While every dentist wants to ensure their patient receives a high-quality restoration that will last for a very long time, it is also advisable to make sure each patient’s expectations are properly managed. Patients need to be made aware that every restoration requires proper ongoing maintenance and that eventually, they will need to be replaced. Doing so avoids any unfortunate miscommunications where patients believe their new crown or bridge will last for life, regardless of how it is treated.
In addition to managing patient expectations, it is also important to ensure soft tissues are strong and healthy before treating the hard tissues. Often failures in crown and bridgework can be traced back to poor periodontal support. The idea of placing a crown is to preserve the remains of a tooth, preferably avoiding the need for endodontic treatment or retreatment in the future. Generally, the prime indications for replacing missing teeth are esthetics, comfort, function, and occlusal stability.
From the patient’s point of view, esthetics is often a prime concern and most frequently the main reason for seeking treatment. This does mean the onus is on the clinician to provide a suitable restoration that looks cosmetically pleasing. One vital factor in ensuring an aesthetically pleasing result is selecting a custom shade and doing so can be a challenging task because each individual’s perception of color is slightly different. Digitally taking the shade and supplying photographs that include the shade tab is always useful but it is also important to make sure the shade is taken in a well-lit room with plenty of natural light. Providing additional information such as the surface texture or calcifications will help the technician as will taking the stump shade, particularly where the stump is darker or highly discolored. This, too, can affect the material selection.
Luckily, a patient who is replacing older restorations should notice an immediate improvement in the appearance of their teeth. Modern porcelains are far more able to closely replicate natural teeth, with all-ceramic restorations mimicking the translucency and opalescence found in dental enamel.
The cosmetic appearance of a crown or bridge can sometimes be affected by its function, determining the overall shape and size. When this is the case, explaining this to the patient can make a great deal of difference in ensuring their expectations about appearance are reasonable. This can be especially important when a tooth is being crowned largely for cosmetic reasons. Patients should also understand that severe orthodontic issues cannot be remedied by restorative treatment.
Choosing the right materials for your patient’s restoration will help ensure it is a success. Factors that need to be considered include the location of the tooth to be restored, the amount of space available, and the patient’s expectations. Today, choices are no longer limited to PFMs or full cast, although these are still a very good option. However, lithium disilicates and zirconia restorations will also provide an excellent solution. Lithium disilicate restorations that have been waxed and pressed provide a very good marginal fit since they include all the imperfections in the tooth preparation. In comparison, zirconia is milled, resulting in more even margins with little or no imperfections depending on the smoothness of the preparation. There is also the need to consider whether the restoration will be monolithic or layered. While monolithic restorations provide superior strength, layered zirconia can give superior esthetic results.
No matter which restoration you choose, the final results are generally down to basics that include the preparation of the tooth, marginal consistency and design, as well as tissue management. The experience of the technician fabricating the restoration also makes a considerable difference as extensive knowledge is required to be able to correctly utilize the wide range of materials and porcelains available. Without this knowledge and experience, it can be very difficult to correctly replicate a custom shade. CAD/CAM and impression-free technology is becoming increasingly popular. While this can provide an excellent fit, it has never been more critical to have excellent preparations that are easy for the scanner to capture and read.
Our experienced technicians are always available to provide more information on particular materials or to discuss a case with our clients. The number one factor in the outcome of any case is the communication and relationship between the dentist and the lab. With close collaboration, we will help to ensure even the most complex cases have a successful outcome.
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