IPS Empress: a standard of excellence.

For 10 years, clinicians have been able to provide patients with a proven aesthetic and functional restoration that exhibits wear-compatibility, durability, and marginal integrity. This leucite-reinforced, pressed ceramic (IPS Empress, Ivoclar Williams, Amherst, NY) presents to patients and dentists the option of a metal-free alternative which retains the functional advantages of a porcelain-fused-to-metal restoration. This article illustrates the importance of sound laboratory communication in the utilization of this restorative material, focusing upon three aspects: midline and incisal edge inclination, elimination of open gingival embrasures, and incisal edge translucency. Techniques are also presented in order to efficiently communicate details of each case presented to the laboratory.

Placement protocol for an anterior fiber-reinforced composite restoration.

The new classification of metal-free restorative materials provides the clinician with a durable, flexible, and aesthetic laboratory-fabricated alternative to conventional porcelain-fused-to-metal (PFM) full-coverage crowns, inlay and onlay restorations, and single pontic bridges. With exceptional physical and optical characteristics, restorations fabricated utilizing the new ceramic optimized polymer (Ceromer) (Targis, Ivoclar Williams, Amherst, NY) and fiber-reinforced composite (FRC) framework (Vectris, Ivoclar Williams, Amherst, NY) materials can also be utilized predictably in the anterior segment. The success of metal-free restorations can be achieved by following conventional prosthodontic principles for preparation, cementation, and finishing. This article demonstrates the appropriate treatment protocol in order to achieve aesthetically acceptable and durable anterior results utilizing a metal-free restorative system for "Maryland-like" bridge restorations.

Optimizing form and function with the direct posterior composite resin: a case report.

The acceptance of mercury-containing restorative materials has declined, and the demand for amalgam substitutes has resulted in development of a variety of composite resins. Microhybrids are the newest generation of composite resins, and they incorporate particles of different sizes to maximize wear, polishability, and handling characteristics. The learning objective of this article is to present a technique to maximize form, function, and aesthetics in the placement of a posterior composite resin restoration. Shade selection, use of caries indicator, "total etch" technique, new generation bonding agent, and incremental resin placement are discussed. A step-by-step case presentation demonstrates that an appropriately placed direct posterior composite resin provides an excellent alternative to the traditional metal-colored restorations.

Porcelain veneers: optimizing esthetics while reestablishing canine guidance.

Porcelain veneers have become an important treatment modality in most clinicians' armamentarium. Their proven reliability for correcting otherwise unesthetic situations, such as diastemas, malalignment, or misshapen or discolored teeth, combined with their conservative preparation requirements, have made porcelain veneers popular. The use of porcelain veneers to correct occlusal deficiencies or to reestablish the correct guidance during excursive movements is often overlooked. This article describes the use of porcelain laminate veneers to combine optimal esthetics with the establishment of a more favorable occlusal balance.

Use of bondable reinforcement fiber for post and core build-up in an endodontically treated tooth: maximizing strength and aesthetics.

Post/core placements in endodontically treated teeth are utilized as a means to retain a core or foundation for the final restoration. The question of whether a post placed in an endodontically treated tooth actually increases its strength is still being debated. Prefabricated metal posts have been used in most clinical situations in the past. Due to the reflection of metal through the remaining tooth structure, these posts present some concerns involving aesthetics. To address these concerns, this article presents a method of post fabrication using a bondable reinforcement fiber as the dowel post material. The learning objective of this article is to introduce this new post fabrication technique along with the materials utilized. A clinical case is used to present the technique.

Porcelain jacket crowns: diagnostic try-ins for optimal aesthetics.

All-ceramic restorations have gained patient acceptance and are increasingly utilized in aesthetic appearance-related restorations. This case report describes the utilization of a leucite-reinforced porcelain to fabricate all-porcelain crowns for maxillary anterior restorations for functional and aesthetic improvement. This particular porcelain system was selected for its high tensile strength, fracture resistance, and excellent marginal adaptation. The new generation adhesive agents combined with highly filled resin luting cements allow the clinicians to create an integral unit between the restoration and the natural tooth. This bond provides high compressive strength and low microleakage. The preparation procedure, the fabrication of tooth-colored wax crowns, the wax try-in procedure, and the laboratory technique of all-porcelain crown fabrication are discussed in detail, using intraoral photographs of the case to illustrate each applicable procedure. The learning objective of this article is to share the knowledge of all-porcelain restoration principles and application and to provide a detailed description and illustration of each clinical procedure.

Provipont & Provilink. Maximizing aesthetics and function when fabricating provisional restorations.

Only a few decades ago, the use and fabrication of provisional restorations was still a neglected area of restorative dentistry. Recently, a new recognition has been given to the importance of provisional restoration--maintenance of space for the tooth being, restored, acceptable interim aesthetics, cover against bacterial infiltration, and the registration of vital information for the fabrication of final restorations. This two-part article presents the clinical procedures for the utilization of provisional restorations in the anterior area and in inlay/onlay preparations.

Maximizing aesthetics of debilitated maxillary central incisors: a clinical case.

With the advent of true "adhesive dentistry," practitioners have at their disposal new multi-purpose adhesive agents which bond to most dental substrates. These new adhesives have a high affinity for roughened or "microetched" surfaces, penetrating and wetting the surfaces to increase the bonding strength. The improved adhesion has altered treatment plans from previous years and has enabled clinicians to practice more constructive dentistry and replace only defective or missing tooth structure. The objective of this article is to present a case report to illustrate the utilization of one of the new bonding agents in an especially difficult clinical situation.

Repair of Class IV fractures utilizing resin and porcelain.

The utilization of a highly-filled microhybrid composite resin, followed by a porcelain veneer, to achieve conservative aesthetic restorations in the treatment of large Class IV fractures is presented in this paper. Indications, contraindications, case selection, and clinical procedure are discussed; four cases are used to illustrate. The learning objective of this article is to enhance the knowledge of restorative options and procedures available.