Clinical management of vital and non-vital discolored tooth preparation stump shades: A clinical case series.

OBJECTIVE: Traditional and modern-day laboratory techniques can be used to mask vital and non-vital discolored teeth. CLINICAL CONSIDERATIONS: Two clinical case reports are presented showing different treatment approaches to differing clinical scenarios of partial coverage veneer and full coverage crown restorations, respectively. CONCLUSIONS: Feldspathic ceramics should be considered when customization of stump shade correction and equalization is required with minimum facial reduction with veneer restorations. Translucent zirconia (5 mol% Y2 O3 ) can be used to mask metal posts and core restorations on non-vital teeth using an opaquer material that is infused into the intaglio surface in the green state. CLINICAL SIGNIFICANCE: Different clinical scenarios will present to the clinician in regard to discolored stump shades where understanding what laboratory material treatment options are available that will help guide definitive restoration types and ultimately tooth preparation design.

Managing restorative space, color matching, and tooth replacement with a novel implant through interdisciplinary treatment: A case report of partial anodontia and malformed teeth in the esthetic zone.

A case report of tooth agenesis and excessive intraarch space due to tooth size discrepancies and malformed teeth is presented. Interdisciplinary treatment including orthodontics, implant surgery, prosthodontics, and laboratory fabrication with dissimilar restoration and material types was used to accomplish an esthetic and functional outcome. Proper diagnosis of individual tooth width and proportion were key elements in treatment. CLINICAL SIGNIFICANCE: Knowledge and understanding of the relationships of the mandibular to maxillary anterior teeth and shade management of dissimilar restoration types will allow the interdisciplinary team to achieve the desired esthetic restorative result.

Using glass-graded zirconia to increase delamination growth resistance in porcelain/zirconia dental structures.

OBJECTIVE: Porcelain fused to zirconia (PFZ) restorations are widely used in prosthetic dentistry. However, their tendency to delaminate along the P/Z interface remains a practical problem so that assessing and improving the interfacial strength are important design aspects. This work examines the effect of modifying the zirconia veneering surface with an in-house felspathic glass on the interfacial fracture resistance of fused P/Z. METHODS: Three material systems are studied: porcelain fused to zirconia (control) and porcelain fused to glass-graded zirconia with and without the presence of a glass interlayer. The specimens were loaded in a four-point-bend fixture with the porcelain veneer in tension. The evolution of damage is followed with the aid of a video camera. The interfacial fracture energy GC was determined with the aid of a FEA, taking into account the stress shielding effects due to the presence of adjacent channel cracks. RESULTS: Similarly to a previous study on PFZ specimens, the fracture sequence consisted of unstable growth of channel cracks in the veneer followed by stable cracking along the P/Z interface. However, the value of GC for the graded zirconia was approximately 3 times that of the control zirconia, which is due to the good adhesion between porcelain and the glass network structure on the zirconia surface. SIGNIFICANCE: Combined with its improved bonding to resin-based cements, increased resistance to surface damage and good esthetic quality, graded zirconia emerges as a viable material concept for dental restorations.

Ceramic Veneers With Gingiva-Shaded Porcelain to Replace Lost Interdental Papillae: A Case Report.

With implant-supported reconstructions, gingiva-shaded pink-colored restorative materials serve as an option for replacing both hard and soft tissues cosmetically. This article presents a case report describing restorative treatment for a patient who requested individual crowns and veneers after she had had multiple surgical interventions to replace a failing implant tooth No. 9. In addition to replacement of the implant prosthesis, this case involved restorative papillae reconstruction that was performed to treat interdental recession that had occurred after the surgeries. A beveled slip-joint concept was used whereby the flat plane approximating porcelain surfaces would not be visible from the frontal perspective, resulting in an esthetic-appearing restoration.

Color matching strategies for non-vital discolored teeth: part 2. In-vivo bleaching options for discolored teeth preparations.

UNLABELLED: The following is a case report exemplifying the esthetic restorative and correction of a discolored substrate of a non-vital maxillary right lateral and central incisor tooth. Frequently, clinicians are presented with discolored teeth preparations after removal of a restoration and face difficult decision-making strategies in regards to materials selection, tooth preparation depth, and design. Part 2 will discuss the diagnosis and clinical bleaching treatment options when restoring non-vital discolored substrate preparations. The key is to know when such techniques should and can be applied with the associated esthetic clinical results. CLINICAL SIGNIFICANCE: Esthetic restorative correction of discolored teeth preparations can be clinically managed with an understanding of non-vital bleaching concepts and techniques along with the associated risks and rewards.

Color-matching strategies for non-vital discolored teeth: part 1. Laboratory ceramic veneer fabrication solutions.

UNLABELLED: The following is a case report exemplifying the restorative and esthetic correction of a discolored stump shade of a non-vital tooth maxillary left central incisor tooth. Treatment options are non-vital bleaching of the root canal-treated tooth or esthetic restoration through an understanding of color and layered ceramics, where the latter was employed. Proper shade communication as well as additional facial tooth preparation and reduction are key clinical requirements in order to allow the ceramist adequate room to affect a color change without sacrificing translucency or vitality of the definitive restorations. CLINICAL SIGNIFICANCE: Esthetic restorative correction of a discolored stump tooth shade can be managed with an understanding of color, shade communication, proper tooth preparation, and ceramic layering techniques.

A novel prosthetic device and method for guided tissue preservation of immediate postextraction socket implants.

Preservation of the surrounding hard and soft tissues associated with an immediate postextraction socket implant to replace a nonrestorable tooth in the esthetic zone is one of the greatest challenges facing the dental team. Several studies have documented the biologic and esthetic benefits of bone graft containment with either a custom healing abutment or provisional restoration. Use of a prefabricated shell that replicates the extracted tooth at the cervical region can help achieve guided tissue preservation and sustainable esthetic outcomes in an easy, simple, consistent, and less time consuming way. The following case report of a hopeless maxillary right central incisor in a female patient possessing adjacent teeth with a thin periodontal phenotype illustrates this new treatment device, method, and concept.

On the interfacial fracture of porcelain/zirconia and graded zirconia dental structures.

Porcelain fused to zirconia (PFZ) restorations are widely used in prosthetic dentistry. However, their susceptibility to fracture remains a practical problem. The failure of PFZ prostheses often involves crack initiation and growth in the porcelain, which may be followed by fracture along the porcelain/zirconia (P/Z) interface. In this work, we characterized the process of fracture in two PFZ systems, as well as a newly developed graded glass-zirconia structure with emphases placed on resistance to interfacial cracking. Thin porcelain layers were fused onto Y-TZP plates with or without the presence of a glass binder. The specimens were loaded in a four-point-bending fixture with the thin porcelain veneer in tension, simulating the lower portion of the connectors and marginal areas of a fixed dental prosthesis (FDP) during occlusal loading. The evolution of damage was observed by a video camera. The fracture was characterized by unstable growth of cracks perpendicular to the P/Z interface (channel cracks) in the porcelain layer, which was followed by stable cracking along the P/Z interface. The interfacial fracture energy GC was determined by a finite-element analysis taking into account stress-shielding effects due to the presence of adjacent channel cracks. The resulting GC was considerably less than commonly reported values for similar systems. Fracture in the graded Y-TZP samples occurred via a single channel crack at a much greater stress than for PFZ. No delamination between the residual glass layer and graded zirconia occurred in any of the tests. Combined with its enhanced resistance to edge chipping and good esthetic quality, graded Y-TZP emerges as a viable material concept for dental restorations.