Dental Asia Mar/Apr 2020

Clinical Feature 34 DENTAL ASIA MARCH / APRIL 2020 I n the maxillary anterior region, the integrity of the teeth is of great importance to many people. In the case of damage, restoring an attractive smile is a great need for patients. Depending on the defect size and its configuration, various clinically proven direct and indirect therapeutic options are available. For heavily damaged anterior teeth, all-ceramic crowns are a reliable and proven therapy option for restoring function and aesthetics. Lithium-disilicate glass ceramic The integrity of their anterior teeth is of paramount importance formost patients due to their prominent position. The impairment of teeth in the anterior aesthetic zone by carious defects, chipping or fractures, clear visible fillings, discolourations, anomalies in shape, alignment and position within the dental arch often results in considerable restrictions for the patients. Therefore, dentists should take into account all aspects of treatment, including a team of different specialists, in order to preserve or restore the natural dentition. Today, the range of therapies in modern dentistry offers a variety of methods to restore or optimise the function and aesthetics of the teeth in the anterior By Prof. Dr. Juergen Manhart & CDT Hubert Schenk Fig. 1a – b: Initial situation: 24-year-old female patient after trauma. In addition to the fractured tooth 11, there is extensive injury to the lower lip. The first treatment of the soft tissue injury occurred at the venue of the accident abroad region. These include – depending on the initial situation and the degree of destruction of the individual teeth – polychromatic multilayer direct composite restorations, laboratory-made or industrially manufactured composite veneers, ceramic veneers, partial veneers (additional veneers), veneer crowns, full crowns (metal ceramics, all-ceramics) and orthodontic measures 1-3 . A majority of today’s patients asks for aesthetic restorations and metal-free alternatives to traditional prosthodontic approaches. All-ceramic restorations have gained popularity during the last 30 years for a number of reasons; especially their favourable optical properties, excellent and durable aesthetic appearance, wear resistance, colour stability, chemical inertness and durability, biocompatibility, and strengthening of the remaining tooth structure when they are adhesively bonded 4-17 . In the last three decades, many different all-ceramic systems were introduced to the dental profession 19 . Dental ceramics can be classified according to their material composition, fabrication workflow (for example, powder-liquid slurry, slip-casting, pressable ceramics, CAD/CAM millable), or clinical indications 20-22 . Nowadays, the most common clinical indications for all-ceramic restorations consist of inlays, onlays, partial crowns, full crowns, bridges, veneers, posterior occlusal veneers (table tops/ posterior cuspal protection restorations), implant abutments and implants 23-36 . These restorations present a scientifically proven, high-quality permanent treatment option for the aesthetically challenging anterior and load-bearing posterior regions when the indications and limitations of the respective ceramic systems are respected and an appropriate luting procedure is employed; their reliability has been documented in literature 18, 32, 37-56 . All-ceramic restorations are used meanwhile on a routine basis in everyday dentistry. For single-unit restorations, lithium-disilicate (LS2)glassceramicisthematerialofchoicefor many dental practitioners because of its good mechanical strength (IPS e.max Press: 470 MPa mean biaxial flexural strength), excellent aesthetic properties and its versatility. It can be used in monolithic form, when maximum strength is required (for example, table- top restorations for increasing the vertical dimension of occlusion or posterior crowns), or in a layered form (pressed LS2 coping with additional veneering porcelain) when aesthetics is of utmost importance. Single- unit LS2-crowns demonstrate an excellent longevity for anterior 57-59 and posterior teeth 56-59 , comparable to the survival rate of metal-ceramic crowns 60, 61 . This clinical report illustrates the restoration of a maxillary central incisor affected by a complicated crown fracture with a veneered lithium-disilicate glass ceramic crown after endodontic therapy. Anterior Full Ceramic Crown After a Complicated Fracture of the Natural Tooth