Choice of ceramic for use in treatments with porcelain laminate veneers

El tratamiento mediante Frentes Laminados de Porcelana (FLP) se utiliza desde hace más de dos décadas para el tratamiento de problemas estéticos y/o funcionales, particularmente en el grupo anterior de las arcadas dentarias (1,2,3). La actual oferta en el mercado de cerámicas dentales aptas para este tipo de tratamiento, pero muy distintas en cuanto a composición, características ópticas y sistema de elaboración, hace complicada la selección del material más adecuado a cada paciente en particular. Proponemos un sistema sencillo de elección de la cerámica teniendo en cuenta las dos variables que más influirán en el resultado estético final: de un lado las características propias del diente (sustrato en el que nos apoyamos), y de otro las características propias del material cerámico en cuanto a resistencia y propiedades ópticas

Influence of bruxism on survival of porcelain laminate veneers

Objectives: This study aims to determine whether bruxism and the use of occlusal splints affect the survival of porcelain laminate veneers in patients treated with this technique. Material and Methods: Restorations were made in 70 patients, including 30 patients with some type of parafunc - tional habit. A total of 323 veneers were placed, 170 in patients with bruxism activity, and the remaining 153 in patients without it. A clinical examination determined the presence or absence of ceramic failure (cracks, frac - tures and debonding) of the restorations; these incidents were analyzed for association with bruxism and the use of splints. Results: Analysis of the ceramic failures showed that of the 13 fractures and 29 debonding that were present in our study, 8 fractures and 22 debonding were related to the presence of bruxism. Conclusions: Porcelain laminate veneers are a predictable treatment option that provides excellent results, rec - ognizing a higher risk of failure in patients with bruxism activity. The use of occlusal splints reduces the risk of fractures

Post-fatigue fracture resistance of metal core crowns: press-on metal ceramic versus a conventional veneering system

Background: The aim of this in vitro study was to compare the mechanical failure behavior and to analyze fracture characteristics of metal ceramic crowns with two veneering systems – press-on metal (PoM) ceramic versus a conventional veneering system – subjected to static compressive loading. Material and Methods: Forty-six crowns were constructed and divided into two groups according to porcelain veneer manufacture. Group A: 23 metal copings with porcelain IPS-InLine veneering (conventional metal ceramic). Group B: 23 metal copings with IPS-InLine PoM veneering porcelain. After 120,000 fatigue cycles, the crowns were axially loaded to the moment of fracture with a universal testing machine. The fractured specimens were examined under optical stereomicroscopy and scanning electron microscope. Results: Fracture resistance values showed statistically significant differences (Student’s t-test) regarding the type of ceramic veneering technique ( p =0.001): Group A (conventional metal ceramics) obtained a mean fracture resistance of 1933.17 N, and Group B 1325.74N (Press-on metal ceramics). The most common type of fracture was adhesive failure (with metal exposure) ( p =0.000). Veneer porcelain fractured on the occlusal surface following a radial pattern. Conclusions: Metal ceramic crowns made of IPS InLine or IPS InLine PoM ceramics with different laboratory techniques all achieved above-average values for clinical survival in the oral environment according to ISO 6872. Crowns made with IPS InLine by conventional technique resisted fracture an average of 45% more than IPS InLine PoM fabricated with the press-on techniqu

Biologically oriented preparation technique (BOPT) for implant-supported fixed prostheses

A patient of 58 years of age without medical problems came to the clinic due to missing teeth in the upper posterior region and to change the partial fixed prosthesis in the upper anterior area. Proposed treatment: surgical phase of three conical shape tapering implants with prosthetic platform in occlusal direction with mechanize collar tissue level with fixtures to place implant-supported metal-ceramic restorations. In the anterior area, a zirconium oxide fixed partial prosthesis was vertical preparation of the tooth?s. When preparing teeth to receive fixed prostheses, the definition and shape of finish lines has been a subject of endless discussion, modification, and change ever since the beginnings of restorative prosthetic dentistry. The BOPT technique (biologically oriented preparation technique) was first described in the context of tooth-supported restorations but has recently been applied to dental implants with the aim of ensuring healthy peri-implant tissue and creating the possibility of modeling the peri-implant sulcus by modifying prosthetic emergence profiles. Vertical preparation of teeth and abutments without finish line on implants is a technique which was found to be adequate for ensuring the remodeling and stability of peri-implant tissues

Oral health-related quality of life of implant-supported overdentures versus conventional complete prostheses: retrospective study of a cohort of edentulous patients

Background: This work aims to confirm if implant-supported overdentures are a good treatment option for edentulous patients and offer an improvement in quality of life compared with traditional complete prostheses (dentures). Material and Methods: This retrospective clinical descriptive study included three evaluation groups: validation group (n=57); control group of patients with complete removeable prostheses (n=56); study group of patients with implant-supported overdentures retained with the Locator® system (n=80). The study also validated the Oral Health Impact Profile-20 questionnaire. Individual protocols were created that included socio-demographic data, the Oral Health Impact Profile-20 (OHIP-20) questionnaire and Oral Satisfaction Scale (OSS). Descriptive and bivariate statistical analysis was carried out applying χ², Pearson, Kruskal-Wallis, and Student t tests, transferring data into SPSS-Windows® software from a Microsoft® Excel spreadsheet. Results: The OHIP-20 proved to be a valid instrument and provided reliable assessment of health-related quality of life among both the Spanish general population and edentulous patients. The control and study groups proved comparable, showing socio-demographic homogeneity. For patients with overdentures retained by means of the Locator® system, these restorations had significantly lower impact on quality of life (19 vs 33), both generally and for each individual questionnaire item, and much higher satisfaction with the state of their oral cavities (8.3 vs 5.3) than patients wearing dentures; both sets of data showed a direct linear relationship, so that as the level of impact on quality of life increased, perceived oral satisfaction worsened. Conclusions: Patients rehabilitated with implant supported overdentures retained by the Locator® system, presented significantly lower levels of impact on their quality of life and significantly higher oral satisfaction than patients with conventional complete prostheses

Full maxillary rehabilitation with an all-ceramic system

With the appearance of all-ceramic systems, providing a choice of framework porcelains and allowing the same material to be used for the veneer, it is now possible to select the ideal structure in terms of both function and esthetics. Silicate ceramics allow porcelain laminate veneers and crowns to be used in the anterior region, providing excellent esthetics; while for the posterior area, where function takes precedence, oxide ceramics, specifically zirconium oxide, are preferred. The IPS e.max ceramic system, heir apparent to the IPS Empress 2 system, combines the advantages of zirconium oxide ceramics (IPS e.max Zircad) with the excellent esthetic qualities of silicate ceramics (IPS e.max Press). This paper presents a clinical case requiring complete maxillary rehabilitation for esthetic purposes. An overview of some of the porcelains used in this system, analyzed from both the clinical and laboratory perspective is provided. The esthetic advantages of a single ceramic veneer, the need to select appropriate ceramics for anterior and posterior regions, and cementation and surface treatments are discussed

A clinical longitudinal study 323 porcelain laminate veneers. Period of study from 3 to 11 years

Objective: The objective of this study was to evaluate the clinical results of 323 porcelain laminate veneers over a period of 3 to 11 years. Material and Methods: This study included 70 patients, aged between 18 and 74 years. Of the 323 total veneers, 124 were of a simple design and 199 were of a functional design. The condition of the soft tissues and hygiene, in addition to the condition of the abutment teeth, the restorations and patient satisfaction were all clinically examined. In carrying out the statistical analysis, a descriptive approach was taken in analyzing the data. The Kaplan Meier method was used for statistically analyzing the survival rates of the porcelain laminate veneers. Results: Analysis of the soft tissue revealed marginal recession in 7.7% of the cases, and in 21.6% of the cases, bleeding was detected on probing. Analysis of the condition of the abutment teeth revealed secondary caries and hypersensitivity in 3.1% of the cases, and changes in pulp vitality were observed in 2.8% of the cases. In studying the condition of the restorations, marginal integrity was observed to be excellent in 98% of the cases, slight marginal pigmentation was present in 39.3% of the cases, fractures were present in 4% of the cases and decementation in 9% of the cases. The degree of patient satisfaction was considered to be excellent in 97.1% of the cases. Conclusions: Porcelain laminate veneers are a predicable treatment option that offer excellent results

Effect of two whitening agents on the color of composite dental restorations

To evaluate color changes to composite resins used to restore extracted teeth compared with composite discs after whitening with two agents: hydrogen peroxide (HP) and carbamide peroxide (CP). Ten human molars with class V vestibular and palatine cavity preparation obturated with Vita hybrid nanocomposite were hemisected to obtain 20 specimens assigned randomly to two groups: O1 and O2. Twenty composite discs were divided into two groups: D1 and D2. The groups O1 and D1 were treated with 16% CP, while groups =2 and D2 were treated with 37.5 % HP. Chromaticity coordinates L*, a* and b* were registered using a spectrophotometer. Statistically significant differences were found in O1 for L* and a*, in O2 for all three coordinates, and in D1 and D2 only for L*. Comparisons between groups found significant differences in ?Ee (end of treatment) between O1 and O2, between O2 and D2, and between D1 and O1. Both whitening agents produced significant decreases in the three-color components of composites used for dental restorations, while color changes to composite discs were limited to changes in luminosity. HP produced a greater color change to composite dental restorations than to composite discs

Fractographic study of the behavior of different ceramic veneers on full coverage crowns in relation to supporting core materials

Objectives: To observe porcelain veneer behavior of zirconia and metal-ceramic full coverage crowns when subjected to compression testing, comparing zirconia cores to metal cores. Study Design: The porcelain fracture surfaces of 120 full coverage crowns (60 with a metal core and 60 with a zirconia core) subjected to static load (compression) testing were analyzed. Image analysis was performed using macroscopic processing with 8x and 12x enlargement. Five samples from each group were prepared and underwent scanning electron microscope (SEM) analysis in order to make a fractographic study of fracture propagation in the contact area and composition analysis in the most significant areas of the specimen. Results: Statistically significant differences in fracture type (cohesive or adhesive) were found between the metalceramic and zirconia groups: the incidence of adhesive fracture was seen to be greater in metal-ceramic groups (92%) and cohesive fracture was more frequent in zirconium oxide groups (72%). The fracture propagation pattern was on the periphery of the contact area in the full coverage crown restorations selected for fractographic study. Conclusions: The greater frequency of cohesive fracture in restorations with zirconia cores indicates that their behavior is inadequate compared to metal-ceramic restorations and that further research is needed to improve their clinical performance