Dr.

Mohamed Abd-el Aziz

Presented by

Dr. Mohamed Abd-el Aziz

Lecturer of Fixed Prosthodontics

At the initial examination, it is important to make a full assessment of the appearance of each patient, noting which areas of which teeth show during smiling, talking and laughing. The patients esthetic requirements must be discussed and related to oral hygiene needs and the potential for disease. The final decision regarding an appropriate restoration can then be made with the full cooperation and informed consent of the patient.

The poor appearance of some metal-ceramic restorations is often due to :

Insufficient porcelain thickness. The labial margin of a metal-ceramic crown is not accurately placed.

To correct these deficiencies, certain principles are recommended during tooth preparation that will ensure sufficient room for porcelain and accurate placement of the margins.

(a) Facial tooth reduction :

Two principles should be fulfilled during facial tooth reduction to obtain excellent esthetics: Adequate thickness of porcelain is needed to create a sense of color depth and translucency.

 The labial surfaces of anterior teeth should be prepared for metal-ceramic restoration in two distinct planes.

If they are prepared in a single plane, insufficient reduction in either the cervical or the incisal area of the preparation will result.

(b) Incisal reduction:

An incisal reduction of 2 mm is recommended for good esthetics. The incisal edge of a metal-ceramic restoration is constructed with no metal backing and can be made with a translucency similar to that of natural tooth structure. Excessive incisal reduction must be avoided because it will reduce the resistance and retention form of the preparation.

(c) Proximal Reduction :

The proximal surfaces of an anterior teeth will look most natural if they are restored as the incisal edges, without metal backing. This will allow some light to pass through the restoration in a manner similar to what occurs on a natural both.

(d) Labial margin placement :

Although supragingival margin plcement has many biologic advantages, subgingival margins may be indicated for esthetic reasons.

The patients smile is observed as part of the initial examination. It is important to record which teeth and which parts of each tooth are exposed.

 Patients with high lip line, which exposes considerable gingival tissue, present the greatest problem if complete crowns are needed. The tooth can be restored with a metalceramic restoration having a supragingival porcelain-labial margin.

If the patient has a low lip line, a metal supragingival collar may be placed because the metal is not seen during normal function.

 Whenever possible, partial-coverage restorations are preferred, not only because tooth structure in conserved but also because no restorative material can approach the appearance of intact tooth enamel. Esthetic partial-coverage restorations depend on accurate placement of proximal and facial margins.

 The proximal margin should be placed just buccal to the proximal contact area, where metal will be hidden by the distal line angle of the neighbouring tooth.

 Tooth preparation angulation is critical and should normally follow the long axes of posterior teeth and incisal two thirds of the facial surface of anterior. If a buccal or lingual tilt is given to the tooth preparation, metal may be visible.

(2) Facial margin:

The facial margin of a maxillary partialcoverage restoration should be extended just beyond the occlusofacial line angle. If the buccal margin is skilfully placed following the original cuspal contour, the final restoration will have an acceptable appearance.

 Anterior partial-coverage restorations can be fabricated with no metal display, but their preparation requires considerable care. The facial margin is extended just beyond the highest contour of the incisal edge but not quite to the incisolabial line angle. Here the metal will protect the tooth from chipping but will not be visible.