Crown and Bridge
Clinical success in this field results from achieving two distinct fundamental principles. The first is functional acceptability, which includes proper occlusal relationships, well-fitting margins, and avoiding postoperative sensitivity. The second is aesthetic acceptance, both by the patient and the dentist. Functional integrity is achieved by following fundamental, clinical, and proven research principles. Aesthetic acceptance is achieved by establishing thorough communication between patient and dentist, and dentist and ceramist. The dentist becomes the channel between the patient and the ceramist, interpreting what the patient desires and ensuring it is achieved by the laboratory. Success of this interpretation is a direct result of establishing laboratory communication guidelines which include various diagnostic information such as color-mapping, intraoral photography, and detailed instructions and models. This ensures that the ceramist receives a clear and thorough treatment prescription, which is essential for obtain the desired end result.
In order to reproduce natural dentition with ceramics, the material must exhibit similar optical properties to the components of natural teeth. Colored stains are applied internally to provide warmth and variation. The art of acquiring the right combination of color, opacity, and translucency can be varied to imitate an infinite number of natural incisal patterns.
Although porcelain fused to metal crowns are fine for posterior regions, we tend to encourage use of all-ceramic crowns in the anterior areas where aesthetics are more of a concern. Often, the use of metal presents a compromise resulting from the inability of light transmission through the substructure and the need for opaquers to mask the dark color of the metal. The introduction of all-ceramic systems in the 1980s provided alternatives to the use of metal in treatment plans which emphasized aesthetics. Early systems however were compromised in terms of strength and marginal integrity. This is no longer the case. Today, metal free restorations ( such as Targis and IPS Empress 2 ) are no longer experimental, unproven alternatives to metal reinforced porcelain in anterior or posterior crowns. Achieving optimal aesthetics no longer compromises strength and longevity.