Anterior Esthetic Techniques & Materials Lee Ann Brady DMD www.pinterest.com Lee Ann Brady www.leeannbrady.com www.restorativenation.com Planning Information Tooth Position Arrangement Contour Color Material Selection Cored : A central core covered with a dissimilar material Monolithic : uniform in structure or composition throughout
Material Selection Cored : Metal Ceramic Zirconia Lithium Disilicate Alumina Monolithic : Stacked Ceramic Pressed Lithium Dislicate Zirconia Hand Stacked Ceramic Must Be Bonded for Strength 70-100 MPa Opaque layer possible Etch with 5% Hydrofluoric 1-2 mins Pressed or Milled Ceramic Must Be Bonded for Strength 90-120 MPa Alters Shade One or Two Tabs Etch 5% Hydrofluoric for 1-2 mins Ceramics By Pressed or Milled Lithium Disilicate Must Be Bonded for Retention 360-400 MPa Multiple Opacity Ingots Etch with 5% Hydrofluoric for 20s Ceramics By
Class Four Fractures Increase Reduction as you roll over incisal Repair with opaque Composite Restore with Hand Stacked glass Full Coverage Monolithic Hand Stacked Pressed Ceramic Milled Ceramic Pressed Lithium Disilicate Milled Lithium Disilicate.8-1mm Reduction Bond for Strength or Retention Not ideal for Color Masking Etch Internal Surface Full Coverage Monolithic Full Coverage Cored Metal Ceramic Captek Lithium Disilicate Zirconia Alumina
Strength of Hand Stacked Glass With or Without a Core: 70-100 MPA flexural Strength at the Incisal Edge Strength of Pressed Glass With or Without a Core: 90-120 MPA flexural Strength at the incisal edge If Strength is a Concern Monolithic Lithium Dislicate, Stained Only: 360-400 MPA flexural Strength at the incisal edge Natural Esthetics Thin enamel, thick dentin, high chroma Thick enamel, thick dentin, moderate chroma All enamel, high translucency
Material Selection Prep Color Tooth Reduction Final Color Material Properties Mixed Restorations Use the same layering material on all of the restorations Mixed Restorations Have adequate reduction on crown preps for core, dentin layer and equal thickness of layering porcelain Mixed Restorations If altering color seat the veneers and wait two weeks to finish crowns
Minimal Preparation Over-contoured Cervicals Challenging Fabrication Minimal Color Change Challenging Provisionals Challenging to Seat.3mm.5mm.7mm Conventional Preparation.5mm Moderate Color Change Dentin at Cervical Third Margins at Gingival Crest.7mm.9mm 2.0mm Extensive Preparation.8mm Depends on Dentin Bonding Subgingival Margins Contour Impacts Gingival Health Loss of Natural Tooth Structure 1.0mm 1.2mm 2.5mm Lingual Margins Ease of Seating Wear Facets Centric Contact Retention Form Resistance Form
Interproximal Margins Interproximal Caries Class Three Restorations Open Gingival Embrasures Contour Change Color Change Preparation Procedure Mock-Up Prep Guides Incisal Reduction Labial & Lingual Reduction Margins Refinement Bite Records Tissue Management Tissue Management Retraction Impression Trays Materials Tissue Management Old Restorations Time Provisionals Medicaments
Retraction Retraction Cord Retraction Paste Lasers Material Selection Cemented: Metal Ceramic Zirconia Lithium Disilicate Alumina Bonded : Stacked Ceramic Pressed Lithium Disilicate Resin Reinforced Glass Ionomer No bonding agent required Use with all restorations where bonding is not necessary for strength or retention SE SP Resin Cement No Bonding Agent Required Use with Restorations where bonding is not required
Porcelain Conditioning Etch Glass with Hydrofluoric Acid Lithium Disilicate: 5% x 20 secs Pressed: 5% x 60-120 secs Rinse & Dry Porcelain Cleaning Ivoclean for 30 secs Rinse Thoroughly Dry Thoroughly www.leeannbrady.com Total Etch 30-40% Phosphoric Acid 25 Sec on Enamel 15 Sec on Dentin Self Etch 10% Maleic Acid Acidic Monomers Etching combined with primer or primer & resin
Light Cured Resin Cement Bonding agent required Use with all ceramic restorations where light can pass through easily and cement color stability is critical Dual Cured Resin Cement Bonding agent required Use with all ceramic restorations where light can t pass through easily and cement color stability is not critical Cementation Sequence Try In Verify Cement Shade Clean Ceramics Silanate Ceramics Dry Ceramics Etch Teeth Apply Teflon Tape Dentin Adhesive Veneer Cement Seat/Tack Clean Excess Glycerin Final Cure/Clean Cementation Sequence
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