Repairing Porcelain

8/22/2019 Repairing Porcelain

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Why TakEThis CoursE?The use of porcelain-metaland all-ceramic restorationsto restore teeth that havehad many restorations overthe patients lifetime is aroutine procedure. Learnabout the materials andtechniques you can use foraesthetic management ofthese restorations.

PaTiEnT CarEWhilerepairs can be durable, thepatient needs to under-

stand all the implications oftreatment before commit-ting to the intraoral repair.

ConvEniEnCEContin-ue your education withouttraveling, taking time awayfrom work and family, orpaying high tuition, regis-tration, and material costs.

CE CrEdiTsSuccessfulcompletion of this courseearns you 2 ContinuingDental Education Units.

high QualiTyAuthored for dental profes-sionals, by dental profes-sionals, Dental U continu-ing education courses areengaging, concise, anduser-friendly.

Who should TakE

This CoursE?Dentists, Dental Assistants,and Dental Hygienists.

T ese courses have been designed speci cally to

meet the n eeds o busy proessionals like yoursel,

who demand ef ciency, convenience and value.

Begin your Benco education al experience wit h

this course today, and watch the mail or live CE

events in your area.

ACCEPTED NATIONAL PROGRAMPROVIDER FAGD/MAGD CREDIT

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2 CONTINU ING EDUCATION CREDITS

Howard E. Strassler, DMD, FADM, FAGD

Professor, D ivision of O perative Dentistry

University of M aryland Dental School

650 W. Baltimore St

Baltimore, M D 21201

Email: hstrassler@ umaryland.edu

suPErvisEd sElF-sTudy CoursEs FroM BEnCo dEnTal

CoursE oBj ECTivEs

At the completion o this program the partici-pant: will be able to: describetheindicationsforcrownandbridge

repair listmaterialsandtechniquesthatcanbeused

to adhere to exposed metal o a ractured por-celain-metal restoration

list thematerials and techniques that can beused to adhere to ractured porcelain o a por-celain-metal restoration

describethetechniquesforcrownandbridgerepair with direct composite resin

CoursE sPonsor

Benco Dental is the course sponsor. Bencos ADA/CERP recognition runs rom November 2009through December 2013. Please direct all coursequestions to the director: Dr. Rick Adelstein, 3401Richmond Rd., Suite 210, Beachwood, OH 44122.Fax: (216) 595-9300. Phone: (216) 591-1161.email: [email protected]

sCoring & CrEdiTsUpon completion o the course, each partici-pant scoring 80% or better (correctly answering16 o the 20 questions) will receive a certi cateo completion veriying two Continuing DentalEducation Units. T e ormal continuing educa-

tion program o this sponsor is accepted by theAGD or FAGD/MAGD credit. erm o accep-tance: November 2009 through December 2013.Continuing education credits issued or partici-pation in this CE activity may not apply towardlicense renewal in all states. It is the responsibili tyo participants to veri y the requirements o theirli censing boards.

CoursE FEE/rEFundsT e ee or this course is $54.00. I you are not com-

pletely satis ed with this course, you may obtain aul l reund by contacting Benco Dental in wri ting:Benco Dental, Attn: Education Department, 295CenterPoint Boulevard, Pittston, PA 18640.

ParTiCiPanT CoMMEnTsAny participant wishing to contact the authorwith eedback regarding this course may do sothrough the course director: Dr. Rick Adelstein,3401 Richmond Rd., Suite 210, Beachwood, OH44122. Fax: (216) 595-9300. Phone: (216) 591-1161. email: [email protected]

rECord kEEPingo obtain a report detailing your continuing educa-

tion credits, mail your written request to: Dr. RickAdelstein, 3401 Richmond Rd., Suite 210, Beach-wood, OH 44122. Fax: (216) 595-9300. Phone:(216) 591-1161. email: [email protected]

iMPorTanT inForMaTionAny and all statements regarding the e cacyor value o products or companies mentionedin the course text are strictly the opinion o theauthors and do not necessari ly re ect those oBenco Dental. T is course is not intended to bea single, comprehensive source o inormation onthe given topic. Rather, it is designed to be taken

as part o a wide-ranging combination o coursesand clinical experience with the objective beingto develop broad-based knowledge o, and exper-tise in, the subject matter.

CoursE assEssMEnTYour eedback is important to us. Please completethe brie Course Evaluation survey at the end oyour booklet. Your response will help us to bet-ter understand your needs so we can tailor uturecourses accordingly.

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Our increasing population o older individuals

is comprised o patients who have received exten-

sive, comprehensive dental care. T ey grew up in an

era o non- uoridation which has lead to numerous

restorations. T at, and the combined advances andsuccesses o periodontal and endodontic treatment,

have allowed our patients to keep there teeth longer.

Practitioners are seeing more patients without miss-

ing teeth who are educated to the value o treatment

to maintain an intact dentition. With this in mind, the

use o porcelain-metal and all-ceramic restorati ons to

restore teeth that have had many restorations over the

patients lietime is a routine procedure.

With the increased usage o crowns and xed par-

tial dentures, the clinician is aced with the dilemma o

the aesthetic management o these restorations. Por-celain i s an inherently brit tle material. Over time, the

atigue and catastrophic accidents can create stresses

that lead to porcelain racture. When a porcelain-met-

al restoration or an all-ceramic restoration ractures

in normal unction or due to trauma, some patients

cannot af ord replacement o the restoration and seek

some orm o maintenance and repair. In some cases,

the desire to repair xed prosthodontic restorations is

a personal one. When a xed partial denture replaces

many teeth, the patient may not want to undergo the

complicated procedure o removing the deective res-

toration. T ey may also orego subsequent treatmentvisits to include a new provisional restoration with the

use o local anesthetic, ollowed by an impression that

requires gingival retraction procedures that will leave

the so tissue uncomortable or days. Future visits

include the metal ramework try-in, porcelain try-in

and adjustment and cementation. For some patients,

a less durable procedure with ewer dental appoint-

ments is a way to x the problem, or at least provide a

temporary x without having to undergo the number

o visits and levels o discomort they had in the past.

Porcelain and comPosite

resin fractures:

Ceramic, porcelain-metal and the newer bonded

-to-metal composite resin restorations may need re-

pair due to ractures o the substrates or wear o the

veneering materials. Metal, ceramic and composites

undergo stress atigue due to occlusal and unctional

orces over time. In the case o ceramics and com-

posites, they are inherently brittle materials. Once a

crack initiates in the surace, it will propagate until

the restorative material breaks away rom the tooth or

metal understructure.(1)

Fixed prosthodontic restora-

tions can also racture due to trauma, carelessness or

hard substrates within ood bitten on by the patient,

e.g., biting a pen or pencil or ood having a hard or-eign object, and paraunctional grinding habits.

(2,3)In

some cases, the reason or restoration racture may

be due to poor and inadequate laboratory techniques

during abrication o the restoration. T ere may be

poor metal design by the laboratory o the coping or

bridge substructure leaving unsupported porcelain

or inadequate porcelain over the metal substructure.

Metal may be incompletely or improperly prepared

or bonding porcelain to the metal or the ceramic

may be red too many times during restoration ab-

rication, creating a weakened ceramic structure.(4)While laboratory errors can contribute to porcelain

ractures, the challenge o the practitioner is to pro-

vide the laboratory with an impression o adequately

prepared teeth so that a proper metal coping can be

abricated. Sometimes, the practitioner does not ad-

equately reduce a tooth or ceramic or ceramic-metal

restorations. T is can lead to poor metal design, or or

an all -ceramic crown, insu cient porcelain thickness

that will be subject to racture in normal unction.

treatment Planning

When a porcelain-metal or all-ceramic restora-tion ractures, the patient will requently either call

the dental oice or show up as a walk-in emergency.

Ozcan and coworkers reported on the reasons and lo-

cations o metal ceramic restoration ractures.(5)

O

153 patients with 289 ractured porcelain-metal res-

torations, 255 o the ractures were on ixed partial

dentures and 34 on single crowns. Meanwhile 65%

o the ractures were in the anterior region; 60% were

on acial suraces including a cusp or incisal edge;

27% at the buccal gingival area; 5% incisal edge only;

and 8% involving occlusal porcelain. he ractureswere predominantly i n the maxillary arch (75%), pre-

dominantly on the acial surace. Implant-supported,

porcelain-metal prostheses are at a greater risk o

porcelain racture when the opposing occlusion is

another implant supported restoration.(6)

It was rec-

ommended that patients with a history o occlusal

paraunctional habits have occlusal appliances abri-

cated to protect the restorati ons.

Whenever a patient presents with porcelain rac-

ture o a porcelain-metal or all-ceramic restoration


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Fig. 1 single-crown or mult iple-unit xed part ial denture,

the patient should be told that the most predictable

outcome would be replacement o the ractured resto-

ration.(7, 8)

Replacement allows the clinician to control

all actors that will contribute to restoration success,tooth preparation, occlusion, gingival health, labora-

tory abrication (you have a history with your dental

laboratory), and cementation. I the porcelain rac-

ture is small and not in the esthetic zone, polishing

the porcelain to remove rough edges so the patient is

comortable, is the next best choice.(3, 7, 9)

Fractured

porcelain or a single crown, in this authors opinion,

should lead to a treatment plan or a new replacement

crown. For the emergency or that day, abrication

o a new provisional restoration is the best course o

treatment. For mult i-unit xed partial dentures, thedecision to replace the entire restorati on is a more in-

volved one. As earl ier stated, mult iple-uni t xed par-

tial dentures are expensive restorations to replace, and

are more complex rom a clinical standpoint.(10)

In

Ozcans study o repairing anterior and posterior rac-

tures o porcelain with adhesive composite resin, re-

pairs o ractures o porcelain in the posterior region

are less successul than anterior repairs.(5)

I a pa-

tient has a racture o occlusal porcelain or a proximal

marginal r idge, which also includes the proximal con-

tact, replacement o the restoration is the best choice.

(Figure 1) Occlusal ractures are usually due to thinporcelain, and any repair wil l also be too thin to with-

stand occlusal orces. For posterior teeth, in these cir-

cumstances, polishing the porcelain or replacement is

the best solution. In some cases, porcelain ractures

leaving a signi cant surace o metal exposed are di -

cult to achieve predictable repair. (Figure 2) Anterior

repairs with an adhesive composite resin are more

predictable or success i occlusion and adequate sur-

ace area or retention o the repair is achieved.(3,5,6)

When a patient presents with a ractured restoration

the clinician needs to evaluate the reparability o the res-toration and the cause o the racture. (9, 11) I the cause

o the racture is a single traumatic event, the decision

to repair or replace the restoration is very straightor-

ward. Many times, the racture is due to stresses over

long periods o time. Higher success with composite

resin repairs o porcelain-metal restorations will occur

i there is control o opposing occlusion to minimize

stresses on the porcelain repair, the repair is on suraces

not subject to shear stresses, the restoration has intact

margins and the preparation o the site to accomplish

the repair does not weaken the entire restoration, lead-

ing to other problems, e.g, preparation o an abutment

crown or a porcelain repair will not weaken the con-

nector o a xed partial denture.

Pati ents must be part o the decision-making pro-cess. As stated earlier, the patient must understand

that when porcelain has ractured, the best course o

treatment is the remake o the restorati on. I the rac-

ture is small, and can be managed esthetically and

unctionally by minor recontouring and polishing

with abrasives, this is the next best choice or treat-

ment. I the restoration is in the esthetic zone, re-

pair o the racture would be a third choice. hrough

inormed consent, the patient should be told o the

limited durability o the repair when compared to

restoration replacement. hese choices must be not-

ed in the patient record. For the patients on which I

have done porcelain repair, I always remind them,

during subsequent recall appointments,o the status

o the repair: how long it has been in place and ex-

pected continued longevity, beore the need or re-

making the restoration or remaking the repair. An-

terior repairs will have greater success and longevity

than posterior repairs.

While porcelain repair with di rect placement com-

posite resin or small ractured areas is the most com-

Fe 1: Fractured

marginal ridge on a

porcelain-metal crown.

Fe 2: Fractured

facial surface of a

porcelain-metal crown

abutment of a four-unit

xed partial denture

exposing the metal

understructure. Fe

3a:Preoperative view of

fractured porcelain onpontic of 3-unit bridge.

Fe 3B: Note the lack

of occlusal clearance.

Fig. 1

Fig. 2

Fig. 3a

Fig. 3B


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mon method or repair, there are other techniques

that have been described. For more extensive repairs,

the practitioner may choose repairing the restoration

using a laboratory-abricated porcelain veneer or a

porcelain-metal overlay crown.(7)

surface treatments of metal and

Porcelain for rePair:

Dif erent surace treatments wil l be necessary to

establish a bond between the existi ng crown or bridgeand the type o repair material being used. T ese

dif erent treatments depend on the size and type o

racture, and whether or not the repair is bonding to

metal, metal/porcelain, or porcelain.

chemical metal bonding:

Over the years laboratories have used a wide vari-

ety o cast metals to abricate crowns and xed partial

dentures. T ese metals may have a high gold (noble)

content or be a base metal with high concentrations

o nickel and chrome with no noble alloy present. It

is almost impossible to know which metal has been

used in an existing restoration that needs a repair.

Chemically adhering to metal substrates with com-

posite resin has been investigated. A research project

tested a metal bonding agent, GoldLink (Den-Mat,

Santa Maria, CA) or bonding to ve dif erent metal

substrates, including a high noble alloy, a three di-

erent palladium alloys and a base metal alloy.(12)

T e

ndings indicated that GoldLink was able to adhere to

all metal substrates. A 4-Meta-containing metal adhe-

sive, C&B Metabond (Parkell, Farmingdale, NY) has

been well investigated and has been demonstrated to

adhere to all types o metal alloys as well.(13-15)

T e

use o a phosphate ester containing composite resin,

Panavia (Kuraray, CA) has been shown to bond to

base metal. Newer metal bonding agents such as M-

Bond (J. Morita, Ir vine, CA), Metal Primer II (GC

America, Alsip, IL), MonoBond Plus (Ivoclar Viva-

dent, Amherst, NY) and Z-Prime (Bisco, Schaum-

burg, IL) have been introduced.

chemical Porcelain bonding:

Dental porcelains are chemically very similar.

he ability to adhere composite resin to porcelain

is based upon the chemical coupling agent, silane,

used to surace treat glass particles used as illers

in composite resins.(16)

Investigations o porce-

lain-silane bonding with a variety o porcelain re-

pair agents have been reported.(16-20)

Shear bond

strengths o composite resin to silane-treated por-

celain in laboratory studies has exceeded the cohe-

sive strength o porcelain.(21)

Silane coupling agents

are also reerred to a ceramic primers. hey include

Silane Bond Enhancer (Pulpdent), Silane Coupling

Agent (Dentsply Caulk), Versa Link Silane Porcelain

Bonding and Repair (Ivoclar Vivadent), CerinateP-

rime (Den-Mat, Santa Maria, CA), Clearil Porce-

lain Bond (Kuraray, New York, NY) and Rely-X Ce-

ramic Primer (3M-ESPE, Maplewood, MN). Other

manuacturers provide silane in their porcelain ve-

neer cementation kits.


Fe 4:The mandibular canine has been recontoured to provide for adequate occlusal clearance for the com-

posite resin repair. Fe 5: Preparation of the exposed metal creating undercuts in the metal. A. Facial view B.

Incisal view Fe 6: Application of GoldLink 2 metal bonding agent. Fe 7: Application of TetraPaque resin

opaquer. Fe 8: Use of dead soft metal matrix on gingival area of pontic to shape the composite resin repair.

Fig. 4

Fig. 6

Fig. 5a

Fig. 7 Fig. 8

Fig. 5B


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surface roughening of metal

and Porcelain:

Surace treatments o metal and porcelain with air

abrasion to microscopically roughen the suraces to

be repaired is beneicial.(19, 22-24) Relatively inexpen-sive air abrasion units, microetchers (Mini Etcher II,

Danville Engineering, San Ramon, CA; MiniEtcher,

DenMat, Santa Maria, CA) can be used to create high

-velocity stream o aluminum oxide parti cles that mi-

croscopically roughen both metal and ceramic sur-

aces to prepare them or bonding. Recently intro-

duced was an air abrasion unit that can be used or

crown and bridge repair and or tooth preparation or

preventive resin restorations that is signiicantly less

expensive than large stand-alone air abrasion cavity

preparation units. he RONDOlex (Kavo, Lake Zu-rich, IL) i ts on the Kavo coupler or their high speed

handpiece and is a multiuse instrument. In the past,

all air abrasive particles unctioned similarly. Some

recent research has shown that a unique particle or

air abrasion, CoJet (3M-ESPE, Maplewood, MN),

containing a silanized silica coating on aluminum ox-

ide particles, leaves a coating o silica on both metal

and ceramic suraces that enhances the bond o the

repair using composite resin.(25)

Another method to microscopically roughen por-

celain to enhance micromechanical retention o com-

posite resin to porcelain is to etch the porcelain witheither hydro uoric acid

(11, 24-28)or 1.23% acidulated

phosphate uoride.(11, 28)

Hydro uoric acid (HF) is a

very caustic chemical and should be used careully in

the oral cavity. When used, the so ti ssues adjacent to

the restoration being treated must be protected and

isolated with either a dental dam or a light-cured res-

in-based paste. ypically, intraoral-use hydro uoric

acids are o low concentration in the 6%-10% range

and in a gel ormulation to allow or controlled place-

ment. ypical etching o porcelain with an intraoral

hydro uoric acid gel is 30 seconds to 10 minutes,depending on the type o porcelain being etched.(11)

During etching, it is important to keep the surace

being etched moist with gel over the time o etching.

When using 1.23% acidulated phosphate uoride the

etching time is 5-15 minutes. T e main advantage o

acidulated phosphate uoride is that this acid agent i s

sae to the oral tissues.(11)

A comparison o HF etching

to air abrasion o porcelain has shown that air abra-

sion provides an equivalent adhesion or a porcelain

repair. Also, the use o air abrasion is considered saer

to the so tissue, hence the recommendation or a

barrier protection to the gingival tissues when using

a porcelain HF etchant.(11)

With the use o diamonds

and burs, metal and porcelain can be roughened to

enhance bonding. It is important that whenever por-celain is prepared with a diamond abrasive, copious

water spray is used to cool the diamond. I the dia-

mond heats the porcelain, it can cause heat-checking

o the porcelain which initiates microcracks in the ce-

ramic surace that can lead to urther ractures o the

porcelain. When preparing the racture site or com-

posite resin repair, it is important the site be enlarged

by at least three to our t imes the ori ginal racture sur-

ace area.(4)

T is increased surace area is crit ical or a

more predictable, longer-lasting repair. In the case o

repairing only metal, composite resin retention can beenhanced urther by creating mechanical undercuts

in the metal. Because adhesives are used to seal the

composite resin repair, these undercuts can perorate

through the metal portion o the crown into the tooth

without any ill ef ects. A new class o burs has been

designed to cut even the hardest o crown and bridge

sElF-sTudy Cours

Fig. 9

Fig. 10

Fig. 11

Fe 9: Placement

of nanohybrid com-posite resin.

Fe 10: Complet-

ed composite resin

repair of the lateral

incisor

Fe 11: Fractured

incisal edge of pontic

of 8-unit xed partial

denture.


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Fe 12: Etching the por-

celain with a 1.23% acidulated

phosphate uoride gel for 10

minutes total.

Fe 13: Etched porcelain

surface. Note the amount of

porcelain preparation to assure

retention of the repair.

Fe 14:Application of

adhesive.

Fe 15: Completed por-

celain repair with nanohybrid

composite resin.

metals. T ese metal cutt ing burs include the Great

White series (SS White Burs, Lakewood, N.J. and e-

cutters (Brasseler USA, Savannah, GA).

case rePort 1:

he patient presented with a 3-unit porcelain-

metal ixed partial denture that included a maxillary

central incisor and canine abutment with a lateral in-

cisor pontic that had been abricated 18 months pre-

viously. Four months ago, porcelain ractured rom

the lateral incisor leaving the metal exposed. A com-posite resin repair had been attempted, but at this

visit, it had ractured away. he canine o the bridge

was an abutment or a clasp and rest seat or a par-

tial denture abricated ater the bridge was cemented.

Reabrication o the ixed partial denture would have

led to the remake o the removable partial denture.

he patient was on a ixed income and wanted to

have the repair attempted again.

Evaluation o the site revealed a very tight occlu-

sion that had contributed to the porcelain racture

and the subsequent composite resin repair racture.(Figure 3) T e opposing mandibular canine was re-

shaped to allow or adequate room or a composite

resin repair o the ractured site.(Figure 4) When the

last repair was attempted, very little had been done

to enhance retention o the composite resin to the

metal. Without weakening the connectors o the xed

bridge, metal was air abraded with CoJet Sand (3M-

ESPE, Maplewood, MN) using a Minietcher (Den-

Mat, Santa Maria, CA). T e air abrasion particles can

be problematic and need to be suctioned when using

the air abrasion unit. A unique air abrasion particle

suctioning device (Sandrap, Clinicians Choice Den-

tal Products, New Milord, C) minimizes the amount

o abrasive that gets in the patients mouth and on the

instruments, countertops and any other devices in the

operatory even when using a high-speed evacuator.

T e tip o the MiniEtcher is inserted and oriented to

the surace being abraded within the Sandrap, whi le

another ori ce in the Sandrap had a saliva ejector

attached to evacuate the particles. Additional reten-

tion was developed in the metal by placing undercutsin the incisal areas o the metal pontic, using a Great

White #1 metal cutting bur (SS White Burs, Lake-

wood, NJ). (Figure 5)

One problem requently seen when doing repairs

o exposed metal is how to avoid a graying out o the

composite resin repair. T is is best accomplished by

using a composite resin opaquer that can mask the

metal in a thinness that helps avoid overbulking o the

composite resin repair. Most opaquers need a thick-

ness o at least millimeter to adequately opaque

metal. A study investi gated the masking ef ectivenesso 57 dif erent resin color modi ers or opaquers.(29)

By placing the dif erent opaquers over a gray metal

they could measure thickness required to adequately

opaque the metal. One opaquer tested, etraPaque

(Den-Mat, Santa Maria, CA), was able to opaque the

metal with excellent masking abil it y with a thinness o

less than 0.2 mm.

T e air-abraded porcelain and metal was cleaned

with a phosphoric acid etchant or 10 seconds, r insed

and dried rom the surace. T e phosphoric acid does


Fig. 12

Fig. 14

Fig. 13

Fig. 15


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not etch the porcelain surace, but leaves residual hydro-

gen ions that enhance silane porcelain primer bonding.

A silane porcelain primer was applied to all exposed

porcelain suraces with a BendaBrush (Centrix, Shel-

ton, C) or 30 seconds and dried rom the surace. T eair-abraded and prepared metal was covered with an

opaque metal adhesive bonding agent, e.g., (GoldLink

2, Den-Mat, Santa Maria, CA or CB Metabond, Parkell,

Farmingdale, NY) (Figure 6) and a resin opaque, e.g.,

Kolor Plus Opaquer Shade A3 (Kerr, Orange, CA) or

etraPaque, (Den-Mat, Santa Maria, CA) using a Ben-

daBrush Micro (Centr ix, Shelton, C).(Figure 7) T e

suraces were light cured with a high power quartz

halogen curing light (Optilux 501, Ker,, Orange, CA) or

10 seconds.

For this case, another challenge was creating thetissue surace side o the pontic when repairing it with

composite resin. o control the contour o the pon-

tic adjacent to the gingival t issue, a dead so stainless

steel matrix strip (Den-Mat, Santa Maria, CA or Pulp-

dent, Watertown, MA) was cut to orm a trapezoidal

shape. T is trapezoidal shape is perect or adapting

the matrix under the pontic and into the embrasure

spaces. T e narrow port ion o the trapezoid is slid rom

acial to lingual under the pontic. T e wider wings o

the trapezoid are then stabilized into the gingival em-

brasures with wooden wedges.(Figure 8) T e composite

resin was placed on the acial surace being certain themetal was opaque.(Figure 9) I there is shine through, a

more opaque composite may be needed. T e completed

restoration utilizing a nanohybrid composite resin was

esthetically acceptable and was able to match the ap-

pearance o the glazed porcelain on the adjacent teeth.

(Figure 10) T e composite resin was nished and pol-

ished using nishing burs (E burs, Brasseler USA, Sa-

vannah, GA) ollowed by a silicone abrasive points and

cups (Enhance Finishers, Dentsply Caulk, Milord, DE)

and composite resin polishing disks (So ex Disks, 3M-

ESPE, Maplewood, MN). At three years the restorationwas still unctioning acceptably.

case rePort 2:

A 68-year-old male patient presented with a rac-

tured porcelain-metal 8-unit xed part ial denture on

the pontic o tooth #9. (Figure 11 ) When presented the

treatment choice o remaking the xed partial denture,

which was highly recommended due to age o restora-

tion (15 years), presence o recession and intact margins,

the patient requested a second alternative- a composite

resin repair. T e racture site was prepared, creating ad-

ditional surace area (3 times greater) than the racture

site on the acial and lingual surace using a medium

grit diamond with a high-speed handpiece with water

spray. o create additional retention to the site, the por-celain was etched with 1.23% acidulated phosphate uo-

ride (Nupro topical APF gel, Dentsply, York, PA) or 5

minutes, rinsed rom the porcelain, dried and reapplied.

(Figure 12) T ere was no need or a so tissue barr ier to

protect the gingival during the etching process with the

uoride gel. T e gel was ri nsed rom the porcelain again

and dr ied. T e etched porcelain had a dull appearance.

(Figure 13 ) T e porcelain was treated with a silane or

30 seconds and air dried. An adhesive resin (Prime and

Bond N, Dentsply Caulk) was painted on the etched

porcelain surace, air thinned and light cured or tenseconds on the acial surace and 10 seconds on the lin-

gual surace.(Figure 14) T e porcelain racture site was

then restored with a nanohybrid composite resin (Filtek

Supreme Plus, 3M-ESPE). (Figure 15)

conclusion:

In the past, crown and bridge repair was not very

successul. With the latest technologies o air abrasion,

porcelain and metal bonding agents, the durability o

porcelain repair is more predictable.(30)

While repairs

can be durable, the patient needs to understand all the

implications o treatment beore committing to the in-traoral repair o ractured porcelain, knowing that, in

most circumstances, remaking the crown or xed parti al

denture is the better choice. For this arti cle, two di f erent

techniques or roughening o the porcelain and metal to

create micromechanical retention were presented (air

abrasion and porcelain etching). As part o the treat-

ment planning process, the clinician should evaluate the

reason or the porcelain racture. I occlusion contrib-

uted to the racture, it may be necessary to evaluate and

adjust the occlusion in all dynamic movements to mini-

mize the risk o racture o the composite repair.

references1. Etman MK. Conocal examination o subsurace cracking in ceramic ma-

terials. J Prosthodont . 2009; 18:550-9.

2. Mi ller E, Connelly ME. Guidelines or salvage, repair and conversion o

existing prostheses. Cali Dent Instit or Contin Educ. 1993; 45:14-28.

3. Str assler HE, Gerhardt DE. roubleshooting everyday restorati ve emer-

gencies. Dental Clinics o North Ameri ca. 1993; 37(3):353-365.

4. Strassler HE. Achieving predictable crown and bridge repair. GP Insider.

1992; 1(5):71-74.

5. Ozcan M, Niedermeier W. Clini cal study on the reasons or and location

o metal-ceramic restorations and survival o repairs. Int J Prosthodont .

2002; 15:299-302.

sElF-sTudy Cours


8/10100 incisal edge

references (contd)

6. Kinsel RP, Lin D. Retrospecti ve analysis o porcalin ail ures o metal-

ceramic crowns and xed part ial dentures supported by 729 implants

in 152 patient: patient speci c and implant-speci c predictors o ce-

ramic ailure. J Prosthet Dent. 2009; 101:388-94.

7. Strassler HE. Aging patients/aging restorations: predictable crown

and xed part ial denture repair. Contemp Esthet Restorative Pract.2002; 6(11):20-32.

8. Cranham JC. Why porcelain breaks: ten actors to consider in the re-

storati ve process. Dawson Academy Vistas. 2008; 1(1):22-27.

9. Ahmad I. Salvaging ractured porcelain crowns with a direct compos-

ite repair technique. Pract Proced Aesthet Dent. 2002; 14(3):233-238.

10. Raposo LH, Neiva NA, DaSilva GR, Carlo HL, et al. Ceramic restora-

ti on repair : report o two cases. J Appl Oral Sci. 2009; 17:140-4.

11. Reston EG, Filho SC, Arossi G, Cogo RB, et al. Repair ing ceramic res-

torations: nal solution or alternative procedure? Oper Dent. 2008;

33:461-6.

12. OKray K, Suchak AJ, Stanord JW. J Dent Res. 1989; 66 (Special Is-

sue): 207, abstract no. 805.

13. anaka , Alsuta M, Nakabayashi N, Masuhara E. Surace treatment o

gold alloys or adhesion. J Prosthet Dent. 1988; 60:271-279.

14. Yu XY, Xu JW. T e tensile bond strength o various composite resins

to alloy. Quintessence Int. 1987; 18:145-147.

15. Cooley RL, Burger BS, Chain MC. Evaluation o a 4-MEA adhesive

cement. J Esthet Dent. 1991; 1:7-10.

16. Alex G. Prepari ng porcelain suraces or opti mal bonding. Compend

Contin Edu Dent. 2008; 29:324-35.

17. Roulet JF, Soderholm KJM, Longmate J. Ef ects o treatment and stor-

age condi ti ons on ceramic/composite bond strength. J Dent Res. 1995;

74:381-387.

18. Kwok-hung C. Yen-chang H. Bonding strengths o porcelain re-

pair systems with various surace treatments. J Prosthet Dent. 1997;

78:267-74.

19. Suliman AH, Swi EJ Jr. Perdigao J. Ef ects o surace treatment and

bonding agents on bond strength o composite to porcelain. J Pros-

thet Dent. 1993; 70:118-20.

20. Van der Vyyer PJ, de Wet FA, Botha SJ. Shear bond strength o ve

porcelain repair systems on Cerec porcelain. SADR. 2005; 60:196-

200.

21. Diaz-Arnold AM, Wistrom DW, Aquili no SA, Swi EJ. Bondstrengths o porcelain repair adhesive systems. Am J Dent. 1993;

6:291-294.

22. el-Sheri M , Shil li ngburg H, Duncanson MG . Compari son o bond

strength o resin-bonded retainers using two metal etching tech-

niques. Quintessence Int 20:385-388, 1989.

23. el-Sheri MH, el-Messery A, Halhoul MN. T e ef ects o alloy surace

treatments and resins on the retenti on o resin bonded retainers. J

Prosthet Dent. 65:782-786, 1991.

24. Ozcan M, Valandro LF, Amaral R, Leite F, et al. Bond strength du-

rability o a resin composite on a reinorced ceramic using various

repair systems. Dent Mater. 2009; 25:1477-83.

25. Boyer D, Armstrong S. Reinhardt J, Aunan D. Ef ect o surace treat-

ment on porcelain repair with composite. J Dent Res (Special Issue).

1997; 76: 72, abstract no. 466.

26. Denehy G, Bouschli cher M, Vargas M. Intraoral repair o cosmeti c

restorations. Dent Clinic North Am. 1998; 42(4):719-737.27. Stangel I, Nathanson D, Hsu CS. Shear strength o the composite bond

to etched porcelain. J Dent Res. 1987; 66:1460-1465.

28. ylka DF, Stewart GP. Comparison o acidulated phosphate uoride

gel and hydro uori c acid etchants or porcelain-composite repair. J

Prosthet Dent. 1994; 72:121-127.

29. McInnes-Ledoux PM, Zinck JH, Weinberg R. T e ef ecti veness o

opaquer and color-modi er materials: a laboratory study. J Am Dent

Assoc 114:205-209, 1987.

30. Ozcan M. Longevity o repaired composite and metal-ceramic resto-

rati ons: 3.5-year clinical study. J Dent Res. 2006; 85: Abstract no. 76.

ConTinuing EduCaTion TEsT QuEsTions

test questions

1. ypcally, hn pclan actus m apclan mtal cn bdg, th asn s

a. Exposure to hot and cold beverages and ood havea cumulative ef ect on porcelain racture.

b. Fatigue and/or traumatic racture o therestoration. ***

c. T e reasons or porcelain racture are not known.d. None o the above.

2. Accdng t ths atcl, hn pclanactus, sm patnts cannt ad tplac th statn. in sm cass, thpatnt may nt ant t undg th xtnsvand cmplcatd pcdus mvng thdctv statn, and thn subsqunttatmnt vsts th abcatn andcmntatn th statn.

a. Both statements are true.b. T e rst statement is true, the second is alse.

c. Both statements are alse.d. T e rst statement is alse, the second is true.

3. Pclan s an nhntly bttl matal.onc a cack ntats n th suac thpclan

a. I not stressed again, the crack with sel-heal.b. It wi ll spread along the surace but wil l not cause

urther problems.c. It wil l propagate unti l the restorative

material breaks away rom the tooth or metalunderstructure.

d. It should be polished to heal the crack.

4. rasns pclan actu n cns andbdgs can b du t

a. rauma when a patient alls and the crown hits ahard object.

b. T e patient bit ing on hard substances, like a penor pencil.

c. Poor metal design by the laboratory technician ora porcelain-metal restoration

d. Paraunctional grinding habits.e. Al l the above can contribute to porcelain racture.

5. Accdng t ths atcl, th ptns that shuldb d t a patnt t pa a pclan-mtal xd patal dntu (bdg) t btan

th mst pdctabl utcm uld b tplac th statn, small actusplshng th pclan t mv ugh dgs,and ant actus n th sthtc zn apclan pa. T s atcl cmmnds thathn pclan actus n a sngl cn, thbst ptn s placmnt th cn.

a. Both statements are true.b. T e rst statement is true, the second is alse.c. Both statements are alse.d. T e rst statement is alse, the second is true.


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CUTALONG

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LINE

ConTinuing EduCaTion TEsT QuEsTion

6. in ths atcl, a clncal study byozcan valuatng pclan paptd that

a. No porcelain ractures were seen,porcelain ractures are a very rareevent.

b. When porcelain repairs are done in

the posterior and anterior region, therepairs in the posterior region are lesssuccessul than anterior repairs.

c. Porcelain ractures were only seen inthe anterior region.

d. Porcelain ractures were only seen inthe posterior region.

7. whn pclan actus a snn cclusal suacs psttth t s usually du t

a. A traumatic all or automobileaccident.

b. Poor restoration design leading to

thin porcelain on the occlusal surace.c. Porcelain ractures on the occlusal

surace are never seen.d. Fracture o the acial or lingual

porcelain that pulls the occlusalporcelain of the restoration.

8. rpang pclan-mtalstatns th cmpst snqus suac tatmnt thatll hlp cat a bnd btnth xstng cn bdg andth pa matal bng usd.T s d nt tatmnts dpnd

n th sz and typ actuand hth nt th pa sbndng t mtal, mtal/pclan, pclan.

a. Both statements are true.b. T e rst statement is true, the second

is alse.c. Both statements are alse.d. T e rst statement is alse, the second

is true.

9. Chmcal bndng t mtal sa. Not possible.b. Is not a recommended procedure

when doing crown and bridge repair.c. Uses specialized chemical metal

bonding agents to adhere compositeresin to metal.

d. Will not work unless porcelain isbonded to as well.

10. Chmcal bndng t pclana. Is a process using specialized

chemical porcleain bonding agents toadhere composite resin to porcelain.

b. Is not possible.

c. Is not a recommended procedurewhen doing crown and bridge repair.

d. Will not work unless metal is bondedto it as well.

11. T chmcal bndng agnt pclan s a

a. Polyvinyl siloxaneb. Hydrogenated esterc. Silane.d. Sodium uoride.

12. Mcscpcally ughnng thsuac pclan can b dn

a. Using a paint-on resin gel.b. Using a intraoral-use hydro uoric

acid gel.c. Using an air abrasion unit.d. Both b and c.

13. Pclan can b tchd t mak tmcscpcally ugh and tntvth a

a. Hydro uoric acid gelb. Phosphoric acidc. Lactic acidd. Acidulated phosphate uoride.e. Both a and d.

14. whn usng hyduc acd ttat pclan t s advsd n thsatcl t ptct th gngval tssusadjacnt t pa st th all thllng eXCeP

a. Petroleum jelly.b. Dental/ rubber damc. Paint-on light cured resin paste.

15. ypcally hyduc acd usdntaally s a cncntatn nth ang _____________ andn a gl mulatn t all cntlld placmnt.

a. 1-2%b. 6-10%c. 35-50%d. 65-85%

16. whn pang pclan accdngt ths atcl, th actu st mustb

a. Polished beore startingb. Covered with a resin adhesive to

init iate the procedure.c. Prepared so the site is enlarged by at

least three to our times the originalsurace racture.

d. Nothing needs to be done to the site,just do the repair.

17. whn pang nly mtal a pclan-mtal statn,ths atcl cmmnds thattntn b nhancd by catngmchancal undcuts n th mtal.Bcaus adhsvs a usd t salth cmpst sn pa, ths

undcuts can pat thughth mtal ptn th cn ntth tth thut any ll cts.


statement is alse.c. Both statements are alse.d. T e rst statement is alse, the second

statement is true.

18. A unqu a abasn patclsuctnng dvc that mnmzsth amunt abasv that gts nth patnts muth s namd

a. SuctionHogb. Sandrapc. Instant Powder-awayd. T ere is no such device.

19. in ths atcl, th st dscbdcas pclan pa, thmanagmnt th cntu thpntc adjacnt t th sf tssuas accmplshd usng a

a. Mymar matr ix str ip cut in anelliptical shape.

b. dead so stainless steel matrix str ipcut to orm a trapezoidal shape.

c. A piece o rubber dam shaped like a ve-pointed star.

d. Flowable composite syringed into thespace but not light cured.

20. As dscbd n th cnclusn ths atcl, hl pas canb duabl, th patnt nds tundstand all th mplcatns tatmnt b cmmttng tth ntaal pa actudpclan and that, n mstccumstancs, makng th cn xd patal dntu s th btt

chc. patnts that dmanda sngl cn th actudpclan b pad, th patntshuld b tld ths s th bst andmst pdctabl ptn.


is alse.c. Both statements are alse.d. T e rst statement is alse, the second

is true.


10/10


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Documents

Repairing Porcelain