TOOTH PREPARATION FOR METAL CERAMIC CROWNS
METAL-CERAMIC RESTORATION
ALSO CALLED PORCELAIN FUSED TO METAL RESTORATION (PFM).
Consist of a ceramic layer bonded to a thin cast metal coping that fits over the tooth preparation.
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 of ceramic alone.
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
Disadvantages
While cosmetic appearance is excellent, they are not as aesthetically pleasing as other types of crowns. Gingival inflammation causing gray line (due to metal) compared to porcelain 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 those teeth 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 the metal tooth substructure underneath, which is often gray in appearance.
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.
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 to correct the occlusal plane.
METAL-CERAMIC RESTORATION
Can be used in a wide variety of situations including the replacement of missing teeth with fpds.
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 metalceramic 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 porcelain laminate veneer is preferred.
- 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.
ARMAMENTARIUM
1. 2. 3. LAB KNIFE WITH NO:25 BLADE SILICONE PUTTY FLAT END TAPERED DIAMOND ROUND END TAPERED DIAMOND SMALL WHEEL DAIMOND LONG NEEDLE DAIMOND RADIAL FISSURE BUR (ROUNDED SHOULDER) MODIFIED BINANGLE CHISEL
4.
5. 6. 7. 8.
ANTERIOR METAL-CERAMIC CROWNS
Silicone index made before tooth preparation If the tooth badly is broken down, index made on waxed up diagnostic cast.
ANTERIOR METAL-CERAMIC CROWN PREPARATION
Step no : 1 Placement of depth orientation grooves ( 1.2mm ) the labial grooves cut in two sets 1. 2. one set parallel with the gingival half of labial surface one set parallel with the incisal half of labial surface
ANTERIOR METAL-CERAMIC CROWN PREPARATION
ANTERIOR METAL-CERAMIC CROWN PREPARATION
ANTERIOR METAL-CERAMIC CROWNS
To achieve adequate reduction without encroaching upon the pulp facial surface prepared in two planes that correspond roughly to the two geometric planes present on the facial surface of an uncut tooth
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO : 2 Incisal reduction- (2mm) with flat end tapered daimond.
ANTERIOR METAL-CERAMIC CROWN PREPARATION
Inadequate incisal reduction results in poor incisal translucency
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO : 3 Labial reduction (incisal half) with flat - end tapered daimond.
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO :4 Labial reduction (gingival half) with flat-end tapered daimond to create shoulder finish line.
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO : 5 Lingual reduction (0.7 -1mm ) using small wheel daimond.
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO :6 Initial proximal reduction Using long needle daimond
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO : 7 Lingual axial reduction round - end tapered daimond (chamfer finish line)
ANTERIOR METAL-CERAMIC CROWN PREPARATION
STEP NO : 8 Smoothening the sharp angles
METAL-CERAMIC RESTORATION
Adequate reduction is essential for achieving a good esthetic result.
METAL-CERAMIC RESTORATION
Inadequate space for a sufficient thickness of ceramic material1. Poorly contoured restoration affecting both esthetic and health of the surrounding gingiva.
METAL-CERAMIC RESTORATION
2.The shade and translucency of the restoration will not match the adjacent natural teeth.
ANTERIOR METAL-CERAMIC CROWNS
A uniform reduction of approximately 1.2- 1.5mm is needed over the entire facial surface.
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
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.
ANTERIOR METAL-CERAMIC CROWN PREPARATION
ANTERIOR METAL-CERAMIC CROWN PREPARATION
IMPROVED ESTHETICS ALL CERAMIC LABIAL MARGIN THIS ELIMINATES THE METAL COLLAR AT THE FACIOGINGIVAL MARGIN OF THE FINISHED METALCERAMIC RESTORATION
ANTERIOR METAL-CERAMIC CROWN PREPARATION
IMPROVED ESTHETICS ALL CERAMIC LABIAL MARGIN THIS ELIMINATES THE METAL COLLAR AT THE FACIOGINGIVAL MARGIN OF THE FINISHED METALCERAMIC RESTORATION
POSTERIOR METAL-CERAMIC CROWNS
POSTERIOR METAL-CERAMIC CROWNS
STEP NO : 1 OCCLUSAL REDUCTION FOLLOWED BY FUNCTIONAL CUSP BEVEL
POSTERIOR METAL-CERAMIC CROWNS
STEP NO : 2 DEPTH ORIENTATION GROOVES
POSTERIOR METAL-CERAMIC CROWNS
STEP NO :3 FACIAL REDUCTIONOCCLUSAL HALF
POSTERIOR METAL-CERAMIC CROWN
STEP NO :4
FACIAL REDUCTION GINGIVAL HALF
POSTERIOR METAL-CERAMIC CROWN
STEP NO: 5 PROXIMAL AXIAL REDUCTION
POSTERIOR METAL-CERAMIC CROWN
STEP NO :6 LINGUAL AXIAL REDUCTION
POSTERIOR METAL-CERAMIC CROWN
STEP NO : 7 AXIAL FINISHING
POSTERIOR METAL-CERAMIC CROWN
POSTERIOR METAL-CERAMIC CROWN
POSTERIOR METAL-CERAMIC CROWN
References
Contemporary fixed prosthodontics ; Rosensteil, Lang,Fujimoto;3rd ed. Fundamental of fixed prosthodontics ; Shillingburg et al,3rded
