mm fe-
fired. Thickness is 0.1 mm feathering otfiering lo o knife edge with
the cosiing at the margin.
to a knife edge at the margin.
8. Body porcelain is applied as
usual, but the margins ore finished
with optical aid as in step #3
(Figs. 18 to 21).

Figs. )8to20 Sodfporre-

lain is applied as usual but is
feaiheredfo fhe motgin un-
Figure 1 der magnífico (ion
 43

ñg. 2T The ceramo-meh

sondwJch in cross-sd
44

Porcelain margins can be fabricated fig. 22 Even in Ihe su-

piogrngryol rnode, esfliedcs
on a routine basis in this manner. ore occeploble
Since there are no extra steps, accu-
racy is not compromised. There is no
limitation to the number of units in a
restoration since there is no unsup-
ported porcelain (Figs. 6 and 18).
The only deviation from our standord
technique is thot two steps are done
with the aid of magnification.
Insertions of these morgins 0.25 mm
into the sulcus produces a very
lifelike result (Figs. 23 to 25) but even
in the suprogingival mode esthetics
ore acceptable ¡Fig, 22). •

figs.23la25 Placedsllghr-
ly inio the sulcus, o lifelilie
restofadon resulls

Metolwork and graphics by Richord E. Mu-

nyon, ASME; Ceramics by Isomu
Hosegawa, CDT

premier nickel-chromium olbys: those

alloys characterized by great strength,
superior flow ond resistance lo oüidotion
Their composition is basically N¡, O, Mo, Figure 25
Be