PORCELAIN JACKET CROWNS AND ALL CERAMIC CROWNS Dr. Mausi N. Shirley _ -Definition + Ceramics are inorganic compounds formed of metallic or semi metallic and non-metallic elements, which are subjected to high treatment(firing) for a time period to achieve desirable properties + Ceramics produce superior aesthetics of all crown restorations. . They may also wear less + Anterior teeth are preferred due to aestheti compared to molars due to their function. + However these restorations are more susceptible to fracture due to being made entirely of ceramic which is a brittle substance.History + Ceramics use in dentistry dates as far back as 1889 when Charles H. Land designed the porcelain “jacket” crown by using high fusing feldspathic porcelain. + The first modern porcelain crowns were used in 1903. An improvement in fracture resistance of all porcelain crown was later reported by Mc Lean and Hughes in 1965 who introduced aluminous core ceramic. + The all-porcelain crown system, despite its esthetic advantages, failed to gain popularity due to its brittle nature & shrinkage. The introduction of a “shrink-free” all-ceramic crown system(Cerestore, Coors Biomedical) and a castable glass-ceramic crown system (Dicer, Dentsply/York Division, York) in the 1980s provided additional flexibility for achieving esthetic results, introduced advanced ceramics with innovative processing methods, and stimulated a renewed interest in all-ceramic crowns.In 1993, materials arrived that allowed skilled professionals to reach new heights of realism in dental ceramics. The first was Lucite- reinforced ceramic, a tooth-colored porcelain that improved strength. The Cerestore system gave dentists the ability to create dental crowns in the office using a solid block of dental porcelain. The system uses CAD/CAM to create a custom crown using an accurate fast milling unit. Cerestore means no need for an outside dental lab to complete, and less waiting time for the patient.Advantages of dental ceramics + Superior aesthetics, made of translucent porcelain, which reflects light and looks almost exactly like natural teeth blending with them. + Biocompatible + Long-term color stability + Wear resistance + Possibility of shade manipulation + High compressive strengthdisadvantages + Can be used as single restoration only + The least conservative restoration in terms of preparation + Brittle nature of material, (low tensile strength). + Reduced strength compared to metal ceramic crowns. + Wear of opposing teeth enamel « Fractured crowns cannot be repaired. + Expensiveindications + Discoloration e.g fluorosis, tetracycline staining,unfavorable Root canal treatment staining + Genetic dental defects like amelogenesis imperfecta. + Metal allergies. + Crowns for dental implants. + Instances where plastic restorations can not be retained in grossly carious teeth or fractured teeth + Bruxism,severe attrition of teeth. + Patient preferenceContraindications « Handicapped patients/patients with compromised medical condition + Severe mottled fluorosis due to brittle enamel which predisposes restoration to open margins. + Contact sports + Young patients due to large pulp chambers + Short clinical crowns where there's lack of enough vertical height to support incisal & facial surfaces of restoration. + Thin teeth faciolingually. + When superior strength is requiredTypes of dental ceramics + Porcelain jacket crowns + Aluminous porcelain + Aluminous reinforcement zirconia + Lithium disilicate IPS-E-Max If an all-ceramic crown is placed posteriorly, one made using zirconia would likely make the best choice due to the greater strength characteristics that this material offers.Requirements/principles Retention and resistance(taper,surface area, freedom of displacement) Adequate marginal integrity Structural durability Good cement retention Preservation of supporting tooth structure and periodontium Aesthetic consideration Relief of 50 um for luting cement Matching cote & thermal conductivity to enamel/dentine Stiffening without optically dense backgrounds Should not obscure pulp outline in radiograph Future ret scope Light transmission should approach that of dentine and enamel Surface quality (smooth )« The decision to make full coverage crowns should only be considered after a partial veneer has been considered unfavorable because of inadequate retention or aesthetics. + Thorough diagnosis to be done before crowns are considered.Preparation Criteria + 1 Criteria- Axial walls: Taper of the axial walls should result in a 6 degree taper. A taper of To degrees has been proposed as betag achievable clinically while still affording adequaté retention (Nordlander 1988, Weed 1980) 24 Criteria- Tooth structure reduction should be about 1.2- 2mm, 3! Criteria- Height of anatomical crown should be approx 2/3 of the tooth 4 Criteria- For anterior teeth, the Incisal edge of the final preparation should be flat and placed at a slight inclination toward the linguogingival to meet forces on the incisal edge and prevent shearing. 5‘ Criteria- Planar occlusal reduction should follow the occlusal morphology of the tooth 6 Criteria- Margins: Shoulder finish should be all round, Width of the shoulder should be 1,2-1.5mim wide to provide a flat seat to resist forces directed from incisal area,Fig. 1-3 To produce an optimal 6-degree taper. SrZonvergence angie. each opposing sal wal Should Rake an Unciviaios of P degrees to heTooth Preparation technique Requirements Rotary instruments : handpiece,burs Burs; Flat ended long tapered diamond no. 556 and 557 Small round bur No. 2 Straight fissure diamond bur Hatchet or chisel Small wheel diamond or bullet Retraction cord Cons tray Matrix bandVarious Diamond ShapesFig. 3-1 The three types of rotary instruments Used in tooth preparation are, left io night the di- lamand stone, the tungsten carbide bur, and the twist il Fig. 3-2 Thove five diamonds are part of the standard general inarument get usod Tor prep ing teeth for cast melal and. cerame testora tions, "They ate (eff to righ) the round-end ta ered diamond (056-010): the flatend tapered Siamona (@47-016)” the long: needle siamond (0006-012). the shortneeale amor (852. (012)"and the small ound-edge whe samen (09.040), Fig. 33. Tho concopt of diamend/bur dual in Einmentaton. fast developed by Lustig in Ns ACB sores: is based on Gamonds. and car Gis fare 04 modching sions and shapoe: Th torpedo diammend. 77-010)" and bur {282-010y" on the left ave part of the. orginal FCB kt. A fe-grt lame diamond (862-010) fn but (1401-070) ae seen on te rhTechnique: Labial preparation + Depth orientation grooves, 1.2-1.4mm deep are placed on labial and 2.0mm deep incisal surfaces with coarse grit flat end tapered diamond bur- 3 labial grooves cut parallel to gingival 1/3 of labial surface. 2 grooves parallel to incisal 2/3 of uncut labial surface. The area between the grooves is then reduced. The grooves are used to accurately gauge the depth of tooth reduction. + The labial surface preparation is done in 2 planes; gingival and incisal half to Sot adequate clearance for good esthetics without encroaching on the pulp. + The gingival portion of the labial surface is reduced to a depth of 1.2-1.4 mm. This reduction extends around the labio-proximal line angles and fades out on lingual aspect of the proximal surfaces.1.124, wan atom ng popes wos a rom ten sarc rr Failure to use biplanar facial reduction in anterior teeth results in insufficient space for porcelai pulpal exposure.‘shoulder Maral ey sonia any sta reduction es ams easance rte ana ene Sree ity eee Pounded anes Concave cngwumraustan Sa ‘Secu dayIncisal Reduction + Approximately 1.5 to 2.0 mm of tooth structure is removed. Tooth structure remaining between depth orientation grooves on incisal portion of labial surface is planed away. + Incisal reduced edge should be parallel to the original incisal edge and perpendicular to occlusal forces in anterior teeth. + Incisal bevel should be near 45 degrees to reduce stress at the shoulderAxial reduction + Extend the labial reduction to the proximal surface as far into contact area. + With a needle shaped bur cut the tooth structure in downward movement from incisal edge + Break the contact without damaging the adjacent tooth using the long needle diamond fissure bur. A matrix band can be used. + With the long tapered bur remove the tooth structure to achieve 6 degree taper,maximum of 16. + Extend to the lingual surface. + Precaution must be taken to avoid damaging the interdental papilla. The Id shoulder at interproximal line angles should not be dropped at the same level 2 | surface midpoint.Lingual Reduction + Concave cingulum reduction is done using football shaped diamond bur. + Depth grooves of 0.7-1mm.At least 3 are made using a round bur + Tooth structure between the grooves is removed + Reproduce the concave cingulum + Shoulder finish of 1mm and minimal taperMig, 3921 nquel reduction: svat whoo! cheFig, 443. Facil and ingual ai reducer tr petodarrend ty-4 pete mangoes cr ep raearaac ar Reread fae hove Sie seeoeh cepa Siirnarrab arms Ei oenors rem rte toe eboniae poe ee queen tan Selaeee tenet soagteiar petty s i afin i acer ali meranctoncs Samer eerene tartans EaartaeFig, 418 Tho faoal acs reaucion i cares ‘tat ae pomsble to merproual embsasutes steroulneng ne asic Fig. 416 nginx ecucten done win e'sare daond Secase othe ings Pater 9! mary mancbcar ears, cari Inu area mgt bs tse provounded, Grey ef fen saat be mado to proae onaor attr tran a kde edge to eure suticetepace the rection nadeauasvooucon wit usa tn overconoung of the reacraion = A ogre prolored18 Compe ail ecuton: shart. in, peed Barer ar poso arena FoesFig. 4-22 Once sulicient space has been pro- ‘duced, sweep the short thin ciamond back and forth, planing the mesial surlace to smoothness, Be caretul not to incline the diamond towar the center of the tooth being prepared, o¢ the preparation wll be overtapered. Fig. 424 Now go back over both proximal sur faces wih the torpedo diamond. This will pro- ‘duce a chamler finch line and increase the axial ‘depth of reduction, It wil also avord the common problem of an underprepared proximal surtace, Wwhich loads to overconiouring of the restora: tion.Finishing the Preparation + Round off the axial walls and eliminate any undercuts + Round off any distinct positive angles on areas like the incisal edge to avoid porcelain fracture + The shoulder is smoothened using a binangle chisel + Rounded internal line angles + Because the adhesion of dental cements depends primarily on the projections of the cement into microscopic irregularities on the prepared tooth surfaces,the prepared tooth surface should not be highly polished. + Some of the Luting cements used are Zinc phosphate,Zinc poly carboxylate, Glass ionomer cements.+ An impression is then taken and a die cast model of the tooth made after which the porcelain crown is fabricated in the lab or milled directly.Precautions Avoid burning of the tooth by ensuring adequate flow of water coolant,dry cutting should be avoided even in non vital teeth. Dry cutting introduces microfractures in the enamel which contributes to future marginal failure. Margins should be placed supragingivally whenever possible. All clinical guidelines must be adhered to to curb the spread of COVID- 19Fig. 1-29 When viewad with one eye from a Gistance of 30 cm, all tho axial surfaces. Of a Preparation win an ideal taper ar angio of con” Nergence ot 8 degrees canbe seen Bloyea to valuate a. pr faper. with both eyes open. a proparation that 1 Undoreut can appoar 10 have an acceptable co Gree of taper.Fig. 1-31 A minor is used to ‘evaluate a preparation where direct vision is not possible. An unob- structed view of the entire finish line barely outside the circumter- ‘ence of the occlusal surface indi ‘cates correct taper.References 1,Shillingburg HT, Sather DA, Wilson EL et al. All Ceramic Crown preparation. In: Fundamentals of Fixed Prosthodontics. 4% ed Chicago: Quintessence;2012 2.Blair FM, Wassell RW, Steele JG. Crowns and other extra-coronal restorations: preparations for full veneer crowns. Br Dent Jr. 2002;192:561-571.THANK YOU