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.
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. |
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