Quick reference/description
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Unacceptable appearance of the teeth
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Loss of normal function
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Progressive tooth wear resulting in pulp necrosis and/or difficulty in teeth restoration
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Conventional fixed restorations
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Removable onlay/overlay prostheses
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Minimal preparation adhesive restoration
Overview (see Table 1)
Indication | Application | Contraindication | Advantages | Disadvantages | ||
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Conventional fixed restorations | Worn and broken teeth | Fixed restoration of dentition requiring reorganisation of dental occlusion | Parafunctional clenching and grinding | Versatility with regard to appearance and occlusal form Can be used as provisional crown | Invasive procedure High cost and skill demands | |
Removable onlay/overlay prostheses | Moderate/severe tooth wear Missing strategic teeth | For patients with more severe forms of tooth wear | Parafunctional clenching and grinding | Simple Non-invasive Cost-effective Maintenance of alveolar bone and support Improved sensory feedback Masticatory performance Reduced psychological trauma of tooth extraction | Space demands are usually greatest The abutment teeth are at an increased risk of primary dental disease Risk of root surface caries | |
Minimal preparation adhesive restorations | Cervical tooth wear | Aesthetics sensitivity Prevention of further tooth wear | Parafunctional clenching and grinding | Minimal tooth preparation Better aesthetics | Micro-leakage Marginal Discoloration of the restoration Restoration longevity | |
Anterior tooth wear | Palatal tooth wear | To offer some resistance to further palatal tooth wear which will reduce the risk of significant enamel fractures | ||||
Incisal/palatal tooth wear | Worn upper anterior teeth | |||||
Labial/incisal/palatal tooth wear | For patients with particularly compromised dentitions | |||||
Posterior and generalized tooth wear | Full mouth reconstruction of the dentition |
Materials/instruments
Conventional fixed restorations
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Porcelain-fused-to-metal (PFM) crowns
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All-metal crowns
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All-ceramic crowns
Removable onlay/overlay prostheses
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Acrylic resin
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Composite resin
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Cobalt–chromium framework
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Gold alloy framework
Minimal preparation adhesive restorations
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Composite resin
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Glass ionomer cements
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Resin modified glass ionomer cements
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Dentin bonding agent
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Resin-bonded palatal metal alloy veneers (heat-treated gold alloys or nickel–chromium alloys)
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Rubber dam
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Gingival retraction cord
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Modified porcelain laminate veneer
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Indirect densified composite resins
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Metal–ceramic crown
Procedure
Conventional fixed restorations
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Opposing tooth reduction.
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Elective endodontic treatment and post retention.
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Occlusal adjustment (retruded arc of mandibular closure).
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Periodontal surgical crown lengthening (Fig. 1).×
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Localized orthodontic tooth movement (conventional fixed appliance or ‘Dahl’ appliance) (Fig. 2).×
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Overall increase in occlusal vertical dimension (Fig. 3).×
Removable onlay/overlay prosthesis
Minimal preparation adhesive restorations
Cervical tooth wear
Lesions with margins that are still confined to enamel | Microfine or polishable densified composite resin, in conjunction with acid-etched enamel |
Lesions that usually involve root cementum and dentin along with enamel | Form of dentin bonding agent in combination with a composite resin or a self-adhesive composite resin formulation OR Glass ionomer cement |
Higher aesthetic demand | Polishable composite resin combined with some form of adhesive bonding agent |
Lesions are not visually prominent and involve more of the root surface, partly below the gingival margin | Glass ionomer cement |
Deeper cervical lesions | Glass ionomer cement and polishable composite resin |
Anterior tooth wear
Posterior and generalized tooth wear
Pitfalls and complications
Conventional fixed restorations
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Pulp necrosis
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Tooth fracture
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Loss of cementation
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Marginal caries
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Postoperative sensitivity
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Interproximal spacing
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Placement of crown margins on root surfaces
Removable onlay/overlay prostheses
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Maintenance demands–material wear and fracture being common
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Difficulty in adapting both functionally and psychologically