20th Anniversary International Symposium on Ceramics
Explore New Vistas of Esthetic Materials

June 20-23, 2002
San Diego California

Program Chairman
Gerard J. Chiche, DDS

Sponsored by
The International Quintessence Publishing Group
Louisiana State University

Program Abstracts

Dental research targeted at the development of ideal restorations has been ongoing for many years. This joint lecture will present a comparison of ceramic materials, a review of fabrication and milling strategies for prosthodontics, an explanation and comparison of CAD/CAM systems, and a discussion of laboratory techniques and clinical aspects of the Lava system. A short history of dental ceramic materials and an overview of processing schemes, including a discussion of the pros and cons associated with the new fabrication systems, will also be provided.

In 1997, Shofu Inc introduced ShadeEye-EX, which eliminated human error in shade-taking techniques by computerizing the measurement of natural tooth color. The latest innovation in precise shade-taking methods, ShadeEye NCC, features a cordless, compact sensor unit, transfer of measurement data by infrared beam, and convenient printing capabilities. The clinical performance of ShadeEye NCC in conjunction with a digital camera will be evaluated, and other advanced digital shading techniques will be discussed.

The introduction of IPS Eris layering ceramic for the IPS Empress family ushers in new possibilities for restoring form, function, and esthetics to metal-free restorations. Step-by-step procedures utilizing the IPS Eris system for comprehensive care will be highlighted. Both laboratory and clinical criteria will be discussed in detail and unique methods of enhancing communication between dentist and technician will be offered to ensure consistency, predictability, and ultimate patient satisfaction.

Esthetic predictability is based on a comprehensive use of myriad esthetic principles by the dental ceramist and the clinician. With the routine use of contemporary all-ceramic materials, a successful team approach must be based on a step-by-step approach to set high esthetic standards and to address challenging esthetic dilemmas. This discussion will present a methodical approach devised to resolve esthetic deficiencies and to guide the dental team during esthetic treatment.

This presentation will provide methods to achieve the highest-level esthetic results. It will include all the key elements of esthetic treatment planning and the most current information available on the materials and techniques used in contemporary restorative dentistry. In addition, this presentation will outline an interdisciplinary approach to proper diagnosis and treatment planning of complex cases. The treatment of complex cases involves periodontics, orthodontics, and implantation. Therefore, restorative dentists need to consult orthodontists, surgeons, and dental technicians regarding complete diagnosis and sequential treatment planning before, during, and after the treatment.

The intimate relationship between the appearance of the gingival tissue and crown form will be discussed. The physiologic contour and arrangement of natural teeth will be analyzed as it relates to the gingival architecture. Frequently, restorations are created that do not adequately support the gingival tissue, resulting in dark spaces in the gingival embrasure. Guidelines will be given to assure that the optimal gingival esthetics will be achieved.

It is a simple fact that dental materials rarely fracture on their own. Failures most commonly occur as a result of excessive forces related to a traumatic event or occlusion. This program will link the different types of failure patterns and make recommendations for how to design the occlusion as well as which materials to use in specific situations.

There are two factors that have a great influence on whether prostheses are fabricated in harmony with nature: (1) recovering the proper shapes of individual teeth (both in terms of esthetics and in relation to the health of the periodontal tissues) and (2) reproducing natural tooth shades. This lecture will focus mainly on tooth morphology, including concavity, convexity, and the Brassiere technique, and its significant influence on periodontal tissues; it will also cover the reproduction of natural tooth color with new ceramic materials.

Esthetics is not about restorative dentistry. It utilizes restorative dentistry in conjunction with periodontics, orthodontics, and implantology. Esthetics is about beauty!
This program will incorporate innovative techniques and a plethora of new restorative products critical to satisfying the public's growing demand for smile enhancement. It also will demonstrate the importance of the relationship among the patient, clinician, and ceramist for esthetic success. All three parties must have a definitive vision of the potential end results-satisfying the elements of smile design-without compromising the final result by utilization of an inappropriate laboratory technology. This is a team approach and an all-encompassing look at achieving "successful esthetics by design."

At the moment, no other metal-free material for restorative dentistry is receiving as much attention as zirconium oxide. Only the introduction of computer-controlled machines has made it possible to attain previously unknown limits of precision and stability. Outstanding properties such as a high flexural strength (900 to 1,200 MPa) and a fracture toughness that is about twice that of aluminum oxide make it a suitable material for use wherever long-term stability is expected and high-stress conditions prevail.
The clinical and laboratory guidelines for successfully using zirconium oxide technology for both implant-borne restorations and AllZirkon (Procera) crowns and bridgework will be outlined in this presentation.

Existing shade guides provide poor coverage of the color space of natural teeth and are not systematically arranged. Also problematic are conditions in which shades are taken, ie, different light conditions and inherent differences in spectral reflectance curves of the restorative material, the shade guide, and the natural tooth. Newer shade systems, eg, the Vita 3D Master, better cover natural teeth and have a logical arrangement but cannot control for shade-taking conditions. Computerized shade instruments that use special spectrophotometers or colorimeters have the potential to accurately record the shade and translucency of natural teeth. This presentation introduces and reviews several different computerized shade-taking systems. The lecture will review the problem of shade taking and compare traditional techniques with new computerized systems for taking shades.

Designing anterior restorations with optimum esthetics requires correct treatment planning, evaluation of a suitable ceramic material, and skillful application of techniques. Moreover, material selection with a dental ceramist is fundamental to the management of complex rehabilitation cases. It has been shown that the use of metal-free ceramic materials allows the achievement of excellent esthetic results for crown and veneer fabrication in the anterior area. In particular, several clinical follow-ups of glass-ceramic and alumina systems indicate the adequacy of these materials for anterior restorations. This presentation will provide clinical and technical suggestions for obtaining esthetic and durable results.

Ceramics are the materials of choice in terms of biocompatibility and long-term esthetics. However, it is essential to understand the technical characteristics of this class of materials for successful use in daily practice. The goal of this presentation is to give clinical guidelines on how to obtain long-term excellence by pushing the limits without losing predictability.

Contemporary all-ceramic and porcelain-fused-to-metal restorations enable the restorative team to achieve predictable pleasing esthetic results. However, because of the fundamental differences among the various materials used in esthetic dentistry, dentists and technicians alike are frequently faced with the dilemma of selecting the proper surface treatment, cements, and/or bonding agents to provide the optimal structural integrity for the restoration and maintain a long-term marginal seal between the abutment and the restoration. The presentation will provide a classification for the possible available restorative interfaces based on the materials used and on the type of the restoration fabricated as well as guidelines for material selection for predictable delivery of these restorations.

The desire to achieve a long-lasting, natural-looking restoration is a driving force behind the ongoing quest of clinicians and dental manufacturers to improve ceramic systems and their reinforcement properties and adjuncts. This has a direct influence on the esthetic appearance of the restoration and its longevity, on the accuracy of the fit to the abutment tooth or implant, and on the reaction of the supporting tissues. A well-considered approach to selecting a prosthetic system compatible with the case in question and the limitations of present-day techniques will be analyzed and discussed.

Esthetics, although traditionally the drawing card for ceramic restorations, is of secondary importance when restoring the posterior dentition. The conservative, nonretentive cavity design of partial-coverage ceramic restorations provides a number of distinct advantages over traditional, metal-supported, full-coverage options. However, there are unique challenges associated with precise preparation, provisionalization, and delivery of ceramic restorations, mostly as a result of restricted access to the proximal portion of posterior teeth. This presentation looks beyond esthetics and examines the variables that affect the integrity of the ceramic-tooth interface and introduces a number of innovative techniques that assure meticulous delivery of posterior partial-coverage ceramic restorations.

Porcelain facial veneers have been used for more than 10 years and have become a useful and recognized form of treatment. However, significant concerns continue to cloud the decision process and technical management regarding requirements for darker teeth, fracture concerns in patients with parafunction, ideal preparation design for various clinical situations, commercially available options, and luting systems. This presentation will focus on three areas of the tooth-the cervical, middle, and incisal zones-to enable the dentist and laboratory technician to achieve predictable results.

The CerAdapt Abutment continues to demonstrate outstanding functional and esthetic results. However, there is a clear need to simplify and facilitate the existing protocol for the fabrication of ceramic implant abutments. The utilization of ceramic powder technology in conjunction with computer-aided dental design (CADD) has led to the development of custom ceramic abutments. This revolutionary technology allows for the fabrication of custom ceramic abutments that solve the problems of space, alignment, and angulation that are common to dental implant treatment. This presentation will describe the indications and techniques associated with this new technology and also will review the evolution of the technology associated with Procera AllCeram laminates.