Choosing the right material for optimal anterior esthetic results

Pros and cons of common restorative materials

There are three main restorative materials to choose from, namely: composites/hybrids, glass ceramics and oxide ceramics, as well as combinations of these materials, such as PFM (porcelain-fused-to-metal) and veneered ceramics. All of these restorations may be fabricated chairside or in a laboratory. Since CAD-CAM (computer-aided-design and computer-aided-manufacturing) dentistry has grown in popularity and is used quite frequently, this will be the focus here.

Composite and hybrid restorative materials are a growing category of restorative materials but aren’t popularly used in the anterior region for a number of reasons, including the misconception that they aren’t strong or esthetic enough to support the region, the need for more aggressive preparation due to higher material thickness requirements, and a lack of insurance coverage. However, new formulations and techniques have made these materials far more versatile, as well as a viable and beneficial choice for a number of clinical situations. These modern materials address past issues with improved mechanical and esthetic properties as well as improved handling, in turn, creating new opportunities to work more conservatively.

Glass ceramic restorative materials are an excellent choice when high esthetics are required. Feldspathic porcelain and lithium disilicate are the most commonly used materials in this material class as they provide excellent translucency and esthetic qualities. They cover a variety of clinical situations with a range of monochromatic to polychromatic blocks in both high translucency and low translucency options. And while milling glass ceramics is not as easy as milling composite, it can still be performed successfully. Bonding is predictable, and while glass ceramics are weaker than zirconium oxide, their strength is sufficient for anterior restorations.

The main disadvantages of glass ceramics are their accompanying costs for both the patient and the lab. In addition, the extra time needed to bond ceramic crowns can also increase costs and impact your bottom line.

Zirconium oxide restorative materials are used for a fair share of anterior restorations due to their mechanical strength and advanced esthetics. This high mechanical strength allows for thinner restoration walls, which helps improve esthetics and preserve more healthy tooth structure – particularly when used for monolithic restorations (see table below). It’s a naturally tooth-colored material that can also be veneered with porcelain to further enhance the esthetics of the final restoration. The use of monolithic restorations is often limited by esthetic appearance, especially when only a single tooth is restored, and neighboring natural teeth will remain untouched in the visible area. Since porcelain layering is rarely associated with chipping in the anterior region, it’s a good option to ensure esthetic longevity.

And while there’s a misconception that harder materials translate to increased friction and more wear to adjacent teeth, the truth is that polished zirconia has been shown to have less abrasive effect than glass ceramics!1-3 With all this in mind, zirconium oxide is not as esthetic as glass ceramics – and may be difficult to color match, depending on the material chosen.

Ensuring a successful esthetic outcome not only means selecting the optimal material and shade, but also ensuring accurate preparation guidelines and communicating effectively with laboratory technicians. With everything above in mind, how do you decide which material to use?

Ideal crown preparation design in incisors to realize ideal material thicknesses.

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