Veneers, inlay, onlay, bonded bridge 4th year course
Today, aesthetics and beauty, like well-being, are an integral part of the health sector.
The face, a true social marker of personality, has become a capital that must be maintained. Thus, many patients no longer consult for dental pain, but to have “beautiful teeth”.
The main techniques of Aesthetic Dentistry are:
- teeth whitening or lightening
- Composites
- composite or ceramic inlays
- ceramic veneers
- ceramic crowns
- Multidisciplinary smile restoration techniques
- Classification of dental ceramics according to microstructure:
- Glassy matrix with dispersed crystalline particles:
-Feldspathic ceramics: non-reinforced intended for enameling metal-ceramic crowns
-Leucite-reinforced feldspar ceramics: (Empress)
-Vitroceramic (lithium disilicate) (e.max)
- Glass-infiltrated crystalline matrix: aluminous ceramics: the crystalline particles are sintered in a first step creating a porous material between the crystals, these spaces are secondarily infiltrated with glass, which allows them to increase mechanical resistance
- In- Ceram SPINELL: based on magnesium and aluminum oxide
- In-Ceram ALUMINA: alumina
- In-Ceram ZIRCONIA: alumina + zirconium
Disadvantages: Decreased translucency.
- Fully crystalline ceramics: in which there is no glassy phase.
-Alumina based
-Zirconia based
Veneers, inlay, onlay, bonded bridge
- Classification of ceramics according to the implementation processes:
Pressed ceramics: they are injected hot into the cavity of a mold made of refractory material having the shape of the prosthetic element to be produced. For this, the ceramic material must pass through a liquid state allowing its injection.
The press technique is used for glass-ceramic type ceramics.
Infiltrated ceramics: they come from a two-step process:
-Development of a porous pre-sintered ceramic structure (Al 2 O 3, ZrO 3 )
– Infiltration by liquid glass filling the porosities, this infiltration reinforces the structure of the material and gives it its final color.
Machined ceramics: are prepared industrially in the form of a block or cylinder intended to be machined using a CAD/CAM system. The blocks can be:
Dense: completely sintered (hardly machinable)
Porous: pre-sintered (easily machinable)
- Ceramic Veneers: Adhesive ceramic restorations that are bonded only to the vestibular surface of the anterior teeth.
Biological benefits: *maximum tissue preservation
*maintenance of pulp vitality
*the limits below the sulcus
*crown biomechanics
*possibility of treatment on short crowns
*aesthetic results (optical behavior) )favorable)
🡪 Type I: teeth resistant to bleaching
teeth heavily stained by tetracycline, by infiltration of exposed dentin and devitalized teeth.
It is advisable to whiten the teeth beforehand to lighten the base shade and give the restorations a natural appearance.
🡪 Type II: major morphological changes : Very demanding patients
- Coronoid incisors 🡪 minimal preparation with shallow peripheral groove.
Closures of interdental diastemas and black triangles (facet with proximal wings compensating for loss of papillae) 🡪 maximum preparation at the proximal faces with a horizontal insertion path (compatible with divergence) the interdental contact is replaced by a contact line. A more saturated ceramic is used.
This requires the limits of intrasulcular preparations to be drawn.
- Closures of interdental diastemas and black triangles (facet with proximal wings compensating for loss of papillae) 🡪 maximum preparation at the proximal faces with a horizontal insertion path (compatible with divergence) the interdental contact is replaced by a contact line. A more saturated ceramic is used.
This requires the limits of intrasulcular preparations to be drawn.
- Lengthening of the free edges of the incisors Restoration of the length of the incisal edges and restitution of the dominance of the central incisors solves the aesthetic problem and the solidity of the crown, (restoration of the initial volume)
The incisors were lengthened by 2mm.
Ceramic veneers can significantly improve the mechanical strength of the dental crown and restore the tooth to its original strength, especially when the thickness of the ceramic allows its volume and length to be restored.
🡪 Type III: extensive restorations in adults
Major coronary fractures
Extensive enamel loss
Generalized enamel dysplasia and amelogenesis imperfecta 🡪 treatment by peripheral crown
- Tooth preparation for a ceramic veneer
Proximal preparation: Toboggan zone
Contact point below, non-visible area,
Cervical preparation: supra or juxta gingival limit
Rounded internal angle, enamel limit
Vestibular preparation: calibrated preparation using controlled penetration burs
convexity respected, 3 axes of preparation (cervical, middle and incisal) homothetic reduction
Polishing Finish: Cylindrical conical burr with red ring, removal of enamel prisms, removal of sharp angles.
Veneers, inlay, onlay, bonded bridge
- Indirect partial crown restorations
Inlay : small intracoronary obturation (without cusp reconstruction).
Onlay : restoration comprising one or more cusps.
Overlay : restoration of the entire occlusal surface.
- Bonded bridges
Bridge replacing one or two anterior teeth, which consists of fixing the pontic by means of metal or ceramic fins on teeth that are not prepared or minimally prepared on their lingual surfaces. Fixation is done by means of bonding material.
Preparation is lingual at the level of the anterior teeth to receive wings, occlusal and linguae on the premolars.
6.1 Indications
All local or general contraindications to implantology (e.g.: recent infarction with recurrences)
Pulped and cavity-free teeth 🡪The conventional bridge is very damaging.
Anterior or posterior recessed edentulism not exceeding two teeth.
Interesting preparation height (therefore bonding height) (fairly occlusal contact point)
6.2 Contraindications of bonded bridges
*presence of fillings.
*presence of carious lesions.
* Patine at high risk of caries, or presenting malformation of the enamel.
*mobility of the abutment teeth
*rotated or tilted teeth,
*extensive edentulism.
*deep overbite.
*significant abrasion of the abutment teeth.
*parafunctions.
*incisive diastema.
- Principles of preparation of partial crowns
*Tissue economy
*Remote limits of the periodontium
*Sustainment/Stabilization/Retention
*Prepared distance ≥ ½ Total coronal surface replaced
*Equivalent prepared surfaces on the different anchoring elements (eg: 16,15)
*Dentoprosthetic joint always located outside the occlusal contact zones in PIM
- Preparation for anterior bonded bridge
-Determination of support zones
-Preparation of the finishing line
-Cervical leave
-Occlusal leave
-cervical limit 1mm from the enamel/ cement junction
-Occlusal arrangement
-Preparation of stabilization and retention elements
-1.6mm diameter proximal grooves
Veneers, inlay, onlay, bonded bridge
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.