All-Ceramic Restorations

Types of All-Porcelain Restorations | Minimal Prep Porcelain Restorations | Materials Used in All-Porcelain Restorations | Benefits of All-Porcelain Restorations | Limits of All-Porcelain Restorations | Value of a Cosmetically Trained Lab Technician

All-Porcelain (All-Ceramic) Restorations

All-Porcelain Restorations by Dr. Prus

As patients have become more conscious of how their smiles affect those around them, they have demanded higher and higher quality restorations to create the smile that is ideal for them. Each person has different visions of themselves and aspirations for their smiles. In effect, they want their smiles to match their styles. Dr. Prus has been a leading cosmetic dentist since his earliest days in Manhattan. As his patient videos state, he will work tirelessly in coordinating treatment with each patient to help them realize the smile of their dreams while simultaneously create a mouth that is healthy, durable and comfortable so that their combined efforts can yield a lifetime of smiles.

Dental aesthetics is not a one and done procedure. It involves thought, skill, an attitude of determination, and a cohesive and cooperative effort on every person's part, the dentist, the lab technician and the patient, to achieve the best result. All must perform at the top of their game to ensure long-lasting, beautiful smiles.

All-ceramic restorations have improved to the point where they are almost replacing the old standard in dentistry, the porcelain fused to metal crown, which has existed for many decades.The advancement of dental bonding has been at the forefront of this change in cosmetic dentistry, and Dr. Prus has worked since its earliest days with some of the leading research authorities to help create the processes we commonly use today. Each type of restoration and type of material has its appropriate place in dental care.

Types of All-Porcelain Restorations:

There are four main types of all-porcelain restorations:

Crowns: these cover the entire tooth
Inlays: restorations that fit into a pre-shaped space cut into a tooth
Onlays: restorations that fit like an inlay in a tooth, plus cover over other parts of the tooth but not as much as a crown
Veneers: replace the front surface of a tooth to change its appearance

Minimal Prep Porcelain Restorations

What is 'minimal prep' and what are the benefits and risks of it? Minimal prep is a concept recently pioneered in all-ceramic dentistry that involves the least amount of removal of tooth structure to achieve a final restoration that is both strong and beautiful. In the front of the mouth this was marketed as Lumineers. It is sometimes possible to achieve the desired aesthetic result with no tooth cutting. That would theoretically allow the patient to remove the veneer and return the tooth to its original form and structure. In practice that almost never happens. The no-cut approach can only be applied in specific situations and requires a highly skilled ceramist to create the aesthetic veneer in dimensions as thin as 1/3rd mm. Improperly designed ultra-thin veneers can cause chronic gingival irritation and gum disease. Dr. Prus prefers to have his master ceramist hand craft all his minimal prep casework to ensure the best fit and longest functional life.

Ultra-thin restorations can also be applied in the back of the mouth in specific situations. They are best suited for mouths that are badly worn down but still retain enough enamel to bond to. For more information on the process of rebuilding a mouth with minimal prep restorations follow the link to the Full Mouth Reconstructive Dentistry page.

 

Materials Used in All-Porcelain Restorations

Feldspathic Porcelain: no strengthening core

• This type of porcelain exhibits the most translucent, life-like features.
• It has been in use for decades and technicians know how to bring out the best characteristics of life-like aesthetics.
• They cannot be used on darkly stained teeth without an added opaque base to block the unwanted color.
• Lowest strength; cannot be used on posterior teeth.
• Bonds well to teeth

Zirconium core: a pressable ceramic (heated and pressed into a mold or form); can be layered with feldspathic porcelain.

• Much stronger than Feldspathic but less aesthetic, especially pure zirconium core material, which is very opaque. It can block unwanted tooth color due to its opacity. Two levels of core translucency.
• Porcelain can be layered over the zirconium core but it does not bond well to it and can separate under adverse conditions.
• It is very hard and resists breakage; can be designed to be very thin yet stay strong.
• Its hardness reduces its bond strength to teeth.
• It is designed not by hand but by computer programs. Fit is dependent on the accuracy of the program and the program operator. This makes it a favorite amongst many lab technicians.
• The reduced labor fabrication costs generally reduces cost to the patient.
• Any irregularity in fit will stress the brittle material increasing the potential for fracture of the brittle material over time.
• They cannot be repaired when they break; they must be replaced.

Lithium Di-Silicate (E-Max): a pressable ceramic but more aesthetic than zirconium; can be layered with feldspathic porcelain.

• It is stronger than Feldspathic but not as strong as Zirconium.
• E-Max is very aesthetic with less opacity than zirconium. Two levels of pressable core translucency.
• Can be layered over pressable: making it fairly strong and very aesthetic.
• Requires greater thickness and is best when bonded to enamel but bond well to dentin.
• Layered-pressable ceramic requires greater skills from technician to maximize aesthetics.
• They can be repaired under certain circumstances.

Benefits of All-Porcelain Restorations

All-porcelain restorations are preferred in many cosmetic situations:

• They allow the most light into the tooth, preventing unsightly dark margins at gingival edge of crown; seen as the black line near the gums.
• They can be blended to match existing tooth structure and become ‘invisible'.
• All-porcelain crowns can be invisible even when the gums recede exposing the margins. This is a big plus with high smile lines.
• They allow for easy, early detection and repair of decay (initially seen as staining at the margin). Less visible with metal crowns./li>
• Because they are bonded to tooth structure, they seal out bacteria well, protecting the pulp.

Limits of All-Porcelain Restorations

• All-porcelain crowns may be less strong than porcelain fused to metal crowns (PFM). New pressable all-ceramic crowns show equal strength to PFM crowns
• Because of their lower strength (equal to normal biting forces), Lithium DiSilicate (E-Max), must be placed precisely and must be thicker to prevent fracture. This requires more tooth structure to be remove to accomplish it.
• If the natural tooth is very dark, all-porcelain crowns cannot totally mask the color (tetracycline stains) without being very opaque. Thus PFM crowns are preferred in such situations. PFM crowns can be made very aesthetic because they use feldspathic porcelain.
• All-ceramic crowns with zirconium or alumina cores are harder to cement with long-term results. The cores are ‘diamond’ hard and resin cements do not adhere as well.

It is very difficult to repair all-porcelain restorations when they break. In order to last for a long term, especially on back chewing surfaces, proper bite alignment is VIP.

 

Value of a Cosmetically Trained Lab Technician

Throughout his many years in Manhattan Dr. Prus cultivated relationships with many of the top ceramist technicians in the country. While CDE is located conveniently in the Hudson Valley, Dr. Prus teams it up with the same fine cosmetic dental labs to create the ideal smile that suits your style perfectly and naturally, in balance with your facial appearance, and distinctive in its beauty. This harmony comes from a true understanding, both from the dentist as well as the lab ceramist, to be aware of the important roles of tooth shape, texture, position, size and color in creating the blended harmony that becomes your beautiful smile. The art of your smile is all in the details. See the ceramic artwork examples below.

The outstanding feature of these beautiful cosmetic, all-porcelain restorations is the naturalness of their appearance. The artistic styling of these aesthetic restorations is the result of careful planning, thorough communications with both the patient and the ceramist to know exactly what they want and need, and the lab ceramist's skills to create that dream by skillfully blending layers of porcelain with light and color. In the end you will feel happier, healthier, sexier and enjoy the comfort of your beautiful smile for years.

Aesthetically trained lab technician case: the young man came in with the front broken veneer previously made by a cosmetic specialist in Manhattan. The artwork was not a good match to his natural teeth, which had severe enamel decalcifications and discolorations. The patient specifically requested to have the front two teeth match his other teeth. He did not want to change any other teeth. Dr. Prus used his master ceramic technician to create an invisible restoration that was harmonious and in balance with the decalcifications on his natural teeth.

As always, the quality of the ceramic lab technician determines the final aesthetic outcome, no matter which porcelain option is chosen.

Poor lab craftsmanship: flat color, poor coordination between doctor, lab and patient results in bad smiles

Carefully designed cases show effective communication between dentist and ceramist to create harmony and attractive aesthetic smiles.