RBB
Preparation:
• Axial➔0.5mm • Occlusal Rest➔1mm • Proximal Groove➔0.5mm
• 180° Wraparound➔Posteriorly only (to avoid metal display anteriorly)
• Finish Line➔Chamfer 0.3-0.5mm thick, 1mm coronal to gingival Crest
• Lingual cusps may be covered in Lower premolars (short clinical crown)
All Ceramic RBB:
• Thickness: Optimum➔0.7mm, Minimum➔0.5mm
• Connector: Vertically➔3mm, Horizontally➔2mm
E-max connector should be 2.6 times larger than Zirconia
• Macro-Mechanical:
Rochette Virginia Duralingual
Flared Perforation Water Soluble Crystal Nylon Mesh
(150-250µ)➔ Voids (on Lingual & Proximal)
• Weakening • Wearing • 0.5mm no crystals • Technique Sensitive
• Stress Concentration at margin➔Adaptation • Thick Lingually
• Limited Retention • No Long Term Result
Precious & Precious & Precious &
Non-Precious Non-Precious Non-Precious
• Micro-Mechanical:
Maryland (Electrolytic) Chemical Etch Sandblasting
Etched Cast: Nitric acid & Nitric & HCL acid 250µ Alumina - 30s - 2bar,
Electricity➔Porosity 20mins➔Porosity then Ultrasonic bath 10mins
• High Retention • Simple • ⬆Surface Area & Energy
• Highly Polished • Reliable ⬆Wettability
• Thin Retainer: ⬇Flexing • Remove Contamination
• Technique Sensitive
• Time Consuming
• Contamination➔Failure
Non-Precious Non-Precious Precious & Non-Precious
• Alloys & Techniques:
Precious Only Non-Precious Only Precious & Non-Precious
• Tin Plating • Maryland • Duralingual • Rochette
• Adlloy (Ga-Sn) • Chemical Etched • Sandblasting • Virginia
• V-Primer • Conc. Nitric Acid • Ion Coating • Silicoater
• Heating the Alloy • Tribo-Chemical Silica
• Alloy Primer
• Ion Coating surface treatment➔Sputtering Phenomenon
Overalays
• Vonlays cover Buccal & Occlusal, especially in Premolars
• Occlusal Veneers:
For: Over-Eruption, Erosion, Attrition, Abrasion, to increase vertical dimension
Preparation: • Central Fossa➔1.2mm • Cusp Tip➔1.8mm
• Finish Line➔1mm Chamfer • Convergence➔8°
Preparation (Overlays, Onlays, Inlays):
• Occlusal: Composite, LDS➔1-1.5mm, Feldspathic, Leucite➔2-2.5mm
• Finish Line➔1mm Chamfer • Depth➔1.5mm
• Ismuth width(Composite, LDS)➔2mm • Divergence➔6-10°
• Axial Wall Thickness: Vital➔2mm, Non-Vital➔3mm
• Margins away from occlusal contact➔1mm • CSA➔90°
Endocrown
• Cement: Dual cure adhesive resin • Abrasion: Not Indicated
• Axial Wall Thickness➔1.5-2mm • Divergence➔7-10°
• Extension into root canals (Saddle)➔2mm • Depth➔3mm
• Butt Design: Reduction➔2mm, Slope➔not more than 60°
• Ferrule Design: Finish Line➔0.8-1mm Shoulder/Deep Chamfer
Failure
• Most common cause of failure: Caries (36% of Biological Failure)
• Caries➔Bad taste, Bad breath, Bad esthetics, Pain, Loose retainer
• Cervical Fracture (Semilunar):
Facial➔Edge to Edge bite, Sharp preparation, Short inciso-gingival height
Lingual➔Deep bite, Heavy occlusal bite, Insufficient lingual reduction
• Primary occlusal trauma➔Premature contact on Sound PDL
Secondary occlusal trauma➔Premature contact on Affected PDL
PDL
• Free gingival graft aim to increase gingival width
• Minimal distance between crown margin & bone crest➔3mm
• Bone Sounding is used only with Healthy gingiva
• Subgingival finish line➔0.5-1 mm into the sulcus
• All proximal contact are located occlusally & Buccally, except: Upper 6 & 7
• All height of contour are located in cervical 1/3, except: Lower molars (lingual)
Veneer
,
• Preformed: Composite veneers➔Edelweiss
Ceramic veneers➔Lumineers (0.2-0.3mm Cerinate, No Drilling No Shot)
• Ceramics can’t be re-fired after removal from its support, except IPS Empress
• Desired thickness of Porcelain veneer➔0.5 - 1.5 mm
• Cingulum & Lingual marginal ridge➔more than 80% of a tooth strength
• Silane coupling agent improves bond strength by: 30-50%
• If Diastema gap=X, Then: Centrals reduction=X/2, Laterals reduction=X/4
• ⬆Die Spacer➔⬆Cement➔⬆C factor➔Post-Bonding Fracture
• Thickness: not more than 2mm➔Porcelain veneer
more than 2mm➔Lithium Disilicate(Emax) veneer
more than 3mm➔Full coverage all ceramic
Preparation: • Proximal➔0.5mm • Lingual➔0.5-0.7mm
• Facial➔0.3-0.5mm (Cervical, Thin enamel, Lingo-version)
0.5-0.8mm (Middle & Incisal, Thick enamel, Labio-version)
• Incisal➔1-1.5mm Upper Incisors
(75°) 1.5-2mm Lower Incisors & Canines
• Mask Discoloration reduction➔0.2mm reduction/vita shade
If more than 0.7mm➔Emax Super Veneer, Crown
Implants
• Osseointegration (3-6months): Mandible➔3-4months, Maxilla➔5-6months
• Delayed Implant: 3months after extraction • Cover Screw: left for
3-6months
• Healing Abutment (at least 2mm): left for 2-3weeks
• Min. facio-lingual bone:=Implant diameter + 2mm(1.5 facial+0.5 lingual)
• Bone Necrosis➔above 47° • Atrophic Maxilla➔Zygomatic implant
• Counter Sink (Anterior)➔3mm below Gingival Margin, 2mm below CEJ
Posterior maybe flushed with bone
• Distance between 2 implants 3mm • Distance between implant & nerve 2mm
• Distance between implant & tooth 1.5mm
• For Thin diameter implants use One piece implant
• Thin ridge➔Blade/Plate Endosteal implant (Wedge, Vent, Slot)
• The most important factor for osseointegration➔Primary Stability
• Decrease Lateral Forces: Anterior➔Shallow Anterior Guidance
Posterior➔Decrease Cusp Inclines
• CHS less than 8mm or more than 12mm➔Screw retained
less than 8mm: No Frictional Retention, more than 12mm: Vertical Cantilever
• Crest Module➔Anti-rotational for Abutment
• Apex➔Anti-rotational for Implant
• Hybrid Prosthesis➔replaces both Teeth & Resorbed Ridge
• Hybrid Abutment (Two piece abutment)➔Ceramic Abutment + Ti Base
• Hybrid Abutment Crown➔Crown & Abutment are One piece + Ti Base
Cements
• Ideal Film Thickness➔20-40microns
• Varnish: Zn Phosphate➔on Tooth, G.I.➔on Margins(after excess removal)
• Dilatant(⬆Shear rate of mixing➔⬆Viscosity)➔Zn Phosphate
Pseudo-Plastic(⬆Shear rate of mixing➔⬇Viscosity)➔Zn Polycarboxylate
• Insoluble➔Composite Resin, Activa(Pulpdent)
• Setting phases of G.I. : Ion Leaching➔Hydrogel➔Polysalt
• The most important factor affecting working time➔Temperature
• Used when Glossy (free COOH for chemical bond)➔ Zn Polycarboxylate, G.I.
• Water settable polycarboxylate(to ⬆working time)➔Zn Polycarboxylate,
G.I.
• G.I. + Water soluble polymers➔RMGI
G.I. + Calcium Aluminate➔ Hybrid G.I. (Ceramir)
• Not used with All Ceramic (Glass Ceramic) to avoid porcelain fracture:
G.I.➔⬇Modulus of Elasticity (not stiff), RMGI➔ Water Sorption (expansion)
Film thickness:
• Thin➔Zn Phosphate, Zn Polycarboxylate, GI, Adhesive composite resin
• Thick➔ZnO/E, Conventional composite resin
• Short Working Time➔ZnO/E, Zn Polycarboxylate, Conventional Composite
Ceramics
•Ceramic Steel = Zirconia
• Zirconium Silicate➔Zircon • Zirconium Oxide➔Zirconia
•Translucent & Fully anatomical Zirconia is Cubic based
• Zirconia fabrication: Milling Only
Fully Sintered(White Stage)➔Wet, Pre-Sintered(Green Stage)➔Dry
• Transformation Toughening➔Polycrystalline Ceramics (PSZ) (Y-TZP)
Shear strain➔Tetragonal➔More Voluminous Monoclinic➔⬇Cracks
• Glass Ceramics: Glass/Vitreous/Amorphous phase➔Translucency, Etching
Crystalline phase➔Dispersion Strengthening
•Monobond Etch & Prime (Etch & Silane in 1 step) is used with Glass Ceramics
• All Hybrid ceramics are surface treated by: Sandblasting, except:
Vita Enamic➔HF acid 60s
• Refractory die technique: Duplication➔PVS impression
Divestment➔Glass beads sandblasting
• Extra-oral Scanners: Contact➔Mechanical, Non-active
Non-Contact➔Optical, Active (Triangulation)
Biological
• Accepted Marginal Discrepancy: Cast Metal➔50um, Ceramic➔120um
• Opticlean: Rotary conical➔remove excess temporary cement by Abrasion
• Weak Cusps=Walls thinner than ½ their height➔tend to wedge,
go for Onlay or Overlay instead of Inlay
• Vertipreps = Indefinite FL = Feather Edge FL = Knife Edge FL
• In case of heavy proximal contact place the margin Subgingivally
Tissue Dilation:
• Non-impregnated cords (Mechanical)➔Not left more than 24 hrs
• Impregnated cords (Mechano-Chemical)➔left for 5-10 mins
★The Safest➔Alum(Aluminum Sulfate)
• Cordless [Expasyl(Aluminum Chloride), Gel Foam]➔left for 2 mins
Esthetics
Proportions:
• Collective teeth (Inter-dental): Golden proportion, RED, 2&1 and 1.5&1 Rule
• Single tooth (Intra-dental): Chu’s
• Chu’s:Upper Centrals➔75-80%, Lower Centrals➔60%
• Horizontal Symmetry➔Cohesive, Radiating Symmetry➔Segregative
Digitization
Systems:
• Chair-Side full system (In office milling):
In-Office CAI➔In-Office CAD➔In-Office CAM
• Chair-Side scanners only (Lab milling) Integrated/Centralized:
In-Office CAI➔Lab CAD & CAM
• In-Lab/Lab-Side milling systems:
Physical impression➔Lab Extra-oral Scanning, CAD & CAM
CAD/CAM tools:
• Incisal Variation➔Surface texture & characterization
• Smile Design➔Incorporate 2D & 3D • Scale➔Resize (Narrow or Widen)
• Reduce➔Cut back to allow veneering • Grid➔Alignment & Symmetry
