Restoring primary anterior teeth with esthetic crowns


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Restoring primary anterior teeth with esthetic crowns

  1. 1. Sung-Ki Kim Pusan National University CDC Haeundae Children’s Dental Clinic Korea
  2. 2. Requirements for Primary Anterior Crowns
  3. 3. Strip crown Open-faced SS crown discoloration total failure chipping Durable △ Retentive O Esthetic X Durable X Retentive X Preveneered SS crown Durable △ Retentive O Esthetic △ Esthetic O
  4. 4. WHAT IS ZIRCONIA? • Physical property : close to metal • Color : tooth-like • “Ceramic Steel”
  5. 5. Its physical, mechanical (i.e., high strength, hardness, wear resistance, resistance to corrosion, modulus of elasticity similar to steel, coefficient of thermal expansion similar to iron, and elevated fracture toughness) and chemical properties make zirconia a material of interest for biomedical sciences.
  6. 6. Scanning electron microscopy(SEM) observation of fibroblasts cultured on zirconia : cells grow on the whole zirconia surface, covering it with a cellular layer.
  7. 7. Place subgingivally
  8. 8. Zirconia as a material for dental crowns • Behaves as an antibacterial shield • Improves cellular adhesion and proliferation of fibroblast • Generates gingival attachment and reconstruction of the papilla
  9. 9. Advantages of zirconia crowns • Esthetics in addition to strength • Biocompatibility • Chair-time decreased • No impression : only 1-visit
  10. 10. Resin-bonded luting has proved to be the best choice for Zr-ceramic restorations, although the use of conventional cementation may also be permissible.
  11. 11. Zirconia crowns for primary anterior teeth • Strong adhesive strength like permanent crown is not necessary • Bleeding • Passive fit : hard to hold the crown in the proper position Recommendation : Light-cured cement (resin or GIC)
  12. 12. Dental wear
  13. 13. Dental wear is defined as tooth loss or surface damage caused by direct contact between teeth or between teeth and other materials. Dental wear, one of the physiological phenomena that are experienced in a The surface hardness and friction coefficient are lifetime, occurs as a complex form of chemicalof commonly used to estimate the degree of wear and mechanicaldental materials. Conventionally, greater restorative wear. Accordinghasscientific studies, however, there is no hardness to been believed to cause more wear. significantmore wear was expected from zirconia, as Therefore, correlation between the restoration hardness and the degree of wear of antagonistic teeth. zirconia has strong surface hardness. On the other hand, the degree of wear is more affected by the surface structure and the roughness of the restorations or environmental factors.
  14. 14. Wear of Pediatric Enamel by Different Ceramic Materials (Pilot Project) Gary Frey, DDS Davette Johnson, DDS Houston Center for Biomaterials and Biomimetics University of Texas School of Dentistry at Houston 7500 Cambridge St. Suite 5350 width height Houston, TX 77054-2008 Stylus Material X-axis wear Y-axis wear Depth 1 Zirconia 93.6 microns 98.8 microns 46 microns 3 Zirconia 118.2 microns 110.6 microns 112 microns 5 Zirconia 93.2 microns 75.1 microns 75 microns 7 Zirconia 94.8 microns 85.3 microns 41 microns 2 Alumina 100.2 microns 95.3 microns 42 microns 4 Alumina 101.6 microns 88.3 microns 57 microns 6 Alumina 94.3 microns 105.0 microns 54 microns 8 Alumina 87.3 microns 95.3 microns 66 microns Using a Leinfelder style in-vitro wear-test apparatus, 800,000 cycles
  15. 15. Material X-axis wear (mean/year) Y-axis wear (mean/year) Depth (mean/year) Zirconia 24.87 ㎛/year 23.03 ㎛/year 17.12 ㎛/year Alumina 23.96 ㎛/year 23.99 ㎛/year 13.70 ㎛/year Zirconia is not harmful Normal wear rates of enamel : 8-30 ㎛/year (depending on the study)
  16. 16. Post-treatment(immediate) 2010.03.1 5 1M 3M
  17. 17. 8M 10M 13M 1Y 9M
  18. 18. 2Y 2Y 5M 2Y 8M 3Y 3M, last week
  19. 19. No excessive attrition
  20. 20. Clinical Cases
  21. 21. 2011.05.27 Palatal view not fully erupted Restored with composite resin
  22. 22. 3M after treatment Palatal view
  23. 23. 6M after 1st. treatment Palatal decay is found Notice : axis of tooth is inclined palatally Axis of tooth is corrected
  24. 24. 10M after 1st. Treatment / 2M after last treatment 1Y after 1st. treatment/ 4M after last treatment 1Y 8M after 1st. treatment/ 1Y after last treatment 1Y 4M after 1st. treatment/ 8M after last treatment
  25. 25. 2Y after 1st. treatment/ 1Y 4M after last treatment No excessive attrition
  26. 26. 2010.09.10
  27. 27. Post-treatment(immediate) 1M not corrected yet 2M : crossbite corrected 4M : occlusion is stable
  28. 28. 7M 1Y 3M 1Y 2Y 4M
  29. 29. 2Y 4M No excessive attrition
  30. 30. After cementation. asymmetric Reduction of incisal edge 3M
  31. 31. Buccal view 2013.04.30 Pre-treatment occlusion
  32. 32. Preparation(more than that of SSC)
  33. 33. Post-treatment(immediate) Post-treatment occlusion
  34. 34. Buccal view Slight marginal exposure 1 week later occlusion
  35. 35. Summary Esthetics in addition to strength Biocompatibility No excessive attrition
  36. 36.