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Inside Dentistry
August 2016
Volume 12, Issue 8

Indirect Anterior Restorations

Material selection for indirect anterior restorations is governed by indication and patient characteristics (ie, the individual case). Choices need to be made collaboratively by the dentist and laboratory in how to best approach a case to satisfy form, function, and esthetic requirements and ensure clinical success and patient satisfaction, says Chris Brown, owner of Aclivi Consulting/Technical Services. 

“For example, if the patient is at high risk for caries or already has significant structural compromise, we may be more inclined to wrap the tooth with our restoration to reduce the risk of recurrent decay or tooth fracture,” says Bakeman. “If the patient is at increased functional risk, we lean toward stronger materials. However, neither scenario negates the need to manage the occlusion and create functional systems that do not prematurely load the teeth/restorations during function.”

Alternatively, the esthetics of a restorative material may drive the treatment decision if the patient is at high risk esthetically (eg, has a high lip line and the teeth strongly influence the patient’s appearance). The reality is that typically a combination of risks must be considered in order to individualize and design the best solutions for a particular patient, Bakeman emphasizes.

“The determinate is restoration type: veneer, crown, bridge, and/or what combination the particular case requires,” explains Jeff Stubblefield, general manager of DAL Signature Lab. “Today’s product offerings (eg, lithium disilicate, translucent zirconia) are extremely well-suited for the criteria of form following function.”

Among the newer material solutions to choose from are translucent zirconias. Created by either increasing the amount of yttria in the zirconia itself (ie, up to 9.5%), which increases the cubic polycrystal (ie, more translucent component), or by adding ions that exhibit greater translucency into the matrix, translucent zirconias are inherently weaker (ie, 600 MPa flexural strength) than their traditional high-strength zirconia counterparts (ie, 1,100 MPa flexural strength), explains Burgess.

“The concept of using monolithic materials is a better choice for longer-lasting restorations,” Weston says. “When you eliminate a material interface, you eliminate a failure point.”

However, even the more translucent zirconia materials currently available may still not be sufficiently esthetic for use as anterior veneers. They can appear monochromatic and lifeless due to differences in light transmission properties, Weston says.

While it is true that in most cases the new zirconia options won’t be as esthetic as cut-back and layered restorations, Brown says it will be interesting to see if the translucency in the incisal area can be further increased to enhance the esthetics of these materials.

“These new zirconia do offer new choices for the dental laboratory and dentist,” Brown believes. “The multi-layered zirconia materials blocks represent a definite improvement in esthetics regarding shade transitions over previous zirconia offerings.”

And, the advances in zirconia translucency have absolutely started to close the gap between layered esthetic restorations and monolithic restorations, Stubblefield observes. Because customization achieves the finest esthetics, no matter what the material is, he believes that laboratories that excel in their handling of the pre-sintered staining will maximize the esthetic value of monolithic zirconia.

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