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A case series
Daniel Edelhoff, CDT, Dr Med Dent, PhD; Oliver Brix, CDT
C
linicians use all-ceramic restorations
routinely in dentistry today. The
rapid rate of innovation with regard
to materials, computer-aided design/ Background. Encompassing a vast array of
computer-aided manufacturing (CAD/CAM) material.s, today's all-ceramic systems are suitable for a
technologies, and intraoral data acquisition large range of indications in almost all areas of fixed
systems has resulted in the need for dental restorative dentistry.
care professionals to familiarize themselves Methods. The authors describe five cUnical cases
with a large body of knowledge to make use involving different indications to illustrate the use of dif-
of the almost limitless possibilities that these ferent ceramic materials and combinations of materials.
systems offer. They describe the collaboration between the dentist and
Conventional steps, such as careful treat- dental technician for single-tooth restorations and for
ment planning in collaboration with the labo- complex cases, including all stages of the restorative
ratory technician, selection of appropriate procedures from treatment planning with an analjrtic
ceramic materials, and adequate tooth prepa-
wax-up to the selection of appropriate materials, tooth
ration and processing are essential to ensuring
the long-term survival of restorations. Fur- preparation and cementation.
thermore, rapid advances in material tech- Results. The patients described experienced signifi-
nology in the field of glass and oxide ceramics, cant functional and esthetic improvement, even those
as well as in adhesive technologies, have led to who had severely discolored teeth. This was possible
new treatment options that are refiected in an because the authors executed the working steps in a
extended range of indications and in less inva- strictly synchronized manner and selected the restora-
sive tooth preparation designs. All-ceramic tive materials carefully to meet the specific needs of
systems are suitable for a wide range of indi- each patient.
cations covering almost all areas of fixed Conclusions. All-ceramic systems have expanded the
restorative dentistry, and they encompass a range of restorative treatment options significantly; at
diverse range of materials. the same time, their handling has been simplified sub-
We present five cases ranging from place- stantially. The use of lithium disilicate glass-ceramic-
ment of veneer restorations to complex reha- and zirconium oxide-based frameworks along with an
bilitation to illustrate the scope of applica- identical veneering ceramic enables the dental care pro-
tions and procedures used to achieve success- fessional to cover almost all indications in fixed prostho-
ful outcomes with all-ceramic restorations. dontics while achieving the same esthetic results.
Close collaboration between the patient, den- Key Words. Lithium disilicate glass-ceramic; zirco-
tist and laboratory technician is paramount nium oxide; fiuorapatite veneering ceramic.
to define and achieve the treatment goals. An JADA 2011;142(4 suppl):14S-19S.
analytic wax-up, a diagnostic template
derived from the study wax-up and modifi-
able temporary restorations facilitated com- Dr. Edelhoff is an associate professor. Department of Prosthodontics. Ludwig-
Maximilians-University. Goethestrasse 70. D-80336 Munich. Germany, e-mail
munication, decision making and subsequent "daniel.edelhoff(a)med.uni-muenchen.de". Address reprint requests to Dr. Edelhoff.
preparation procedures. Mr. Brix is owner of Innovative Dental Design, Wiesbaden, Germany.
the basis of the wax-up, enabled the patient to watts per square centimeter, Ivoclar Vivadent)
obtain a first impression of the treatment goal. for the final cure. The patient's esthetic expecta-
The diagnostic template served as a guide tions were satisfied completely with reconstruc-
throughout treatment and as an orientation aid tion of the lost tooth structure (Figure 4C),
during preparation of the onlays, which the clini-
cian contoured in full anatomical shape by using REHABILITATION OF DENTINOCENESIS
a lithium disilicate glass-ceramic (IPS e,max IMPERFECTA WITH MONOLITHIC
Press, HT, with the staining technique) with a POSTERIOR CROWNS
minimum thickness of 1 mm (Figure 4B),*'As a Case 4. A 15-year-old boy visited his dentist
result, the dentist had to remove little tooth (D,E,) together with his parents hecause he
structure in accordance with the intended outer wished to have his severely discolored and mal-
contours of the restorations.' The dentist pre- formed teeth restored. He said that he was pain
pared all teeth and recorded the maxillomandib- free but complained about the severe social stress
ular relationship at the same appointment. that he felt because of the appearance of his teeth
The clinician fabricated the temporary resto- (Figure 5), After conducting an intraoral exami-
rations chairside with the help of the diagnostic nation and obtaining a medical history, the den-
template and a bisphenol A-glycidyl methacry- tist diagnosed the patient as having dentinogen-
late-based temporary restorative material esis imperfecta tj^je II (hereditary opalescent
(C&B Provilink, Ivoclar Vivadent [this product dentin). The specialist dental literature refers to
is no longer on the market; the authors now use the importance of early therapeutic intervention
Telio CS C&B, Ivoclar Vivadent]), In the pos- to stop the destruction of tooth structure and pre-
terior region, the minimally retentive tempo- vent the development of inadequate occlusal func-
rary onlays were left splinted. The clinician tion,** Some authors have described the use of all-
placed the temporary restorations with the use ceramic crowns as a possible restorative approach
ofa bonding agent (Heliobond, Ivoclar Vivadent) and have recommended adhesive cementation,'* '"
without any etching of the tooth structure. The challenge faced by the dental team in this
The clinician tried in the restorations with the case was the young age of the patient, who was
use of a tooth-colored glycerine gel (Try-In Paste, still growing, and his request for an immediate
Variolink II) to inspect their shape and shade. improvement in his oral condition. In addition,
He examined the marginal seal and checked the the dental team had to establish an appropriate
static and dynamic occlusal contacts carefully morphology of the teeth, adjust the VDO and
with the help of a low-viscosity silicone. ensure reliable retention of the restorations on
Before placing the glass-ceramic restorations, the damaged tooth structure.
the dentist etched their inner surfaces with Against such a background, a study wax-up
hydrofluoric acid (< 5 percent IPS Ceramic was created and evaluated with regard to
Etching Gel, Ivoclar Vivadent) for 20 seconds esthetics and function. On the basis of the wax-
and then conditioned them with silane up, the dental technician (O.B.) manufactured
(Monobond-S, Ivoclar Vivadent). The clinician full crowns composed of high-density polymer by
used Syntac Primer and Syntac Adhesive on the using CAD/CAM technology and seated them as
teeth. He placed all of the onlays by using a long-term ( 12 months' duration) temporary
single light-curing luting composite (Variolink II restorations.
Base, shade 110) and used a high-performance The clinician performed the final restorative
curing light (hluephase G2, with > 1,000 milli- procedures section by section, first in the max-