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Fig. la. Severe attrition of anterior dentition with loss of vertical
dimension.
Fig. 2. Occlusal, preoperative view of the maxillary dentition
reveals severe erosion.
Fig. 4. Preparation of the maxillary posterior teeth with glass
ionomer cement in place prior to taking the final impression. There
is adequate sound enamel for proper bonding on porcelain onlays.
26 NAWABI: PORCELAIN ONLAYS/VERTICAL DIMENSION
Fig. lb. Loss of vertical dimension of posterior teeth.
Fig. 3. Mandibular centric relation appliance is in place to reestablish proper vertical dimension of occlusion prior to
reconstruction.
Fig. 5. Mirage inlays in place on working articulated cast.
0
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Fig. 6. Typical porcelain bonding and finishing materials.
Fig. 7a. Final reconstruction of the maxillary arch with full crowns and porcelain onlays.
Fig. 7b. Another photograph of the final reconstruction of the
maxillary arch with full crowns and porcelain onlays.
was etched and thoroughly rinsed . A coupling agent was applied to the porcelain onlays and air dried (oil-free) immediately. A bonding agent was applied to the silane surfaces. Clear matrix strips were placed and wedged to avoid interproximal flash. A dual-cure cement (Dual Cement Vivadent)+ was used to enhance light penetration through the thick onlays (Fig. 6). Dual cement is a highly filled radiopaque bonding resin used to cement laboratory-fabricated porcelain restor�tions. It contains both light- and chemicalactivated catalysts to ensure thorough polymerization.
Finishing Excess resin cement was removed with fine-diamond rotary instruments using a water/air spray.11 The interproximal contacts were tested with dental tape to ensure there was no excess resin cement. The occlusion was checked and adjusted. Reshaping and smoothing was done with fine-grade diamonds and a water/air spray, followed by polishing
with a fine-diamond polishing paste on a soft-rubber cup.
During this appointment, the threeunit cantilever also was cemented permanently (Fig. 7a and 7b). The occlusion was adjusted at subsequent appointments.
Summary We presented a conservative method to preserve remaining tooth structure while restoring lost vertical dimension of occlusion with the use of porcelain onlays. The advantages of a centric relation appliance for tentatively reestablishing the vertical dimension of occlusion were discussed. This reversible appliance can be used to determine an accepted vertical dimension of occlusion in centric relation. Dr. Nawabi is a graduate student in the Department of Occlusion, Georgetown University, School of Dentistry, Washington, D.C., where Dr. Freidank ts an assistant clinical professor.
*Chameleon Dental Products, Kansas City, KS 66117.tESPE Premier, Norristown, PA 19401.'IVivadent, Tonawanda, NY 14151-0304.
References 1. Dumas, A.L. et al. A combined
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GENERAL DENTISTRY/JANUARY- FEBRUARY 1991 27
