Modern dentistry is undergoing significant advances in the delivery of clinical care and in the materials used to restore your smile. Over the past decade new dental materials have emerged that improve both the aesthetics and functioning of dental restorations.
The use of gold to restore teeth dates back to around A.D. 200. Because of its high strength and durability, tooth preparation for gold restorations can be more conservative. While gold is still a good restorative alternative, most patients prefer a more natural looking material that blends in with their smile.
The desire for more natural looking teeth restorations, lead to the use porcelain fused to metal. With porcelain restorations, porcelain is bonded on top of a metal substructure. While porcelain restorations appear more natural, they still pose some aesthetic and functional challenges.
Typically tooth preparation for a porcelain restoration is less conservative, usually several millimeters deeper, as there must be enough room for two materials (porcelain and metal). Insuring the preparation is deep enough is especially important as the porcelain, if layered too thin on top of the metal, may chip and compromise the aesthetics of the restoration.
Another aesthetic challenge with porcelain restorations is that the metal substructure can be seen underneath porcelain, since porcelain is a translucent material. Also, porcelain restorations require a metal margin showing near the gum line. This might not be a concern on a back tooth, but in the smile zone, it can detract from achieving high aesthetic success.
Finally, with both gold and porcelain material, a putty impression must be taken and sent to a lab. After about two weeks, patients return to the dentist for a second appointment to cement the final restoration.
Research over the past decade has produced all-ceramic materials that can stand up to the forces of biting and chewing, appear natural, and can be completed in a single visit. Modern dental ceramics can be used in both the front and back of the mouth, and studies have shown some of them to be as durable, or in some cases even more durable, than gold or porcelain.
The most obvious advantage of all-ceramic restorative materials is their natural appearance. Ceramics can be stained and glazed to blend into your existing smile or aesthetically enhance your smile.
Teeth generally appear to have darker shades toward the gum line and lighter shades toward the chewing edge. Newer ceramic materials come in a vast range of shades and translucencies, making it easy to mimic the natural progression of the variances in coloring, of a tooth. In contrast, porcelain restorations are generally a single shade, and cannot replicate the natural coloring and shading of teeth.
Another advantage of all ceramic materials is that a minimal amount of tooth preparation is needed. Because it is one layer less tooth has to be removed to achieve both aesthetic and durable results.
Ceramic restorations can be made in the traditional manner by taking a putty impression and sending it to a lab. However, with the use of computer-aided design and computer-aided manufacturing technology, dentists may also complete ceramic restorations in a single visit.
Most patients prefer a single visit as it saves time, injections, and eliminates the need for temporary restorations while the permanent one is being made. Finally, while rare, there are patients who have metal allergies and all ceramic restorations prevent the need for any metal usage.
Dental materials for crowns, veneers, bridges and inlays have made huge progress in the past few years. All ceramic materials are now just as durable and strong as more traditional materials such gold and offer greater aesthetics than porcelain restorations.
Furthermore tooth preparation for all-ceramic materials is more conservative, and with the added convenience of being able to finish the restoration in a single visit, all-ceramic materials are a preferred choice for treatment.
Dr. Julie Hassid is a general and cosmetic dentist at Gallery57 Dental. She attended dental school at Tufts University and received additional training at Columbia University and NYU College of Dentistry.