DR. MICHAEL DIETER

DDS, Germany; Aesthetic Dentist, Switzerland; Head of Global Education Clinical

Bond It or Lose It – How to Fix Prosthetic Restorations in Daily Practice

The reliable bond to enamel achieved with the adhesive luting technique has greatly impacted preparation designs resulting in significant preservation of tooth structure. The conservation of both enamel and dentin has become an important issue for dentist and patient. The combination of highly translucent all-ceramics and resin composite cements has opened up a new dimension in esthetics fulfilling the highest patient demands. Clinical data confirm the long-term success of all-ceramic restorations. However, adhesive luting techniques require a careful and meticulous clinical protocol. This stage can be considered very critical for a successful outcome and needs as much care as the preceding stages. Once a restoration is cemented there is no scope for modification or repeat. The clinician needs to establish a lasting bond to the tooth surface (enamel, dentin) as well as to the prosthetic restoration (e.g. glass ceramics, Lithium-Disilicate, Zirconium Dioxide, metal alloys). Specific guidelines must be carefully followed in dealing with these clinical challenges. This lecture will provide science-based knowledge on the various cementation techniques and materials available today. It is the goal to enable the clinician to apply the new techniques and materials correctly in order to achieve long lasting and esthetic clinical results.

Learning objectives:

  • To know the difference between the various all-ceramic systems in terms of esthetics, strength, required tooth preparation design and clinical application.
  • To know the difference between the various luting material categories, their preferred indications and their clinical application.
  • Surface treatment of all-ceramic materials prior to cementation.
  • Correct clinical management in case of surface contamination of the ceramic restoration after try-in.

Esthetics and Reliability of All-Ceramic Restorations in our Daily Practice

A fundamental principle in replacing missing tooth structure or missing teeth is the restoration of function and esthetics at minimal biological cost. The introduction of new all-ceramic materials and adhesive cementation techniques have facilitated innovative, conservative preparation designs for single tooth and Fixed Partial Denture (FPD) restorations. The reliable bond to enamel achieved with the adhesive technique has greatly impacted preparation design resulting in significant preservation of tooth structure The reliable bond to enamel and dentin achieved with modern adhesive techniques had a great impact on modern preparation designs resulting in significant preservation of tooth structure. The combination of highly translucent all-ceramics and esthetic resin composite cements has facilitated the clinical use of the adhesive technique and launched a whole new era of esthetic restorative treatment options like ultra-thin veneers, table tops, resin bonded FPDs, and inlay-retained FPDs. Today, the clinician can choose from very different ceramic materials such as Silicate glass ceramics, Lithium-Di-Silicate ceramics, and Polycrystalline materials like Zirconium Dioxide. However, in terms of strength and esthetics there are significant differences that need to be considered for their clinical application. This lecture is designed to provide participants with an overview on the permanently increasing variety of all-ceramic material systems, their features & indications. The clinician will take home useful information on the step-by-step procedures for optimal tooth preparation designs and the adhesive cementation technique for all-ceramic restorations – all illustrated with clinical cases. Additionally, different manufacturing processes of all-ceramic restorations are presented – with a special focus on the latest developments in CAD/CAM technology in the light of current scientific and clinical information.