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      Novel Porcelain Laminate Preparation Approach Driven by a Diagnostic Mock-up

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      Journal of Esthetic and Restorative Dentistry
      Wiley

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          Tooth structure removal associated with various preparation designs for anterior teeth.

          The conservation of sound tooth structure helps preserve tooth vitality and reduce postoperative sensitivity. Innovative preparation designs, like those for porcelain laminate veneers, are much less invasive than conventional complete-coverage crown preparations. However, no study has quantified the amount of tooth structure removed during these preparations. The purpose of this study was to quantify and compare the amount of tooth structure removed when various innovative and conventional tooth preparation designs were completed on different teeth. . A new comprehensive tooth preparation design classification system was introduced. Typodont resin teeth representing the maxillary left central incisor, maxillary left canine, and mandibular left central incisor were prepared with the following designs: partial (V1), traditional (V2), extended (V3), and complete (V4) porcelain laminate veneer preparations; resin-bonded retainer preparation with grooves (A1) and with wing/grooves (A2); all-ceramic crown preparation with 0.8 mm axial reduction and tapering chamfer finish line (F1), all-ceramic crown preparation with 1.0 mm axial reduction and rounded shoulder finish line (F2), and metal-ceramic crown with 1.4 mm axial reduction and facial shoulder finish line (F3). After tooth preparations (10 per group), the crown was separated from the root at the CEJ. The removed coronal tooth structure was measured with gravimetric analysis. Means and standard deviations for tooth structure removal with different preparation designs were calculated and analyzed with analysis of variance at a significance level of P<.05. Significant differences in the amount of tooth structure removal were noted between preparation designs. Ceramic veneers and resin-bonded prosthesis retainers were the least invasive preparation designs, removing approximately 3% to 30% of the coronal tooth structure by weight. Approximately 63% to 72% of the coronal tooth structure was removed when teeth were prepared for all-ceramic and metal-ceramic crowns. For a single crown restoration, the tooth structure removal required for an F3 preparation (metal-ceramic crown) was 4.3 times greater than for a V2 preparation (porcelain laminate veneer, facial surface only) and 2.4 times greater than for a V4 preparation (more extensive porcelain laminate veneer). Within the limitations of this study, tooth preparations for porcelain laminate veneers and resin-bonded prostheses required approximately one-quarter to one-half the amount of tooth reduction of conventional complete-coverage crowns.
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            Crack propensity of porcelain laminate veneers: A simulated operatory evaluation.

            Anterior teeth are especially subject to the thermal variations of ingested food and drinks. Postoperative cracks of porcelain laminates are considered a possible consequence of polymerization shrinkage, function, and thermocycling. This investigation was conducted to define the parameters associated with the development of cracks in porcelain veneers using cyclic thermal fatigue. Twenty-seven maxillary incisors were restored with porcelain laminate veneers and subjected to thermocycling (5 degrees C to 50 degrees C) for 1000 cycles. Ceramic cracks were reported for 11 of the 27 specimens. Teeth were sectioned and prepared for SEM analysis. Measurements of the ceramic and the luting composite thicknesses were performed for each specimen at different restoration locations (facial, incisal, and proximal). No significant differences in the ceramic or the luting composite thicknesses were observed between cracked and uncracked specimens. However, significant differences were observed in the ratio of the ceramic and luting composite thicknesses. Most cracked samples exhibited a ratio at the facial location below 3.0 (2.6 +/- 0.35), whereas most noncracked specimens were above this value (3.9 +/- 0.19). Incisal and especially proximal measurements alone were not significantly different between cracked versus uncracked specimens. Ceramic was slightly thinner in the facial aspect than in the proximal aspect, which was also thinner than the incisal aspect. Composite in the facial aspect was thinner in the cervical area than in the incisal third of the tooth. Significant cyclic temperature changes can induce the development of flaws in porcelain veneers. Control of tooth reduction and the application of die spacers during laboratory procedures undoubtedly represent key elements; a sufficient and even thickness of ceramic combined with a minimal thickness of luting composite will provide the restoration with a favorable configuration with regard to crack propensity, namely, a ceramic and luting composite thickness ratio above 3.
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              Effect of luting composite shrinkage and thermal loads on the stress distribution in porcelain laminate veneers.

              Cyclic thermal fatigue has demonstrated a significant influence of the thicknesses of luting composite and ceramic in crack propensity of porcelain laminates.
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                Author and article information

                Journal
                Journal of Esthetic and Restorative Dentistry
                J Esthet Restor Dent
                Wiley
                1496-4155
                1708-8240
                January 2004
                January 2004
                : 16
                : 1
                : 7-16
                Article
                10.1111/j.1708-8240.2004.tb00444.x
                837fc1ad-cffa-4aea-9ee3-a43a6d6d54d4
                © 2004

                http://doi.wiley.com/10.1002/tdm_license_1.1

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