Emerging Esthetics of All Ceramic Restorations

INTRODUCTION

All ceramic inlays , onlays , venners and crown are some of most esthetically pleasing prosthodontic restorations.As there is no metal to block the light transmission, they can resemble normal tooth structure better in terms of normal color and translucency than any other restorative option.

Restorations today are largely required as a result of trauma, decay, gum disease and aesthetics. The esthetics being a more recent area of high demand and one in which ceramic materials play a large role. Dr Charles Land made the first ceramic crown way back in 1903 . But the popularity of ceramics declined with the intoduction of resin in the 1940’s .Traditionally , ceramic crowns have been made on platinum matrix and were referred to as porcelain jacket crowns. Due to recent advances like high strength ceramics, glass ceramics and adhesives for bonding the ceramic restoration to tooth structure, have led to the resurgence of interest in all ceramic resorations.

Indications for all ceramic restorations

• Esthetics : ceramics are considered the best in mimicking the natural tooth appearance.
• In patients with high smile line.
• In cases of fluorosis and amelogenesis imperfecta.
• In cases of intrinsic stains .
• Endodontically treated post and core teeth.
• Favourable distibution of occlusal load.

Contraindications of all ceramic restorations:

• Limited interocclusal distance : in cases of short clinical crowns, deep overbite, or with a super erupted opposing tooth.
• Heavy occlusal forces : Due to the brittle nature of the material and its abrasive potential, ceramic restorations should be avoided in patients with parafunctional habits
• High caries index
• Insufficient coronal tooth structure for support.
• Bruxism.

This article describes a series of four case reports highlighting the emerging esthetics of all ceramic restorations in full veeneer crown and laminates.

CASE REPORT 1

A 18 yr old female patient reported to the department of prosthodontics with chief complaint of missing anterior mandibular tooth i.r.t 41 and esthetics was her prime concern . Case history was taken and IOPA with OPG was done for diagnostic purpose. It was diagnosed as a congenitally missing tooth and implant was the

Fig.1 Pre operative view

Fig.2 Tooth preparation i.r.t 31

treatment of choice. After CBCT of the concerned edentulous space it was found that the space was insufficient for implant placement. Then it was planned for all ceramic full venner fixed prosthesis with cantilever pontic for replacing the missing tooth. Tooth preparation i.r.t to 31 was done and cantilever prosthesis was fabricated.

Fig.3 Post-operative view

CASE REPORT 2

A 19 yr old female patient reported to the department of prosthodontics with chief complaint of missing anterior maxillary tooth i.r.t 21 . Case history was taken and IOPA of the adjacent abutment tooth i.e 11 and 22 were taken. As the treatment option of

Fig 1 Pre operative view

Fig.2 Tooth preparation 11 and 22

implant was ruled out as treatment time was lengthy.So, all ceramic full veneer fixed prosthesis was planned.Tooth preparation i. r.t 11 and 22 was done. All ceramic fixed prosthesis was fabricated and delievered.

Fig.3 Post operative view

CASE REPORT 3

A 48 yr old female patient reported to the department of prosthodontics with chief complaint of overerupted maxillary tooth i.r.t 21 . Case history was taken and IOPA of the tooth was taken . As ethetics was a prime concern all ceramic full veneer fixed prosthesis

Fig.1 Pre operative view

was planned.Tooth preparation i. r.t 21 was done. All ceramic fixed prosthesis was fabricated and delievered.

Fig.2 Tooth preparation done 21

Fig .3 Post operative view

CASE REPORT 4

A 29 yr old Male patient reported to the department of prosthodontics with chief complaint of discolored maxillary tooth i.r.t 21and 22 . Case history was taken and IOPA of the tooth was taken . As ethetics was a prime concern all ceramic full veneer fixed prosthesis was planned.Tooth preparation i. r.t 21and 22 was done. All ceramic fixed prosthesis was fabricated and delievered.

Fig .1 Pre operative view

Fig. 2 Tooth preparation done i.r.t 21 and 22

Fig. 3 Post operative view

DISCUSSION

The restoration of missing or discolored teeth is a psychological need of patient. All Ceramic restorations have revolutionized the dentistry, as they are most esthetic restoration having a color and translucency near to that of natural teeth. Recent advances in ceramics has led to evolution of new ceramic products like Castable Glass ceramics like mica based, lithia based , Slip-cast ceramics i.e. alumina based and .Machinable ceramics like Cerec system and Celay system which have got excellent marginal fit and excellent flexural strength.

CONCLUSION

Most of the all ceramic restorations require a optimum reduction of tooth structure to restore optimum health and function. As there are wide variety of ceramic products available in practice, proper selection of material , will give good esthetics and function which becomes important. Clinical results are promising as seen in the case reports.