Three tips for All-Ceramics restoratives used to meet patient expectations

All-ceramic materials for restoring teeth in the anterior arch has soared over the past decade. Advancements in material science and increased patient demand for metal-free dentistry have been among the drivers behind the surge. Two of the most popular materials used by clinicians today for restoring teeth in the esthetic zone are zirconia and lithium disilicate. What used to be a choice between restorative strength or restorative beauty has been nullified by the latest advancements in indirect tooth-colored materials that are both strong and esthetic. Today, we are able not only to meet patient expectations for natural-looking restorations that match surrounding dentition, but also restore teeth with materials that have a proven track record for strength, beauty and longevity.

So which material should you use if restoring teeth in the anterior segment…zirconia or lithium disilicate? It depends on what you are trying to achieve and on the patient’s expectations. If it is a single tooth, will you be trying to match adjacent natural teeth or blend the restoration with teeth previously restored with a crown or veneer? If it involves multiple teeth, is the patient a bruxer or one who has no destructive oral habits? It is a balancing act between beauty and strength. If strength is the primary objective, then a highly esthetic zirconia material is the hands-down choice. If beauty is the driver and high strength of less concern, then lithium disilicate is the obvious choice. 

Zirconia can be either cemented or bonded. So how do you know which adhesive method to use? The decision you make should be driven by the preparation. If you are seating zirconia restorations on a preparation that is retentive, then luting with any RMGI (resin modified glass ionomer) is fine. However, if the preparation is not mechanically retentive, meaning the preparation is over angulated, over prepped or is a short clinical crown, then the restoration must be bonded. Retention is your key to deciding when you should lute or bond your zirconia restorations.

Before you seat any restoration, be sure to thoroughly clean the preparation site with an oil- and fluoride-free prophy paste. An unclean or contaminated bonding surface can jeopardize the strength of the bond between the tooth and the restoration and lead to the possibility of debonding or, worse, restoration failure. So be sure that all the temporary cement, blood, saliva or any other contaminants are removed from the preparation before you begin the adhesive process.

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