5. metal ceramic restoration
TRANSCRIPT
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TOOTH PREPARATION FOR METAL
CERAMIC CROWNS
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METAL CERAMIC RESTORATION
- Combines the strength and accurate
fit of a cast restoration with the
cosmetic effect of a ceramic crown.
- With the metal understructure,
metal-ceramic restorations
have greater strength than
restorations made ofceramic alone.
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Advantages
• Strength and stability provided by the underlying metal
• Esthetic having a nearly natural appearance
• Used in single units to bridges
•High rate of Long Term Success
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Disadvantages
• While cosmetic appearance is excellent, they are not asaesthetically pleasing as other types of crowns.
• Gingival inflammation causing gray line (due to metal) compared toporcelain crowns and Porcelain-Fused-to-Gold Crowns.Requires more of the tooth structure to be removed because of its
thickness.• The porcelain crown can chip or break off.
• The porcelain surface of the crown can significantly wear thoseteeth that bite against it.
• In cases where this type of crown has broken, it is generally the
layer of porcelain that has fractured off. This usually reveals themetal tooth substructure underneath, which is often gray inappearance.
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INDICATIONS
• The metal-ceramic crown is indicated on teeth that require
complete coverage, where significant esthetic demands are
placed on the dentist (e.g., the anterior teeth).
• It should be recognized, however, that, if esthetic
considerations are paramount, an all-ceramic crown has
distinct cosmetic advantages over the metal-ceramic
restoration; nevertheless, the metal-ceramic crown is more
durable than the all-ceramic crown and generally has superior
marginal fit.
• Furthermore, it can serve as a retainer for a fixed partial
denture because its metal substructure can accommodate
cast or soldered connectors.
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• Metal-ceramic crown may be successfully modified to
incorporate occlusal and cingulum rests as well as milled
proximal and reciprocal guide planes in its metal substructure
. Whereas the all-ceramic restoration cannot accommodate a
rest for a removable prosthesis.
• Typical indications - extensive tooth destruction as a result of
caries, trauma, or existing previous restorations that
precludes the use of a more conservative restoration
• Within certain limits this restoration can also be used tocorrect the occlusal plane.
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METAL-CERAMIC RESTORATION
Can be used in a wide
variety of situations
including the
replacement of missing
teeth with fpd’s.
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CONTRAINDICATIONS
- Contraindications for the metal-ceramic crown, as for all fixed
restorations, include patients with active caries or untreated
periodontal disease.
- In young patients with large pulp chambers, the metal-
ceramic crown is also contraindicated because of the high risk
of pulp exposure. If at all possible, a more conservative
restorative option such as a composite resin or porcelainlaminate veneer is preferred.
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- A metal-ceramic restoration should not be considered
whenever a more conservative retainer is feasible, unless
maximum retention is needed-as for a long-span FPD.
- If the facial wall is intact, the practitioner should decide
whether it is truly necessary to involve all axial surfaces of the
tooth in the proposed restoration. Although perhaps
technically more demanding and time consuming, a more
conservative solution usually can be found to satisfy the
patient's needs that may provide superior long-term service.
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ARMAMENTARIUM
1. LAB KNIFE WITH NO:25 BLADE
2. SILICONE PUTTY
3. FLAT – END TAPEREDDIAMOND
4. ROUND – END TAPEREDDIAMOND
5. SMALL WHEEL DAIMOND
6. LONG NEEDLE DAIMOND
7. RADIAL FISSURE BUR(ROUNDED SHOULDER)
8. MODIFIED BINANGLE CHISEL
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ANTERIOR METAL-CERAMIC CROWNS
Silicone index
made before
tooth
preparation
If the tooth badly is
broken down,
index made on waxed
up diagnostic cast.
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
Step no : 1
Placement of depthorientation grooves -
( 1.2mm ) the labial
grooves cut in two sets
1. one set parallel with thegingival half of labialsurface
2. one set parallel with theincisal half of labialsurface
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
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ANTERIOR METAL-CERAMIC CROWNS
To achieve adequatereduction withoutencroaching upon the pulp – facial surface prepared in
two planes that correspondroughly to the twogeometric planes presenton the facial surface of anuncut tooth
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
STEP NO : 2
Incisal reduction- (2mm)
with flat –end
tapered daimond.
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
Inadequate incisal reduction
results in poor incisal
translucency
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
STEP NO : 3
Labial reduction
(incisal half)
with flat - end
tapered daimond.
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
STEP NO :4
Labial reduction
(gingival half)
with flat-end
tapered daimond
to create shoulder finish
line.
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
STEP NO : 5
Lingual reduction
(0.7 -1mm )
using small wheel
daimond.
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
STEP NO :6
Initial proximal reductionUsing long needle
daimond
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
STEP NO : 7
Lingual axial
reduction
round - end
tapered daimond
(chamfer finish line)
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METAL-CERAMIC RESTORATION
Adequate reduction is
essential for achieving a
good esthetic
result.
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METAL-CERAMIC RESTORATION
Inadequate space for a
sufficient thickness of
ceramic material-
1. Poorly contoured
restoration affecting
both esthetic and health
of the surrounding
gingiva.
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ANTERIOR METAL-CERAMIC CROWNS
A uniform
reduction of
approximately
1.2- 1.5mm is needed
over the entire
facial surface.
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ANTERIOR METAL-CERAMIC CROWNS
If the facial surface is prepared in a
single plane that is an extension of the
gingival plane
– pulp exposure- overcontoured “block”
- Improper shade
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ANTERIOR METAL-CERAMIC CROWNS
Facial surface prepared in one
plane that has adequate facial
reduction in the incisal aspect
facial surface overtapered
and too close to the pulp.
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
IMPROVED ESTHETICS
ALL CERAMIC LABIAL
MARGIN
THIS ELIMINATES THE
METAL COLLAR AT THE
FACIOGINGIVAL MARGIN
OF THE FINISHED METAL-
CERAMIC RESTORATION
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ANTERIOR METAL-CERAMIC CROWN
PREPARATION
IMPROVED ESTHETICS
ALL CERAMIC LABIAL
MARGIN
THIS ELIMINATES THE
METAL COLLAR AT THE
FACIOGINGIVAL MARGIN
OF THE FINISHED METAL-
CERAMIC RESTORATION
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POSTERIOR METAL-CERAMIC CROWNS
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POSTERIOR METAL-CERAMIC CROWNS
STEP NO : 1
OCCLUSAL REDUCTION
FOLLOWED BY
FUNCTIONAL CUSP
BEVEL
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POSTERIOR METAL-CERAMIC CROWNS
STEP NO : 2
DEPTH ORIENTATIONGROOVES
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POSTERIOR METAL-CERAMIC CROWNS
STEP NO :3
FACIAL REDUCTION-
OCCLUSAL HALF
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POSTERIOR METAL-CERAMIC CROWN
STEP NO :4
FACIAL REDUCTION
GINGIVAL HALF
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POSTERIOR METAL-CERAMIC CROWN
STEP NO: 5
PROXIMAL
AXIAL
REDUCTION
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POSTERIOR METAL-CERAMIC CROWN
STEP NO :6
LINGUAL AXIAL
REDUCTION
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POSTERIOR METAL-CERAMIC CROWN
STEP NO : 7
AXIAL FINISHING
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POSTERIOR METAL-CERAMIC CROWN
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POSTERIOR METAL-CERAMIC CROWN
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References
• Contemporary fixed prosthodontics ; Rosensteil,
Lang,Fujimoto;3rd ed.
• Fundamental of fixed prosthodontics ; Shillingburg etal,3rded