INDIRECT TOOTH-COLORED RESTORATION Flashcards by Love Dog

restoration fabricated outside the mouth

INDIRECT TOOTH-COLORED RESTORATION

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INDIRECT TOOTH-COLORED RESTORATION is a chairside computer aided manufacturing (CAD/CAM)

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INDIRECT TOOTH-COLORED RESTORATION INDICATIONS:

relates to a combination of esthetic demands and restoration size:

o esthetics
o large defects or previous restorations
o economics

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One of the ADVANTAGES of INDIRECT TOOTH-COLORED RESTORATION is it reduced polymerization shrinkage

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CAD/CAM doesn’t require 2 appointments

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INDIRECT TOOTH-COLORED RESTORATION

CONTRAINDICATIONS:

ability to maintain a dry field

(inability to maintain a dry field)

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INDIRECT TOOTH-COLORED RESTORATION

ceramics are chemically inert

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DISADVANTAGES of INDIRECT TOOTH-COLORED RESTORATION

→ technique sensitivity
→ short clinical track record

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INDIRECT COMPOSITE INLAYS AND ONLAYS

the physical properties of composite restorations are improved when the composite is free of voids, and the resin matrix is maximally polymerized

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physical and mechanical properties matching enamel than composites

ceramics

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excellent wear resistance and a coefficient of thermal
expansion close to tooth structure

ceramics

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made from finely ground ceramic powders + distilled water or a special liquid

A. feldspathic porcelain
B. hot pressed ceramics
C. lithium disilicate
D. CAD/CAM

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fired and fused together to form a translucent material that looks like tooth structure

A. feldspathic porcelain
B. hot pressed ceramics
C. lithium disilicate
D. CAD/CAM

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dental laboratories fabricate the inlay/onlay by firing dental porcelains on refractory dies

A. feldspathic porcelain
B. hot pressed ceramics
C. lithium disilicate
D. CAD/CAM

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FABRICATION STEPS of FELDSPATHIC PORCELAIN

(1) Application of Spacer
(2) Application of Separator
(3) Application of Ceramage Flow
(4) Build-Up of Dentin or Body
(5) Build-Up of Enamel
(6) Finishing and Polishing

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in feldspathic porcelain, there is _____ shrinkage instead of polymerization shrinkage

sintering

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discovery of “glass ceramics”

1968

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Year

o were stronger, had a higher melting point than noncrystalline glass and had variable coefficients of thermal expansion

o developed for cookware and other heat-resistant products

1968

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Year where PRESSED GLASS-CERAMICS

Dicor (Dentsply International) patented and became a
popular ceramic for dental restorations

o disadvantage of Dicor is its translucency necessitating
external shade application

1984

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hot pressed ceramics are not significantly stronger than fired feldspathic porcelains, but they provide better clinical service

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FABRICATION STEPS

HOT PRESSED GLASS-CERAMICS

1-5

At approximately 1100 C, the ceramic ingot becomes plastic and is slowly pressed into the mold by an automated mechanism

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FABRICATION STEPS

HOT PRESSED GLASS-CERAMICS

1-5

After tooth preparation, make an impression, and pour a working cast of die stone. A wax pattern of the restoration is made using conventional techniques

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FABRICATION STEPS

HOT PRESSED GLASS-CERAMICS

1-5

After spruing, investing, and wax pattern burnout, a shaded ceramic ingot and aluminum oxide plunger are placed into a special furnace

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FABRICATION STEPS

HOT PRESSED GLASS-CERAMICS

1-5

After being separated from the mold, the restoration is seated on the master die and working cast for final adjustments and finishing

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FABRICATION STEPS HOT PRESSED GLASS-CERAMICS 1-5 To reproduce the tooth shade accurately, a heavily pigmented surface stain is typically applied

DISADVANTAGE → still fragile until cemented but are stronger than porcelain inlays made on refractory dies

HOT PRESSED GLASS-CERAMICS

ADVANTAGES → like traditional “wax-up” processes → excellent marginal fit → relatively high strength → surface hardness and occlusal wear are like enamel

HOT PRESSED GLASS-CERAMICS

available in both pressed and machinable forms A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

moderately high-strength glass ceramic → also used for full crowns or ultra-thin veneers A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

also used for full crowns or ultra-thin veneers A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

expensive laboratory-based units A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

can fabricate ceramic inlays/onlays from high-quality ceramics in a matter of minutes A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

first commercially available CAD/CAM system o rapid chairside design and fabrication of ceramic restorations A. CEREC system B. CERED 3D C. E4D D. A and b E. B and c

CEREC system

most popular recently A. CEREC system B. CERED 3D C. E4D D. A and b E. B and c

COMPUTER-AIDED DESIGN/COMPUTER-ASSISTED MANUFACTURING (CAD/CAM) FABRICATION STEPS 1-5 Dentist prepares the tooth and uses a scanning device to collect information about the shape of the preparation and its relationship with the surrounding structures (optical impression)

COMPUTER-AIDED DESIGN/COMPUTER-ASSISTED MANUFACTURING (CAD/CAM) FABRICATION STEPS 1-5 A video image of the prepared tooth is displayed to ensure proper positioning of the scanning device. To measure the height and depth of the preparation, CEREC systems use: - optical techniques of Moire fringe displacement - active triangulation

COMPUTER-AIDED DESIGN/COMPUTER-ASSISTED MANUFACTURING (CAD/CAM) FABRICATION STEPS 1-5 The system projects an image of the preparation and surrounding structures on a monitor to use the CAD portion of the system to design the restoration. The operator must input or confirm some of the boundaries of the restoration (position of the gingival margins)

COMPUTER-AIDED DESIGN/COMPUTER-ASSISTED MANUFACTURING (CAD/CAM) FABRICATION STEPS 1-5 When the restoration has been designed, the computer directs a micromilling device (CAM portion), which mills the restoration out of ceramic or composite blocks in minutes

COMPUTER-AIDED DESIGN/COMPUTER-ASSISTED MANUFACTURING (CAD/CAM) FABRICATION STEPS 1-5 The restoration is removed from the milling device, ready for try-in, contouring, cementation, and polishing

→ designed for chairside use and in the laboratory → chairside use eliminates need for conventional impression, temporary restoration and multiple appointments A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

DISADVANTAGES → high initial cost → need for extra training A. feldspathic porcelain B. hot pressed ceramics C. lithium disilicate D. CAD/CAM

T/f if necessary, restored walls to nearly ideal form with a light-cured glass ionomer liner/base or a composite restorative material

What instrument to use to o creates gingivo-occlusally divergent facial and lingual walls for passive insertion and removal of the restoration o rounded junction of sides and tip to avoid creating a sharp, stress-inducing internal angles

tapered carbide bur or diamond with rounded junction of sides and tip

T/f TOOTH PREPARATION DESIGN all margins = 80 butt-joint cavosurface angle o ensures marginal strength of the restoration

False all margins = 90 butt-joint cavosurface angle o ensures marginal strength of the restoration

external and internal line and point angles = __ A. rounded B. Staright

T/f Gingivo-Occlusal Divergence > 1-5 degrees per wall compared to cast metal

False > 2-5 degrees per wall compared to cast metal

Occlusal Step mm

1.5 - 2.0 mm deep

Isthmus mm?

at least 2.0 mm

T/f Facial and Lingual Walls requires undercuts

False (no undercuts)

T/f Pulpal Floor needs to be smooth and relatively flat

Facial, Lingual, and Gingival Margins of Proximal Boxes extended by at least ____ mm to clear the adjacent tooth

0.5 mm

T/f Gingival Margin, extended as minimally as possible

T/f portion of facial and lingual surface is carious or defective , extend the preparation with a gingival shoulder around the transitional line angle

when extending through or along cuspal inclines to reach sound tooth o extension is ____or greater than the distance from any primary groove to the cusp tip → cusp is capped o reduce 1.5 - 2.0 mm and should have 90 cavosurface angle

2⁄3

T/f when capping centric holding cusps = prepare a shoulder to move the facial or lingual cavosurface margin away from any possible contact with the opposing tooth, either in maximum intercuspal position or during functional movements

T/f axial wall of resulting shoulder must be sufficiently shallow to allow for adequate thickness of the restorative material

False axial wall of resulting shoulder must be sufficiently DEEP to allow for adequate thickness of the restorative material

T/f axial wall of resulting shoulder must have the same path of draw as the main portion of the preparation

T/f AP line angle is rounded to: -reduce stress concentrations -avoid seating errors

IMPRESSION → an elastomeric or ____ impression of the prepared tooth and the adjacent teeth and interocclusal records o allows the restoration to be fabricated on a working cast in the laboratory → with chairside CAD/CAM systems, no working cast necessary

optical

T/f In PROVISIONAL RESTORATION use of a noneugenol temporary cement is recommended

PROVISIONAL RESTORATION avoid bonding the temporary material to the preparation at this phase o ____ applied if resin-based material was used to block out undercuts and level the walls of the preparation

lubricant

T/f In CAD/CAM no provisional restoration done, needs an optical impression

T/f ABOUT CAD/CAM prepare the tooth, fabricate an inlay, and deliver it in approximately 1 hour

T/f preparations for CAD/CAM inlays must reflect the capabilities of the CAD software and hardware and the CAM milling devices that fabricate the restorations

T/f TRY-IN AND BONDING → delay occlusal evaluation and adjustment until after restoration is bonded o to avoid fracture of the restoration

T/f evaluate fit of inlay/onlay o use light pressure

T/f if restoration doesn’t seat completely = overcontoured proximal

T/f thin dental floss through contact → reveals tightness and position of proximal contact

helps identify overly tight proximal contacts

articulating paper

to adjust proximal contour and contact relationship

abrasive discs and points

polishing of proximal surfaces o will be inaccessible for polishing after cementation

finer grits of abrasive instruments

slight contour excesses removed o use _________ instruments or 30-fluted carbide finishing burs o marginal adjustment done after bonding of restoration to avoid marginal fractures

fine-grit diamond

chairside through brief application of _____% HF - time depends on type of ceramic used (2 mins for some)

5-10

after etching, treat ceramic with a ___ coupling agent o facilitates chemical bonding of resin cement

silane

Instrument to use mix dual-cured resin cement and insert into the preparation and coated on internal surfaces of the restoration

o use paddle-shaped instrument or a syringe

Instrument for seat restoration

ball burnisher with slight vibrating motion

INSTRUMENTATION FOR FINISHING AND POLISHING CERAMIC RESTORATIONS 1-4 medium-grit to fine-grit diamond rotary instrument

INSTRUMENTATION FOR FINISHING AND POLISHING CERAMIC RESTORATIONS 1-4 30-fluted carbide burs

INSTRUMENTATION FOR FINISHING AND POLISHING CERAMIC RESTORATIONS 1-4 sequence of rubber, abrasive-impregnated porcelain polishing points

INSTRUMENTATION FOR FINISHING AND POLISHING CERAMIC RESTORATIONS 1-4 diamond polishing paste