PROSTHO 1 LEC (Aug 24, 2011)

FULL VENEER CROWN

It is an artificial crown that completely covers the entire coronal portion of the tooth. All
surfaces of the tooth are being covered by the restoration. Like Partial Veneer Crown,
FVC may be used as a single unit restoration or as a retainer for FPD (called full veneer
retainer).
This could be used as one-unit restoration and it is called jacket crown.
If it is a part of FPD, FVC is called as full veneer retainer.

INDICATIONS OF FULL VENEER CROWN

Indications are formulated before the introduction of a more advanced restorative material.
These were written when a good composite material was not available yet. Nowadays,
because of the advancement of technology, the indications for jacket crown or full veneer
fabrication becomes lesser and lesser. Before, the only way to restore a badly-broken
down tooth is to put a jacket crown. Nowadays, putting a jacket crown is just one of the
treatment options. This may not be the best treatment.
Amelogenesis Imperfecta enamel is poorly developed
Dentinogenesis Imperfecta both enamel and dentin are poorly developed
Peg Lateral Incisor and Agenesis of missing lateral incisor - very common among
Chinese (enamel hypodontia)

This is brought about by genetics. In this case, you have to restore this with full veneer

Fracture or Primary Trauma

Nowadays, we do not restore a fractured tooth with a jacket crown mainly because if you
restore it with jacket crown, it will require too much tooth reduction (proximal, labial,
lingual). If you just restore with a good composite, then it will be fine. The only time that
you restore this case with jacket crown is if the patient has a greater than average
occlusal force and also when the patient wants it. But basically, if you are going to choose
a particular treatment, you have to choose the most conservative, the one that would not
require too much tooth reduction. This could be restored by just putting a composite
(nowadays). Before, the only way to restore it is by fabricating a crown.
Fluorosis an acquired defect brought about by excessive fluoride intake. There is
mottling of enamel. Enamel becomes porous.
Enamel Hypoplasia brought about by metabolic disturbances while permanent teeth
(enamel) is being formed. Example: Among children when they have high fever. There will
be alteration in the development of enamel.
We do not restore this with jacket crown. We can consider laminates and covering it with
composite or direct veneer.

Discoloration
Nowadays, if the tooth is discolored, we dont fabricate a jacket crown right away. We
consider bleaching, veneers (composite or porcelain veneer).

Toothbrush Abrasion
(faulty toothbrushing)

Toothpick Abrasion

Nowadays, we dont restore it with jacket crown. We just fill it up with composite.
The only time we consider a jacket crown fabrication as a treatment option is if the patient
wants it or if the restoration that you placed keeps on being displaced every now and then.
Tetracycline
Fluorosis (mild) very common among people who live along shorelines and in Cavite.
Attrition a form of mechanical wear brought about by a faulty occlusal contact.
Discoloration after RCT
Common among night grinders (bruxism). The tooth became too short.
Discoloration brought about by trauma to the tooth fractured and became
discolored
Erosion this is brought about by chemical-like acid and common among pregnant
women because of vomiting. Acid coming from the stomach causes erosion of the tooth. This could be treated with bleaching. But if the discoloration is too severe, no matter how
This is also common in people with bulimia. much bleaching agent you put and the color cannot be altered, that is when you consider
putting a jacket crown. The younger the patient, the better the healing.
If the discoloration is not too severe, you can put laminates (labial veneer)
Excessive consider jacket crown
Not that excessive but the patient has bruxism (night grinding habit) you have to use
jacket crown instead of veneer. The veneer will be displaced.
 You have to put dowel pins. Pinholes. Prepare and cover it with a crown.

Multiple Crown crowning of a tooth that is intact mainly because the rest of the
dentition will be restored with a crown. Nowadays, we dont do that. If everything needs a
crown and just one tooth could be restored with a composite, we dont leave that tooth.
Because of labial veneer, instead of choosing a full veneer, you do a labial veneer
fabrication unless there is an edge to edge relationship, the patient is a night grinder,
thats the only time you can consider putting a crown. If it is contraindicated for labial
veneer fabrication, then thats the time wherein you consider crowning the tooth.

Malalignment requires a FPD. For esthetic reason, even if its minimally damaged or
infected crown. We always consider a more conservative restoration unless the situation
is contraindicated to veneer fabrication.
Alteration in inclination
All these cases are definitely indicated for jacket crown (rotated, malaligned tooth, mesially or distally inclined)

This is a candidate for jacket crown fabrication unless orthodontic treatment is feasible.
So you do not recommend jacket crown right away. Consider a more conservative
treatment first. Recommend orthodontic treatment first. If not, another treatment option is
fabricating a crown. If malalignment is not this severe, you can consider labial veneers.

Diastema if diastema is more than 2mm, and orthodontic treatment is not feasible, that
is the time wherein you can consider fabricating a jacket crown.

There are spacing, you cannot place a veneer because there is an edge to edge
relationship. If you put a veneer, the veneer will be displaced when the patient bites.
Consider another treatment (jacket crown) but not veneer.
Fracture fractured tooth wherein more than 2/3 of the tooth is missing already. We
consider crowning this if the tooth is still vital. The patient is 40y/o and there is formation
of reparative dentin, and the pulp become too small, even if half of the tooth is fractured,
you can restore this without doing RCT. Jacket crown will be the final restoration.

Excessively big caries on Mesial/Distal (Mesiodistal caries) - if the cavity is too big,
you restore it with jacket crown. The remaining mid-area of the tooth is already
susceptible to fracture. Instead of restoring it with just composite, you restore it with a
crown.

Class V filling material was repeatedly displaced if there is already exposed dentin
near the pulp, retention of composite becomes around 60%. The bigger the cavity, the
lesser the retention of composite. Remember that composite is more retentive when it is
lying on enamel and retention becomes lesser and lesser as your preparation goes RPD
deeper. More dentin that is exposed, less retention for composite.
There is a telescopic crown. Removable jacket crown. There will be a first layer that will
Tooth is restored but the restoration is too big eventually, the remaining natural tooth cover the preparation. Prepare the tooth, the first layer (metal) will be cemented over the
will be fractured. To protect the remaining natural tooth, instead of replacing this amalgam prep. The tooth-contoured restoration is removable. For better retention, a telescope
filling, we cover it with a crown for protection of the remaining coronal portion. crown was made.

Microdontia small teeth. You can lengthen the tooth. You can consider veneering. If
veneering is not ideal mainly because the occlusal load is too much for the patient and the
patient is not amenable to veneering mainly because it is expensive, you can consider
lengthening by jacket crown.
Gemination [?] you dont need to put jacket crown. You can contour it. Jacket crown is
a treatment option.
Combined Indication
Remember when we discussed Diagnosis and Treatment Planning? In cases of
supraerupted tooth and there is no space for any restoration on the opposing edentulous,
we fabricate a crown on the opposing to create a space for fabrication of a denture on the
lower or upper.
When esthetic is of prime [concern]. For professional reason. If the patient requires
maximum esthetics because he is an actor or a TV personality, jacket crown is a treatment
option.
Patient With Greater-Than-Average Occlusal Forces
Instead of putting a laminate, if the occlusal loading of the patient is greater than average,
you consider a jacket crown as a retainer for FPD. To cover abutment teeth for fixed, full
veneer crown may be used. When you use FVC as part of FPD, it is called a Full Veneer
Retainer.
Abutment Teeth (when FVC is used as a retainer for fixed bridge)
Abutment teeth with short clinical crown wherein PVR is not possible, you
consider FVR
FPD involving a long span edentulous space 2-4 adjacent missing, use a FVR
Patient with greater than average occlusal force. Even if the span length is
short and the clinical crown is quite long, you still consider a FVR
*PVR / FVR partial / full veneer retainer
CONTRAINDICATIONS OF FULL VENEER CROWN
Extremes of age very young and very old patients cannot wear jacket crown
Young patient pulp is too big. But because of large caries and the restorative filling
material that was placed was repeatedly displaced or dislodged, you consider a jacket
crown which must be temporary (amount of reduction is minimal to prevent pup
exposure). After some time, when the patient is old enough (18yrs), you can consider
putting a permanent restoration (porcelain fused to metal crown)
Old patient usually suffer from periodontal diseases and bone support is not good. But if
there is adequate bone support and tooth is still stable, you may fabricate a crown.
Deep bite cases, Edge to edge relationship, Cross Bite if these are the cases, you
cannot fabricate a jacket crown (before). But nowadays, you may fabricate a jacket crown
depending on the material you are going to use (composite, acrylic crowns) but definitely
not a porcelain-fused-to-metal crown or porcelain jacket crown. Because of the
introduction of composite and acrylic crowns, these are no longer contraindications of
jacket crown provided that you choose a material (acrylic and composite) that will not
cause abrasion of the opposing, abrasion of the lingual surface of the opposing and will
not cause fracture of the tooth.
Deep bite excessive overjet and excessive overbite
Normal overjet and overbite 1mm
If the patient is 40 y/o (if the patiet is quite old, there will be no pulp exposure), you do
maximum reduction of the labial, no reduction on the fossa area, reduction is limited only
on the cingulum area (modification in tooth prep)
People engaged in contact sports you cant fabricate FPD because the face is
constantly exposed to direct trauma or direct blow which could cause fracture. Consider
RPD.
Uncontrolled Periapical Condition
Cases with abscess, granuloma, cyst. If the tooth has abscess, ask the patient
to undergo endodontic treatment. After the treatment and the abscess was
removed, the tooth can now be restored with jacket crown.
Uncontrolled Periapical Infection and Existing Periodontal Disease
You cannot fabricate a jacket crown. If periodontal treatment was performed and
successful, you can now fabricate a jacket crown. Do not start restoring this tooth with a
jacket crown when the periodontal fibers, gingiva are still inflamed. The only time you can
do jacket crown fabrication is after all symptoms and periodontal problems has been
resolved. The treatment was instituted and it was successful.
TYPES OF JACKET CRWN BASED ON THE MATERIAL IT IS MADE UP OF
Ceramic (a.k.a. plain porcelain jacket)
Porcelain fused to metal crown (usually called PFM; combination of porcelain
and metal)
Complete metal veneer crown (made up purely of metal)
Plastic crown (acrylic crown)
Acrylic fused to metal crown (combination of acrylic and metal)
Composite crown (made up of composite)
Platinum bounded porcelain crown (obsolete; no longer used)
Cast metal crown with cemented porcelain facing (obsolete; no longer used)
Composite faced crown (obsolete; no longer used)
Ceramics Crown Cannot be used for long span FPD
All porcelain. No metal component. Needs a more detailed preparation
Reduction should be 1.0 1.5 mm uniformly on all surface.

Metal Ceramics Crown

(Porcelain Fused to Metal Crown, Porcelain Veneer Crown, Ceramometal
Crown, Bonded Porcelain Veneer)
Most used jacket crown

Types of Metal Used in Dentistry:

Precious metal
Gold and platinum. It is very expensive.
Semi-precious metal (Nickel, Palladium)
Based metal alloy
Titanium, Nickel and Chromium
Specific Indications:
Conservation of tooth structure and maintenance of periodontal health Porcelain Fused to Metal Crown
This is very good as far as periodontal maintenance is concerned.
All anterior teeth where esthetics is of paramount importance
This is the only jacket crown that could provide maximum esthetics.
Mandibular incisors where space is available
Limited used on premolars

Specific Contraindications:
When clearance is less than 0.8mm
Minimum amount of reduction for ceramics is 1.0 mm on the cervical area and as
you go towards the middle and incisal, it is 1.5 2.0 mm.
Insufficient tooth support
Molars
Nowadays, there are good brands of ceramics which can be used for molars.
Edge to edge bite (Lingual view) PFM crown is used as a retainer for FPD. This is the kind of FVC that is
Ceramics is abrasive. It could cause abrasion of the opposing. used for FPD mainly because the metal can be attached to other tooth by means of
Patient with deep bite casting or soldering[?]
Ceramics is brittle. The lingual area is very prone to fracture
Tooth with very short clinical crown Types of PFM (based on the design)
Maximum retention is very important as far as ceramics is concerned. Wide surface
area and long axial wall height is really necessary.

Advantages of Ceramic Crown

Cheap
It lasts long. Unlike with composite, it has to be replaced after 3 years at the most.
Color stable
This is very durable. After most probably 10 years, the adjacent natural teeth
becomes darker in color. It has to be replaced. PFM with metal collar
Color adaptability
Ceramics are available in 16 basic colors. You can play with so many colors and
come up with a hundred colors.
Plaque resistance
It is highly polished. Food debris will not adhere to a polished ceramics or porcelain.
Insoluble to oral fluid
Cannot be dissolved by saliva
Dimensionally stable
Does not expand and shrink
Superior esthetic quality PFM with metal collar if esthetics is very important to your patient, the patient will not
Provides the best esthetics be amenable to a metal collar. Usually for posterior, you can consider this design.
Favorable soft tissue response
It is used with patients that has undergone because it is highly polished and Porcelain Fused to Metal Crown
biocompatible with the gingival tissue
Maybe used in a minimal thickness and still provide good esthetics
PFM - labial surface (required to reduce 1.5mm)
Ceramics reduction is only 1.2 mm, still you will have a very good esthetics
Full Lingual porcelain protects the crown against impact shock from the
opposing teeth
Brittle
Brittleness is considered as an advantage mainly because instead of the prepared
natural tooth being fractured, it will be the porcelain that will fracture when the tooth All Porcelain Fused to Metal Crown
is subjected to direct hit, flaw or trauma Metal here is just on the inner surface.

Disadvantages of Ceramic Crown

Poor marginal fit
Particularly if you do not make your margin defined. Margin should be uniform and
1.0 mm
Brittleness (Both an advantage and disadvantage)

Metal Backed Crown
PFM with metal lingual. Usually used if you dont want abrasion of the opposing.
Porcelain Crown With Metal Occlusal (and lingual)
Only the facial surface (buccal) is made up of porcelain. Underneath the porcelain is a
metal component. Only the external surface is tooth colored. The inner surface is madu up
of metal. (Distal Half Crown left most)
Specific Indications:
In case of parafunctional mandibular activity where esthetic restoration is
essential
Porcelain is highly abrasive. You can design a PFM crown wherein the occlusal
surface is made up of metal.
Where lingual clearance is less than 0.8mm
This may happen when reduction on lingual is not enough.
Do repreparation, or
Request the technician to make PFM crown wherein the lingual is made up
purely of metal.
FPD
If you are going to use the tooth as an abutment for fixed, use PFM retainer
All posterior teeth where full coverage is necessary
Use PFM crown especially if esthetics is very important
When deep chamfer preparation is desirable
PFM crown wherein there is a metal collar
Specific Contraindications:
Adolescent teeth
Teeth wear enamel wear is high and there is insufficient bulk of tooth
structure to allow room for porcelain and metal.
Anterior teeth where esthetics is of prime importance.
Instead of using PFM, use all porcelain or all ceramics crown.
Advantages:
Very high strength (very strong)
Ideal marginal fit because of the metal component
Ideal for FPD
Can be adapted to any size and shape of tooth preparation
Even if your preparation is excessively tapered, this can still be used unlike with
ceramics crown wherein the prepraration must be ideal.
Disadvantages:
Very strong
Because of the metal component, when the tooth is subjected to a direct blow, the
tooth will fracture, not the restoration. The prepared tooth is the one that will be
fractured.
Difficult to obtain superior esthetics
Mainly because of the metal component
Grayish discoloration of the gingiva
Because of the metal component (oxides of the metal) and irritation of the gingiva.
The oxide content of the metal, once released, will go inside the gingiva if the
gingiva is irritated.
Situations wherein the gingiva may be irritated:
Excess cement, Too bulky restoration, Restoration that impinges the gums
Less conservative tooth reduction because you have to reduce so much
More expensive than metal and acrylic crown
Compared with ceramics, ceramics is more expensive. But, if you are going to use
PFM made up of gold, it becomes more expensive. Gold prevents gingival
recession.
Complete Metal Veneer Crown
(Plain Metal Crown, Cast Full Veneer Crown, Shell Crown)
Made up of metal enritely.
Metal Crown
Specific Indications:
Teeth in a non-esthetic zone
For tooth in non-esthetic zone area only if the patient is okay with it.
An FPD or RPD retainer requiring maximum retention
Posterior teeth with a very short clinical crown
Patient with active caries and poor oral hygiene
A need to change tooth contour for RPD retention
This is a kind of crown that is used together with RPD
Deciduous teeth
Ones seen on anterior. You put a metal cap on anterior tooth of young patient just to
save the deciduous tooth mainly because eruption of permanent will be around 2
years. If you use a metal crown on a deciduous tooth, it is a non-preparation kind of
crown. Just fit in the pre-fabricated crown. No tooth prep. Just enclose it with a
crown until the permanent dentition is ready to erupt.
Additional Circumstances That Requires Full Metal Crown:
Abutment tooth with short crown
Long span edentulous space
For patient with greater than the normal occlusal forces
Abutment teeth alignment that requires full coverage to achieve adequate
retention
If maximum retention is required, you use metal crown.
Specific Contraindications:
Teeth in esthetic zone
Unless the patient requested for a metal crown.
Advantages:
It affords the most effective resistance and retention form
Can be used to make a relatively extensive alteration in tooth form and
occlusion
Conservative tooth reduction
Maximum reduction is 1.0 mm all over. (reduction can be limited to 0.3 mm)
Less chance of pulp exposure because reduction is minimal
Inexpensive only if you use a based metal alloy. If you use a precious metal, it will
be very expensive.
Very strong
Protects the coronal integrity of the natural tooth
PFM it is the natural tooth that will be fractured when the patient is subjected to
direct hit mainly because amount of reduction is much more.
Metal Crown it makes the tooth stronger, not making it liable to fracture mainly
because minimal amount of reduction is okay.
Provide favorable contour and guide plane for RPD
For posterior teeth
Ideal for patient with craniofacial anomaly
Ideal for posterior retainer of FPD
Buccal flute maybe develop for a preferred contour
Contact area can be coniently develop
Enable enhancement of embrasure area
Disadvantages:
Unaesthetic
Very strong (Only if you have reduced more than what is necessary.)
Limited to non-esthetic zone area
 More arduous tooth preparation Chipped and fractured tooth
The margin must be well-defined Diastema
Belated soft tissue response Replacement of anterior tooth (missing anterior)
Unreliable vitality test Short span edentulous space
Difficulty in developing axial contour Rotated and malaligned tooth
Difficult marginal adaptation Discoloration
Difficulty in detecting post cementation gingival caries
Less conducive to optimal gingival response Contraindications:
Time consuming restoration are critical for a favorable soft tissue response Parafunctional habits
Occlusion can be capricious without provisional seating Opposing porcelain restoration
Trial fitting is very important If the tooth is restored with porcelain and the opposing tooth would require a jacket
crown restoration, the material should be porcelain as well.
Acrylic Crown High caries rate
Made up of plastic. Compared with the ones used with temporary, this is being processed. Poor oral hygiene
It is subjected to heating (cooking procedure). Minimum heating time is 3 hours and can Severe crowding
reach up to 9 hours. This is made up of heat-cured acrylic resin. Long span FPD
Specific Indication: Advantages of Composite Crown
Treatment restoration High polishability
This is used while other treatment is being performed You can polish even at chair side.
Patient with edge to edge bite Porcelain must be returned to a technician for polishing
Very young patient Easy to repair at chair side
If the young patient dont want a metal crown, you use acrylic Long term luster
Patient with excessively deep bite Exceptional esthetics but not as good as ceramics
Reinforced strong margin only if you add metal but usually, we dont.
Advantages: Metal free
Cheap Color stable
100 to 150 pesos Not really. In this case, its the length of time that the color will not change. This will
Conservative tooth reduction change in 5 years
This is not lasting. The most is 2 years Excellent margin adaptation
Increased durability
Disadvantages: Excellent surface finish longevity
Difficulty in shade matching High tensil and shear strength
Available only in 5 shades
Low wear, tear and abrasion [resistance]
Easily discolored
Poor marginal fit
Disadvantages of Composite Crown
Poor dimensional stability
More tooth reduction
Wear off rapidly
High allergy risk
Could be abraded by brushing or by any other instrument
Technical difficulty in fabrication (not our concern but the technicians)
Increase coefficient of thermal expansion
It expands when the patient drinks hot beverages which could cause displacement. Difficult to modify color once bonded in-placed (has to be replaced)

Acrylic Veneer Crown Platinum Bonded Porcelain Crown (obsolete)

Initially there is a metal crown and the porcelain is just cemented.
(Acrylic Fused To Metal Crown)
Before: The metal frame is fabricated and later the porcelain is just cemented.
Combination of acrylic and metal
Nowadays, what we have is the porcelain and the metal fabricated together at the same
time.
Specific Indication:
Badly broken down abutment teeth of patient with edge to edge bite Cast Metal Crown With Cemented Porcelain Facing (obsolete)
Badly broken down abutment teeth of patient with excessively deep bite Difference is just the kind of metal that was used.

Composite Crown Composite Faced Crown (obsolete)

- Solidex Crown Metal and then composite on the surface.
- Belle Glass Crown
Bonded Alumina Crown (obsolete)
These are not available in the Philippines. What we have is the Ceramaj.
Composite crown is more expensive than PFM crown that is made up of based metal alloy In all these, porcelain or composite material is just bonded and may only last for months.

Indications: