001 Crowns Lecture

7/25/2019 001 Crowns Lecture

1/62

PPA 2ndInternational ConferencePeshawar

27 to 30 September 2013


2/62

INTRODUCTION TO CROWNS

Dr Fazal GhaniBSc, BDS (Pesh), MSc, PhD (London), FDS RCPSGlasg

Department of Prosthodontics

Kh!er Colle"e of Dentistr Pesha#ar


3/62

Relevance of Knowin ! "oin

Clinical ! #echnical Practice $$$$$

%illers& P'ramidof (earnin ! "oin

Awareness(evels)nderpinnin*iher (evelsof


4/62

%iller&s P'ramid or Prism of Knowin! "oin+

Knows "oes

#raditionall' , staes-

#wo .nderpinnin staes of awarenesslevels .s.all' occ.r before one "knows".

#he /rst two staes, knows ! knowshow, can be assessed .sin thetraditional assessment tools of ritten

and Viva / Oral Examinations-*owever nowin& and nowin how&

clearl' do not necessaril' e4trapolate tothe application of knowledge in the

workplace / clinical practice.


5/62

Clinical ! #echnical Competence+It is the 5"oes #rianle6 that indicatesthat the doctor is tr.l' Performin-


6/62

8cac' of

ect.re inmpartinearninracticin sills


7/62

#'pes of "ental Restorations+Dental restorations designed to do specifcjobs.

May be: - Direct or Indirect.- Intra-coronal or Extra-coronal.- Metallic or Non-metallic (Tooth-

colored.Sealants+ !hite flling "o#-able materialsto fll the caries s$sceptible groo%es o&

posterior teeth in children '-) years (apre%entati%e proced$re.9illins+ *old+ ,g-g+ ements (/n012+3ilicate+ *I+ omposite resin fllingmaterials. 0laced directl into the re ared


8/62:IC 9illin


9/62

Inla's+ 3ame as fllings b$t pre-made piecesbonded into the tooth res$lting in s$periorphysical properties #ith a li&espan 7-8 times

longer than a composite flling. 9etteralternati%es to a flling. Traditionally gold alloyhas been $sed &or inlays+ b$t no# ceramics 5rein&orced composite are $sed.;nla's: 4sed in sit$ations #here the tooth is&ract$red or has been se%erely #ea6ened.1nlay is similar to inlay except that it co%ers

the entire or most o& the occl$sal s$r&ace.4nli6e a cro#n+ it does not co%er the &acial ling$al str$ct$re. No need to grind a#ay sideso& the tooth $nless there is a specifc reasone.g. caries.


10/62

:old Allo' Inla' ! ;nla'


11/62

9iber


12/62

Porcelain Inla'


13/62orcelain ;nla' = ;verla' = Partial Crown


14/62

Inla's = ;nla's = ;verla's


15/62

>eneers+Thin porcelain or composite &acingsthat co%er the &acial s$r&aces o& teeth. 4sed

cosmetically to change the length+ color 5shape o& teeth.

Crowns ?@Cap@+ 4sed #hen there is limitedtooth str$ct$re le&t+ #hen an existing cro#nm$st be replaced+ or #hen the tooth is an;anchor; tooth &or a fxed bridge.

Brides+ iber-rein&orced composite+eramic+ /irconi$m-based ceramic 5 metal-ceramic (0>M.


16/62

Implants+Titani$m posts s$rgically placedinto the ja#bone to s$pport a dental prosthesis(single cro#n+ >0D+ remo%able dent$re or

maxillo&acial prosthesis.Removable Partial "ent.res+


17/62


18/62

Crowns = Caps+

,rtifcial restorations cemented o%er theremaining part o& prepared teeth to gi%e them

strength+ shape 5 shade o& nat$ral teeth.3$pport and impro%e teeth that are grossly

cario$s+ damaged+ mal&ormed+ mal-posed+disfg$red+ crac6ed+ or discolored.

0rotect eroding teeth &rom &$rther damage ordecay.

Made to loo6 li6e nat$ral teeth.


19/62

C # i ll R d d 9


20/62

Crowns are #'picall' Recommended 9or+

- 9ro6en Teeth+ Excessi%ely #orn teeth.

- Teeth not s$ccess&$lly treatable #ith dental

fllings.- Impro%ing the esthetics o& discolored 5 flled

teeth.

- 0rotecting 5 restoring root flled teeth.

- 0Ds 5


21/62


22/62

Before and After Crownin of


23/62


24/62


25/62

Crown asBrideRetainer

Bride


26/62

Indications for Crowns+

To protect #ea6ened tooth str$ct$re. To restore the tooth to &$nction.

To impro%e or restore aesthetics.

To act as retainer &or fxed bridge#or6.

o#e%er+ recent de%elopments in dental

materials mean that the $se o& lessdestr$cti%e alternati%es s$ch as %eneers+onlays+ 5 s$itably designed plastic

restorations are o&ten an option.


27/62

Alternatives to "ental Crowns+Minimal Inter%ention Dentistry (MID.

onser%ati%e approach by frst selecting: - Treatments that are less in%asi%e 5

destr$cti%e to tooth str$ct$re.

Preparin a tooth for a crown reD.ires+ - remo%ing a &air amo$nt o& nat$ral tooth

str$ct$re.1pting &or an alternati%e treatment can: - 0re%ent the occ$rrence o& s$ch a damage. - 3ignifcantly red$ce the o%erall treatment

cost.

Alternatives to "ental Crowns+


28/62

EEEEE Alternatives to "ental Crowns+I& a more conser%ati%e treatment can be

per&ormed sa&ely 5 e?ecti%ely+ it is a better

option.9iomimetic restorations better than cro#ns.3imple treatments o& great help &or people #ith

monetary constraints #ho may not completely

#ithdra# the need &or cro#n+ b$t can postponecro#ning &or some time.

9e&ore opting o$t &or a cro#n+ it is right to #onderi&:

- That is the only option.- 0atient #ants to delay cro#ning 5 opt &or a lessexpensi%e approach.

- ,n alternati%e one is a%ailable 5 is s$itable.

- The res$lts may not be o& short-term nat$re.

Alternatives to Crownin of #eeth+


29/62

EE-- Alternatives to Crownin of #eeth+"ela' dental treatment+- not good i& tooth cario$s+ bro6en or trapping &ood.Provision of #emporar' #reatment+- >inancial constraints+ Temporary restoration can

delay cro#n. 3$ch patients sho$ld &ollo#preca$tionary meas$res to a%oid &$rther damages.

9illin+ 3imple or pin-retained (Aarge lesion BBB. Most flled teeth e%ent$ally need cro#ing BB.

4tract the tooth+ (9ad option+ onseC$ence o&no treatmentB ,nd Treatment is more costly.

Inla' ;nla' ! ;verla'+ 3$bstantial portion o&tooth str$ct$re missing ($sps+ 1ccl$sal s$r&aces.

Alternatives to Crownin of #eeth+


30/62

EE-- Alternatives to Crownin of #eeth+"F#A( IF(AGS+- 4sed to treat teeth #ith decay or damage lying

#ithin the occl$sal s$r&ace bet#een c$sps."F#A( ;F(AGS = ;verla's+- 4sed to treat decay or &ract$re extending to one or

more o& the tooths c$sps.Composite Reb.ildeneers+- Extreme stains or small abrasions on teeth+ ,I 5 DI."ental Bondin+- >or small &ract$res+ replacing old eroded fllings+

small sied ca%ity.Bleachin+ Tooth #hitening agents $sed to bleach

stained teeth to impart nat$ral #hiteness.- Not a permanent remedy+ b$t a simple+

inexpensi%e 5 attracti%e option.


31/62


32/62

Bleachin

Porcelain onla's


33/62

Before After

Composite resin b.ild


34/62


35/62

omposite 9$ild-$p Feneering

Crown #'pes+


36/62

Crown #'pes+

Extra-coronal restoration ft aro$nd remaining o& atooth.

>ixed o%ering G H o& the coronal portion o& tooth.Several t'pes+ *old+ Ni-r+ 0orcelain+ ,crylic+ or a

combination o& these materials+ 3tainless steel+,l$min$m+ 0olycarbonate+ $stom+ 0re&ormed+

Defniti%e+ Interim+ 0ro%isional.Partial Crown+

, cast metal restoration co%ering more than hal& b$tnot all o& the toothJs clinical cro#n.

In most instances+ the &acial s$r&ace o& the tooth is notdist$rbed &or esthetic reasons.

Named according to the &raction o& the clinical cro#n itco%ers. Examples incl$de:

- al&+ Three-C$arter + >o$r-f&th+ 5 3e%en-eighth.


37/62

#emporar' Crowns


38/62

P9% = %C Crowns


39/62

Implant


40/62

K ro#n ,nterior K ro#n 0osterior

Complete Crown+


41/62

Complete Crown+

o%ers the entire anatomy o& tooths clinicalcro#n.

Several t'pes-

Interim or Defniti%e+ ast or 0re&ormed.

,ll-metal or alloy+ s$ch as ,l$min$m+ *old+ Ni-

r+ 3tainless steel+ or plastic+ rein&orced resinor porcelain.

, complete %eneered cro#n consists o&complete coronal co%erage o& the tooth #ith ametal s$bstr$ct$re o%erlaid #ith:

- 0orcelain (0>M M ro#n or resin &oresthetic

e?ect.


42/62

9.ll Cast :old


43/62

Toothcolormaterial

Metal

Post


44/62

Post


45/62

$stom made post core constr$cted by thedental technician acc$rately fts the shapeo& the prepared root canal. The post is

placed into the root canal and cemented inposition+ ready &or the cro#n to be attached.

, pre&abricated post in metal+ fber-rein&orced

polymer or irconi$m can also be ftteddirectly into the root canal.

I& a root-flled tooth is not completely bro6endo#n+ it may be possible to b$ild it $p #ith

a core $sing restorati%e materials. ThisJcoreJ is then prepared in the same #ay as anat$ral tooth 5 impressions made to

&abricate cro#n ftting o%er the core.

All ceramic mpress Crowns+


46/62

All


47/62

CA"


48/62

(A>A CR;FS Hirconi.m 9K+ CA"


49/62

CA"


50/62

Parallel sided threaded post forwhich the root canal is pre


51/62


52/62

9actors In.encin #he Selection of #he


53/62

Crown #'pe+

!here cro#ning is in the patientJs best interests the

type o& cro#n pro%ided #ill $s$ally depend onthe :

- &$nctional reC$irements.

- strength 5 %itality o& the remaining tooth.

- patientJs aesthetic demands.- patientJs real or imagined concern.

- biocompatibility o& cro#n material.

All


54/62

Porcelain Jacet Crowns ?PJC+


55/62

- indicated in areas o& critical aesthetics.

- b$t problems o& &ract$re $nder occl$sal load limit their$se to anterior teeth.

*ih Strenth Porcelain Crowns ?*SPC+

Do not need a metal s$bstr$ct$re+ $sed on posteriorteeth 5 in certain selected cases &or bridge#or6 ($pto8-$nits.

o#e%er+ not all systems are s$itable &or these p$rposes.

0reparation design &or 30 is important 5 destr$cti%e.

Eno$gh tooth tiss$e needs to be remo%ed to permit anadeC$ate thic6ness o& porcelain core.

>or boded porcelain cro#ns+ the degree o& taper sho$ldbe greater than &or a con%entionally cemented cro#n.

,ll corners 5 line angles need to be ro$nded to allo#$nhindered+ passi%e seating o& the cro#n.

Resin Bonded Porcelain Crowns


56/62

?RBPC+

No rein&orcing ceramic core.

4nli6e ceramic %eneers co%er all s$r&aces

o& tooth.

3trength largely rely on the resin bond.

Excellent aesthetics.

Aess destr$cti%e prep than &or 0Ls or 0>M

cro#ns.


57/62

?P9%+,lso called metal-ceramic (M cro#ns.

Most %ersatile combining strength #ithaesthetics.

Destr$cti%e tooth prep (space &or metal 5

porcelain.Tooth prep design+ partic$larly the

distrib$tion o& porcelain+ needs to becare&$lly planned.

Metal s$r&aces reC$ire less tooth prep 5easier to constr$ct 5 adj$st+ 5 do notchip li6e porcelain.

0orcelain co%era e onl $sed &or aesthetics

. 0>M ro#ns:


58/62

I& &$ll porcelain co%erage is reC$ired &or a 0>Mthe amo$nt o& tooth preparation may be

red$ced slightly by $sing a special metalcomposite coping (apte6+ 3chottlander+Aetch#orth+ 4. This type o& coping is O.O.7 mm thinner than a cast coping made &roma noble metal alloy.

Composite Crowns+

4se ne#ly de%eloped laboratory materials.

a%e not been &$lly e%al$ated.

3pecifc indications 5 limitations ha%e yet to bedefned.

Tooth prepared in the same #ay as &or a 30.


59/62

Capte Crown made b' the capillar'castin technolo'


60/62

Preparation feat.res of a ma4illar' centralincisor for+

a P9% crown b PJC and c Resin bonded


61/62

Sections ?a4ial and transverse thro.h an .pper/rst premolar showin how a loical .se of metallessens the amo.nt of tooth red.ction+ a Porcelain

restricted to b.ccal c.sp b Porcelain coverin


62/62

Thank You

Documents

001 Crowns Lecture