Conservative zirconia bridge for anterior tooth replacement.

The demand for metal-free restorations coupled with the desire for conservation of tooth structure has put new demands on our profession. There is a symbiotic synergy among the great skills of our ceramists, the commitment to successful chemistry of our researchers and manufacturers, and the unwavering desire for happy patients and long-lasting restorations by clinicians (Figure 20). With continually improving bonding materials and when tooth preparation and occlusion are well planned, conservative anterior bridges should be considered in many partially edentulous cases (Figure 21). This treatment option was particularly appropriate in the case described in this article, where an impacted cuspid limited the choices of treatment and the desire for conservative dentistry was maintained (Figure 22).

Excellence in photography: heightening dentist-ceramist communication.

The goal of the dentist is to share accurate color and other tooth characteristics about the tooth being matched. The doctor must also communicate what preparation (stump) shades the ceramist is tasked with covering since this may influence the final outer porcelain color, depending on the restorative material selected. The higher the quality of the data that we share with our dental technicians, the greater chance they have to provide us with a final restoration that matches what we and the patient sees. Dental technicians are at a great disadvantage since they are usually not able to actually see the patient. Therefore, quality digital photo images can fill that important missing link. Precise digital images can be a tremendous asset for most dental offices and they provide a mechanism for heightened communication with the ceramist and the dental laboratory team--one of the keys to aesthetic restorative success.

Using digital photography to visualize, plan, and prepare a complex porcelain veneer case.

Visualization and pre-operative plan are critical to efficient and thorough case preparation. Congenitally missing teeth, coupled with improper tooth positioning, can compromise the aesthetic rehabilitation outcome. Utilizing pre-treatment digital photography as an outline for tooth reduction and laser tissue re-contouring may help to create a symmetric and pleasing smile, even under less ideal conditions.

Assessing aesthetic composite veneer placement via digital photography.

Restoring teeth using direct composite veneers can be quite challenging for a clinician. Achieving natural color blending, masking dark teeth, removing decay, and providing a natural finish require meticulous placement with various composite opacities and shades. Critical self-evaluation using digital photography, documentation, and follow-up visits to perform veneer enhancements are critical to ensure an aesthetic outcome. This article will demonstrate how digital photography is used to achieve an aesthetic result in the placement of eight direct resin veneers.

Efficient, conservative treatment of symptomatic cracked teeth.

Every practice has patients who complain of cold sensitivity and pain on biting while showing no obvious signs of irreversible pulpitis. After loading each cusp and fossa in a symptomatic quadrant and ruling out pulp and periodontal pathology, definitive treatment can be performed to alleviate the patient's symptoms in a consistent, conservative manner using esthetic computer-aided design/computer-aided manufacturing porcelain restorations. Single-appointment definitive restorations can be advantageous for the patient because of the elimination of many steps involved in laboratory fabrication of porcelain or metal restorations.

Correction of congenitally missing lateral incisors with porcelain veneers.

The ability of the dental professional to improve a patient's smile has become a benchmark in modern aesthetic dentistry. When one type of tooth is transformed into another through the restorative process, special care must be taken to ensure correct preparation and gingival contours to create the illusion that the teeth are in their correct position. With accurate digital photographic planning, active patient consultation, detailed tooth preparation, and a meticulous laboratory sequence, porcelain laminate veneers can be functional and can achieve the aesthetic expectations of the patient.

Immediate definitive CAD/CAM restoration of a non-submerged implant.

Implant placement has become a widely accepted treatment for tooth replacement. There are many restorative options, but it is best for the patient and most efficient for the office if the implant is placed and restored in as few appointments as possible. If diagnosis is thorough and accurate, placing the implant and doing a definitive restoration in 1 appointment can be as predictable as the traditional 2 appointment technique. Restoring the implant with computer-assisted designed and machined porcelain can provide predictable fit, esthetics, and restoration and be clinically efficient.

Efficient correction of endodontic obturation and single-appointment CAD/CAM restoration.

Endodontic treatment, when performed with proper instrumentation, canal disinfection, and obturation can be a tremendous service to a dental patient and a key component of any restorative practice. It can be complicated by factors such as poor diagnosis, incomplete canal debridement, ineffective obturation, bacterial invasion, and insufficient restorative treatment. Retreatment or even tooth loss can occur when the canal space is not handled properly. This article demonstrates a procedure for the correction of pre-existing obturation and subsequent treatment with an all-ceramic restoration in a single visit.

Practical posterior composites. Efficient placement and predictable results.

Certainly, we could spend more time matching shades, applying characterizations, placing secondary anatomy, and even finishing. However, if posterior composite restorations are to be a viable alternative to amalgam in appropriate cases, we must accomplish efficient and predictable placement so that fees for the two types of restorations are somewhat in line. Contact must be solid, sensitivity must be kept to a minimum, and placement and finishing must be fairly simple and organized. If the problems with posterior composites aren't kept to a minimum, all of dentistry will suffer. Our contacts are excellent most of the time, but occasionally we need to redo a "light" one. Our best estimate is that about one in 100 fillings that had no preoperative symptoms needed some postoperative care after restoring. Usually these complaints are corrected by occlusal adjustment, and very rarely by replacing the restoration. We have not yet made a perfect restoration in our practice--we are still trying.

Combining monolithic zirconia crowns, digital impressioning, and regenerative cement for a predictable restorative alternative to PFM.

Advances in indirect esthetic materials in recent years have provided the dental profession higher levels of strength and esthetics than ever before with products like lithium disilicate and zirconium oxide. Providing excellent fit and versatile performance, and because there is no porcelain to delaminate, chip, or fracture, monolithic zirconia crowns have the potential to outperform other layered restorations such as porcelain-fused-to-metal (PFM). This review of monolithic zirconia highlights a clinical case in which all-zirconia restorations were combined with CAD/CAM technology for a successful esthetic restorative outcome.