Getting marginal design executed perfectly is critical so the digital scanner can pick up the prep scan accurately, says Jeannie Hughes, one of Dandy’s digital dental experts with 30 years of experience. “Digital scanners struggle with picking up knife/feather edge preps.”

In this article, we’ll cover which crown margin preparations are best for digital dentistry, the differences in shoulder vs chamfer, and why some, like the feather edge margin, aren’t ideal for best practices.

Types of marginal designs in crown preparation

Shoulder margin

The crown preparation technique called the shoulder margin is named that, because of its shape. The 90-degree angle resembles a shoulder and is one of the best marginal designs for digital dentistry. 

Prep dimensions for shoulder margin: 1.0mm for zirconia, PFZ, PFM, and emax Lithium disilicate 

Pros of the shoulder margin

It’s the easiest for the scanner to read, ensuring the restoration fits perfectly.

Cons of the shoulder margin

It can be difficult to put a shoulder margin crown on an anterior tooth. It can be challenging to do a shoulder margin in certain posterior teeth, too.

The shoulder margin is one of the best crown prep techniques for digital dentistry because the scanner can clearly see the prep, says Hughes.

Shoulder margin conclusion

“The shoulder margin is the best prep for zirconia crowns,” she says. Zirconia can be milled best with this prep style.

Chamfer margin

The chamfer margin crown preparation technique got its name because of the shape. It’s like a shoulder margin but with a slight angle.

Prep dimensions for chamfer margin: 1.0mm for zirconia, PFZ, PFM, and emax Lithium disilicate, 0.6mm for emax veneer

Pros of chamfer margins

They’re better for anterior teeth because they create a more seamless margin where it’s aesthetically noticeable.

Cons of chamfer margins

These can be more challenging to prepare.

Chamfer margin conclusion

The chamfer margin is acceptable in digital dentistry but it’s not as good as a shoulder margin due to the mill’s capabilities, making it a harder margin to mill. 

Feather edge margin 

The feather edge margin or “knife edge margin” is named such because it’s a very thin margin.

It’s not recommended in crown prep for digital dentistry because it can’t be 0.6mm thick, the value required for digital scans. “If you make a knife edge margin on a zirconia crown, it’s very likely going to break,” Hughes says. 

It goes back to “minimum thickness,” a very common term in dentistry. We know that 0.6mm is the minimal amount of thickness that zirconia needs to be stable, Hughes says. The chamfer style prep limits the space needed to create adequate material thickness on the marginal region.

“When it’s less than that 0.6mm, it’s at risk for breakage and failure. If the margin in this case—the point where the lip of the crown and the tooth meet each other—is open,” says Hughes. That can lead to bacteria getting in and the crown is more susceptible to decay, infection, and other problems, she says.

With the feather edge margin, that thickness goes down to almost 0 and the scanner can’t read it. “When we’re trying to guess where that margin is, and a lot of times it’ll be too short, or too thin, and now we have an open margin, it leads to the crown having to be remade or it breaks,” says Hughes.

Chamfer vs shoulder margins

Now that you know you’re likely to use chamfer margins or shoulder margins with crown prep because they provide optimal room for the scanner to see the crown, you’re probably wondering the best case for using either one.

When do you do chamfer vs shoulder margins? 

Ideally, the dentist should prep shoulder margin whenever possible in digital dentistry.  This enables labs to create a restoration that flows with the remaining tooth structure with no bulge at the near margin, Hughes shares.

That being said, chamfer can make the transition from tooth-to-crown margin look more seamless with anterior teeth.

So how do you make the transition?

We get it.  Not every tooth can be prepped for a perfect shoulder margin. To learn how to adopt a margin style you aren’t as familiar with, make sure you’re using the correct dental burs, suggest Hughes.

Once the crown margin is fully prepared with digital dentistry, make sure you pack cord so the designers can see the margin accurately.

And don’t be afraid to contact the Dandy team. Sure, you’ll have learned this with our trainers during the onboarding but, it’s easy to forget some details. The team is standing by and available for a private call before, during, and after the crown margin prep process.

Prep styles for zirconia crowns

Zirconia crowns are ideal for digital dentistry done with a shoulder margin prep, but they can be done with a chamfer style. They should be done at least 0.6mm thickness to be stable, Hughes suggests.

When prepping for a Zirconia Crown, keep in mind proper marginal finishing lines for clinical success. Intraoral scanners improve the accuracy and efficiency of the preparation process, reducing turnaround time compared to traditional methods.

Prepping crowns and digital dentistry

Why does a certain thickness matter so much when you’re doing restorations with digital dentistry? 

Designing and milling a crown less than 0.6 mm minimal thickness can lead to fractures and chipping, says Hughes. “So if the doctors reduce 0.6mm or less, there could be an overhang, which leaves a trap for plaque and bacteria to get in. Then the doctor sometimes has to adjust the crown, And basically, so now we have something that’s overhanging and adjusted to fit, but now it’s too thin and is at a risk for breaking.”

Best practices for digital dentistry and crown prep involve using cord. “Make sure that you use gingival packing cord and move the tissue out of the way so the digital team can make you a great-fitting crown with digital precision,” says Hughes. 

Verified by Dandy’s Clinical Support Leads: Brian Arias, Matt Hibert, Colin Kreinbrink

The post The ultimate guide to crown margins appeared first on Dandy.

The history of Zirconia restorations

It’s been a little over 230 years since German chemist Martin Heinrich Klaproth discovered zirconium while analyzing the gemstone jacinth, and we have come a long way in understanding the element and finding uses for it. It wasn’t until the 1960s that zirconia started appearing in medical applications, with the metal being used in hip-joint replacements. During that same time, dentists experimented with zirconia, but the material lacked the proper strength and aesthetics. 

Then in the 1990s zirconia started becoming a more viable option for dentists with the development of Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP), a much stronger and more biocompatible form of zirconia. It was also at this time that CAD/CAM technology emerged, allowing for the precise milling required for zirconia crowns. 

In the early 2000s zirconia crowns started to gain popularity throughout dentistry, especially for the less visible teeth in the back of the mouth. Porcelain-fused-to-zirconia crowns (PFZ) combined the aesthetic value of porcelain with the strength of zirconia, making them suitable for front-of-the-mouth restorations. 

Continuous advancements in material science and technology have led to stronger and more translucent zirconia restorations, monocrystalline zirconia for greater strength and durability, and the amazing precision and efficiency that come with digitally designed and milled zirconia restorations. 

Today, zirconia crowns are a popular choice among dentists for their durability, biocompatibility, strength, and the minimal tooth reduction required during installation. 

What is zirconia material? 

Zirconia, also known as zirconium dioxide (ZrO2), is a ceramic material made of zirconium, a metallic element, and oxygen. It has been harnessed by dentistry for use in crowns, bridges, implants, and veneers due to its strength, aesthetics, and biocompatibility.

Dentists are able to make extensive use of zirconia in part thanks to the advancements in CAD/CAM technology. During the initial visit by the patient, the dentist is able to take digital impressions of the prepared tooth. Then the impressions are sent to the lab, where a tech uses CAD software to design the crown before sending the specs to a dental milling machine, which then precisely fabricates the crown from zirconia. 

Zirconia crown prep vs. other ceramic restorations 

The differences between zirconia crowns and other ceramic restorations start back in preparation. Let’s look at each step involved and compare zirconia crown preparations to other methods. 

Tooth removal

Zirconia: Requires minimal tooth removal due to its strength. It is suitable for situations where tooth structure preservation is a priority.

Other ceramics: The amount of removal varies depending on the material. Lithium disilicate (eMax) needs slightly more than zirconia due to its lower strength, while feldspar (porcelain) might require similar or even more removal.

Preparation technique

Zirconia: Similar to other ceramic crowns, involving enamel and dentin reduction to create space for the crown. It may involve chamfer or shoulder margins depending on the case.

Other ceramics: Similar techniques apply, but specific considerations might exist. Lithium disilicate may require specific bur designs due to its material properties and feldspar might require additional attention to margin integrity due to its potential for chipping.

Impression taking

All ceramics are similar, requiring highly accurate impressions (physical or digital) of the prepared tooth and surrounding area.

Lab work

Zirconia: Often utilizes CAD/CAM technology for precise milling from zirconia blanks. It can be monolithic (solid) or layered with porcelain.

Other ceramics: Lab procedures vary depending on the material. Lithium disilicate might involve pressing or milling techniques, while feldspar typically involves pressing.

Overall

Zirconia: Generally requires less tooth removal due to its strength. The lab process and construction benefits from advanced technology.

Other ceramics: Require slightly more tooth removal depending on the material. Lab procedures vary, with some potentially being less accurate than zirconia.

Zirconia crown cementation

After prepping the tooth and ensuring a perfect fit, the dentist secures the precisely designed zirconia crown onto it. They clean and condition the tooth, apply specific cement to both crown and tooth, carefully seat the crown, remove excess cement, and light-cure the bond. This crucial step, requiring special techniques for zirconia cementation, ensures a strong, aesthetically pleasing, and functionally optimal restoration.

Types of zirconia restorations

There are three main types of zirconia restoration, each offering its own advantages. Let’s take a look at each. 

Layered zirconia restorations

Layered zirconia restorations combine the best of both worlds: strength and aesthetics. A solid zirconia framework provides exceptional durability, especially for back teeth, while a thin layer of porcelain mimics the translucency and color of natural teeth, making them ideal for front teeth, creating what is known as a porcelain fused to zirconia crown (PFZ). This layering process requires skilled technicians and often involves digital design and milling for precise results. While potentially slightly more expensive than other ceramic options, layered zirconia restorations offer a strong, natural-looking, and biocompatible solution for long-lasting smile improvements.

Monolithic zirconia restorations

Monolithic zirconia restorations are exactly what they sound like—crowns crafted from only one material. Made entirely from solid zirconia, they boast exceptional strength and durability, making them ideal for back teeth that endure heavy chewing forces. By forgoing a delicate layer of porcelain, monolithic zirconia crowns minimize chipping concerns and simplify the process. While their natural zirconia color might not perfectly match front teeth, their impressive strength, biocompatibility, and minimal tooth removal requirements make them a popular choice for function and long-lasting restorations.

High translucent zirconia

High translucent or aesthetic zirconia crowns are the ultimate in modern tooth replacement innovation. They combine the exceptional strength of standard zirconia with a special formulation that lets more light through, achieving a level of translucency that closely mimics natural teeth. This makes them ideal for enhancing the aesthetics of front teeth, allowing natural light to play beautifully across the restoration. While not quite as strong as solid zirconia, they’re still highly durable and offer excellent biocompatibility, minimal tooth removal, and long-lasting, bright smiles.

The post Zirconia restorations 101 for dentists appeared first on Dandy.

Reduction copings help to ensure that the final restoration fits properly and has the correct thickness. They can also save time and money by eliminating the need for additional appointments or remakes. 

How to use a crown reduction coping

The workflow for using a crown reduction coping involves the following steps:

• The dentist prepares the tooth, but leaves slightly more tooth structure than is necessary for the final restoration.
• An impression of the prepared tooth is taken and sent to the dental lab.
• The dental technician creates a replica of the prepared tooth.
• The technician creates the reduction coping, which fits over the prepared tooth replica on the model.
• The technician modifies the model removing the tooth structure through the opening in the coping, creating the exact space needed for the restoration.
• The coping is sent back to the dentist with the completed restoration.
• The dentist places the coping on the prepared tooth and removes any tooth structure that protrudes through the opening.
• The dentist then cements the restoration onto the prepared tooth.

Reduction copings are a useful tool for dentists, but it’s possible to alleviate the need for them altogether with better crown preparation. Digital dentistry has revolutionized the process of dental restoration through the use of intraoral scanners which capture precise 3D images of the prepared tooth, eliminating the inaccuracies that can occur with physical impressions.

Detailed communication between the dentist and the lab technician can also help alleviate the need for reduction copings. Clear instructions regarding desired margins, crown material, and thickness can help guide accurate lab-fabricated restorations and potentially reduce the need for further tooth reduction.

Best practices for crown preparation 

Here are some best practices for zirconia crown preparation, aimed at achieving a successful and lasting outcome while minimizing the need for reduction copings:

Pre-operative evaluation

• Thorough diagnosis and treatment planning: Clearly understand the reason for the crown, the patient’s expectations, and any potential complications.
• Radiographic and clinical assessment: Evaluate tooth structure, root health, and surrounding tissues.
• Discussion with the patient: Explain the procedure, risks, and benefits of different crown materials and preparation techniques.

Preparation technique

• Conservative approach: Remove the minimum amount of tooth structure necessary for crown placement, considering material thickness and strength.
• Clear and defined margins: Achieve smooth, well-defined margins for optimal adaptation of the crown and prevention of future leakage.
• Smooth preparation surface: Avoid unevenness or scratches that could affect crown fit and aesthetics.
• Proper reduction angles and chamfers: Follow material-specific guidelines for shoulder, chamfer, or feather-edge preparations to ensure crown retention and strength.
• Adequate occlusal clearance: Provide enough space between the opposing teeth for a comfortable bite and proper function.
• Minimize gingival manipulation: Handle gum tissue gently to avoid inflammation and potential complications.
• Use of depth-limiting burs: Ensure precise tooth reduction within predetermined limits, reducing the risk of over-preparation.
• Employ magnification loupes: Enhance visualization for improved control and accuracy.

Adjunctive procedures

• Digital dentistry: Utilize intraoral scanners and CAD/CAM technology for precise impressions, virtual crown design, and potentially reduced tooth reduction.
• Rubber dam isolation: Maintain a clean and dry operative field for optimal visibility and control.
• Water cooling and air evacuation: Minimize heat generation and ensure clear visualization during tooth preparation.

Communication and collaboration

• Clear communication with the dental lab technician: Provide detailed instructions regarding margins, crown material, thickness, and any specific requirements.
• Consider using reduction copings: While striving for minimal reduction, reduction copings can still be valuable tools for complex cases or ensuring precise crown fit.

Post-operative care

• Provide temporary crown: Protect the prepared tooth and maintain aesthetics while the permanent crown is being fabricated.
• Educate the patient on proper hygiene: Explain how to care for the new crown and maintain oral health.
• Schedule follow-up appointments: Monitor the crown fit, function, and overall oral health.

Tips to create adequate occlusal reduction

Creating adequate occlusal reduction involves achieving the right balance between preserving healthy tooth structure and ensuring enough space for the restoration. Here are some tips to help you achieve that balance:

Planning and preparation

• Understand desired outcomes: Clearly define the restoration type, material, and aesthetic goals. This helps gauge the minimum reduction needed.
• Preoperative assessment: Analyze radiographs, scans, and the tooth itself to estimate enamel and dentin thickness, pulp chamber location, and existing restorations.
• Utilize depth gauges: Take pre-op measurements of existing occlusal clearance and desired restoration thickness to determine reduction target.
• Mark reduction guidelines: Use temporary markers or depth cuts on the tooth surface to visualize the planned reduction.

Technique and precision

• Start conservative: Begin with minimal reduction and gradually increase as needed. Remember, removing tooth structure is irreversible.
• Use depth-limiting burs: These ensure precise and consistent reduction within predetermined limits, preventing over-preparation.
• Follow material guidelines: Different materials have specific thickness requirements. Familiarize yourself with them for optimal restoration strength and durability.
• Maintain smooth surfaces: Avoid unevenness or scratches that could disrupt crown fit and aesthetics.
• Utilize magnification loupes: Enhanced visualization facilitates controlled and accurate reduction.

Considerations for different areas

• Incisors: Focus on preserving aesthetics. Prioritize enamel reduction and minimize dentin exposure.
• Canines: These require more occlusal clearance due to function. Balance preserving structure with providing enough space for the restoration.
• Premolars and molars: Often require significant reduction due to larger cusps and increased chewing forces. Ensure adequate reduction of material thickness and proper occlusal function.

Additional tools and techniques

• Digital dentistry: Intraoral scanners and CAD/CAM technology provide precise data for virtual crown design and accurate assessment of reduction needs.
• Articulating paper and shims: Use them to visualize occlusal contacts and fine-tune reduction for even pressure distribution.
• Bite registration: Capture dynamic jaw movements to guide crown design and ensure proper occlusion.

Remember, minimizing tooth removal while ensuring functional and aesthetic success is key. With careful planning, precise technique, and the right tools, you can create adequate occlusal reduction for a long-lasting and successful restoration.

Capturing occlusal clearance with digital dentistry

Here are some best practices for taking digital impressions with proper occlusal clearance:

Before you begin:

• Inform the patient about the procedure and ensure they are comfortable and relaxed. Encourage them to avoid clenching or biting during the scan.
• Choose a scanner with adequate resolution and depth of field to capture details of the prepared tooth and surrounding tissues.
• Ensure the scanner is properly calibrated for optimal accuracy.
• Evaluate the preparation margins, smoothness, and overall quality before scanning.
• Measure existing occlusal clearance and mark reference points on the tooth to guide later assessment.

During the scan:

• Cut down on excess light to remove the possibility of glare.
• Dry the teeth and gums to reduce moisture in the mouth.
• Use retraction cords and gently retract the gingival tissue for improved visualization and access during scanning. Retraction with dental lasers is not ideal but acceptable due to the risk of scarring and lack of mechanical traction.
• Employ tongue and cheek retractors to maintain a clear field of view and prevent interference from soft tissues.
• Capture the tooth from various angles, including occlusal, lingual, buccal, and interproximal views. Pay close attention to the preparation margins and interproximal spaces.
• Occlusal clearance assessment: Utilize the depth gauge reference points and software tools to analyze and adjust the virtual model for proper occlusal clearance. This could involve using an articulator and articulating paper to physically verify and fine-tune the occlusal contacts in the digital model.

While digital impressions offer significant advantages, proper technique and attention to detail are crucial for capturing accurate occlusal clearance. Consider seeking training from experienced professionals to ensure optimal outcomes.

By following these best practices, you can confidently capture digital impressions with proper occlusal clearance for successful restorations. Most importantly, clearly communicate the desired occlusal clearance to the dental lab technician along with the digital impression.

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VDO or vertical dimension of occlusion (also known as occlusal vertical dimension or OVD) is the measurement of the vertical distance between the maxilla and mandible during maximum intercuspation. It is a key factor in designing many dental products, especially dentures and overdentures. There is no objectively correct VDO, rather, it is relative to the individual. 

A suboptimal or distorted vertical dimension of occlusion (due to tissue loss, improper denture fit, congenital malformation, etc.) will result in not only an odd aesthetic but discomfort; difficulty chewing, speaking, and smiling, or any combination thereof. This erodes the sufferer’s quality of life, and may potentially lead to temporomandibular disorders. 

What determines the dental VDO? 

Visually, VDO registers as the relationship between the position of a patient’s nose, lips, and chin. But, underlying this superficial presentation, VDO is determined by various interrelated factors:

• Tooth size, shape, wear, and occlusion 
• Natural VDR (vertical dimension of rest)
• Alveolar bone structure and health
• Neuromuscular reflex and function (i.e. chewing and swallowing)
• Speech and phonetics
• Patient comfort 
• Necessity for accommodation of appliances/prosthetics (e.g. dentures, nocturnal bruxism mouthguards, mandibular advancement appliances, etc.)

Many (but not all) of these factors can and will be assessed during a comprehensive examination that includes bite registration and patient history.

Methods of recording vertical dimension of occlusion 

When recording VDO, you, the dental professional have several methods to choose from. There is no single “correct” method of measuring vertical dimension of occlusion.

Here are a few methods:

Freeway space – Freeway space technique (the distance between maxillary and mandibular teeth in the mandibular postural position–prototypically between 2mm to 4mm) is appropriate for edentulous patients and is used almost exclusively for mounting models and setting teeth for denture try-ins. Freeway space is derived using various techniques (i.e. having the patient say “M” or “Emma;” lick their lips, swallow, and relax) during which the distance between two fixed, vertically-aligned points on the face and mandible are recorded. Later, during the try-in phase, patients are assessed for proper phonetics and aesthetics, allowing practitioners to finalize a VDO. 

Lateral profile photography – Using a lateral photograph of a patient’s head during occlusion, a measurement is taken recording the relationship between four key maxillofacial landmarks. Using these landmarks, VDO can be mathematically derived.

Face-bow and articulator – A face-bow is used to register the relationship of the patient’s maxillary dental arch to the Frankfort horizontal plane or hinge axis-orbital plane. This measurement provides reference for the articulator, into which plaster dental models are fitted allowing dentists to measure an acceptable VDO range.

Trial splint or appliance – The patient is asked to use an appliance with an adjusted VDO to determine if, over time, the new VDO can be tolerated comfortably.

Transcutaneous Electrical Neural Stimulation (TENS) – Electrodes apply a mild electrical current over the coronoid notch, stimulating the contraction of mastication muscles through cranial nerves. Electromyographic recordings of the temporalis, masseter, and digastric muscles, along with jaw-tracking, are used to assess the mandible’s position relative to the maxilla. Neuromuscular rest is achieved by relaxing the mastication muscles. The relationship between neuromuscular rest and freeway space is used to determine VDO.

Facial proportion – This method for determining vertical dimension aims to correct facial balance by adjusting the length of the lower face to match the midface based primarily on aesthetic  considerations. While suitable for orthognathic surgeons, it poses challenges for orthodontists or restorative dentists due to difficulties in making significant vertical changes that impact facial proportion while maintaining correct occlusal relationships. Additionally, attempts to alter vertical dimension may significantly affect overjet, making it challenging to achieve proper anterior occlusal contact. 

Cephalometry – Using X-ray images, various anatomical landmarks are identified. The relationship between these points is analyzed and compared. Analysis of this information in conjunction with an assessment of the patient’s comfort and needs is used to determine a likely VDO. 

Keep in mind: Some methods of recording vertical dimension occlusion may be more or less appropriate depending on the patient’s dental/medical history (i.e. dentulous vs. edentulous patients) and the purpose of the measurement (i.e. fitting for immediate dentures vs. setting a baseline). The most advisable approach would be to assess the patient’s needs and utilize the appropriate method accordingly.

What happens if VDO is recorded incorrectly? 

Although it has no single, objectively “correct” measurement, imprecise recording can have significant consequences when it comes to VDO. Dental professionals who fail to account for a patient’s highly specific physiology and/or needs may fail to record a correct VDO. As a result, in addition to sunk cost of time and money associated with adjusting or entirely remaking dentures, just a few millimeters’ distortion from optimal VDO can cause discomfort if not health risks. The problems associated with incorrectly recorded VDO are distinct depending on whether the dimension has been increased or decreased.

Some of the potential consequences of an improper vertical dimension occlusion are as follows:

Increased VDO 

• Joint and muscle pain 
• Occlusal issues 
• Speech issues 
• Difficulty eating 
• Aesthetic disfiguration 
• Increased tooth sensitivity
• Increased susceptibility to damage
• Pathologic bone resorption 

Decreased VDO 

• Angular cheilitis 
• Speech issues
• Aesthetic disfiguration 
• Increased susceptibility to damage
• Temporomandibular disorders 

Is changing a patient’s VDO clinically acceptable? 

“Changing a patient’s VDO is clinically acceptable,” says Chad Van Maele, a highly experienced laboratory technician specializing in denture fabrication at Dandy. Van Maele says that in cases related to dentures, changing VDO is, “more than acceptable—it is often necessary to get your patient into a proper restoration.”

Changing a patient’s vertical dimension of occlusion may be indicated for several reasons: to enhance aesthetics, make space for restoration, and to improve overall occlusal relationships. In cases where VDO may be changed, it is crucial that the dentist consider 

• Effects on speech 
• Anticipated muscle pain 
• Changes in bite force
• Impact on temporomandibular joint or tooth loading
• Stability 

Van Maele has witnessed the positive results of proper VDO adjustment, saying that patients “would hold up that mirror and smile again and, for the first time in a long time, they can actually see their smile… you can definitely see their self-confidence come back… not only are they no longer in pain, but they can also speak and smile without being embarrassed.” Achieving optimal vertical dimension of occlusion, he says, “is definitely life-changing on many levels.”

It bears stating that unintentional changes to VDO are not clinically acceptable. Dentists who prescribe appliances indicated for bite, bruxism, or respiration correction should take great care over the course of treatment to track their patient’s VDO. You are obliged to preserve a healthy patient’s natural vertical dimension of occlusion. 

VDO in dentistry: The ticket to better patient education and case acceptance 

Proper VDO combined with a state-of-the-art intraoral scanner and digital impressions greatly aid the perfect outcome for you and your patients. The greatest tool for case acceptance is showing someone how their smile can look, and proper VDO doesn’t just realign teeth, it can reset a person’s whole visage. Seeing is believing. The new smile starts right there.

Beyond visualization capabilities, VDO gives data that guides skilled lab technicians to ensure they are delivering the best-fitting mandibular advancement devices, TMJ pain relief appliances, and/or confidence-enhancing dentures.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

Explore all glossary

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Immediate dentures, also known as “temporary dentures,” are customized full-dentures (upper, lower, or both) prosthetic devices designed for immediate use following dental extractions. Modeled in anticipation of extractions, immediate dentures replicate the patient’s original teeth and bite.

Immediate dentures fulfill various functions: promoting aesthetic continuity, phonetic function, and masticatory efficiency. Additionally, immediate dentures help protect extraction sites from post-surgical complications during the healing process, and promote tissue retention and overall healing until adoption of a permanent restoration or prosthesis.

The pros and cons of immediate dentures

“Immediate dentures come into play when there’s no way [the patient] can afford a crown and bridge style restoration or an implant style restoration without it being an implant or full denture,” says Chad Van Maele, a Dandy lab technician with over 16 years of experience fabricating dentures. “They act as a Band-Aid,” he says, explaining that they help facilitate healing and protect extraction sites. “They definitely help avoid dry socket…that’s no fun at all.” But perhaps the most important aspect of immediate dentures, he says, is that “the patient has a smile day one, so they can smile more confidently and speak and be seen in public, versus a mouth full of open wounds.”

But, Van Maele notes, immediate dentures do have some major drawbacks. “When you first get [immediate dentures], they almost never fit great because the patient has just gone through major trauma,” says Van Maele. “Tissue will shrink and change shape and those immediate dentures will become loose and ill-fitting very quickly.” Which is why monthly relining is necessary. Van Maele also notes that, following extractions, patients newly-fitted with immediate dentures are “still gonna be on a soft food diet for a couple of weeks, if not months… they lose about 70% of their biting force, so those who expect that they’re gonna be eating corn on the cob and steak are more likely gonna be eating creamed corn and steak burger, cut up into little bits.”

Pros:

Immediate restoration – Immediate dentures provide immediate replacement for missing teeth on the same day as extractions, ensuring no extended period without teeth.

Preservation of aesthetics – Temporary dentures maintain the patient’s facial appearance. This can have a huge effect on self-confidence and reduces the likelihood of the prosthesis’ abandonment. 

Functional continuity – Immediate dentures allow for continued phonetic function and masticatory efficiency, aiding in speech and eating during the healing period. Though, masticatory efficiency is limited, it is still better than exposed gums.

Preservation of oral structures – By protecting extraction sites, immediate dentures help prevent complications like dry socket and tissue loss. 

Facilitates bite and size replication in permanent dentures – The immediate placement of temporary dentures allows the dentist to note the patient’s overall experience with a denture. Patients’ preferences and the overall look/function of the fabricated appliance serve as a dry-run of sorts, helping to refine the forthcoming permanent prosthesis. 

Cons:

Need for adjustments – Chairside adjustments are necessary due to the dynamic changes in oral tissues during the six-eight month healing process during which immediate dentures will be worn. 

Temporary nature – They serve as an interim solution and are ultimately replaced by more permanent dentures, hence their other name: temporary dentures. As their function is largely cosmetic and protective, immediate dentures are not a good replacement for permanents or implants.

Discomfort – Patients may experience discomfort while they heal when comparing immediate dentures vs permanent. Whereas permanent dentures are applied after recovery, the active healing process when immediate dentures are worn means they are likely to contact sensitive tissues. Immediate dentures may also trigger gag reflex in some sensitive patients.

Speech and eating challenges – Some patients may face challenges in speech as they adapt to the new dentures, especially with ‘s’ and ‘t’ sounds. Bite force is also limited with immediate dentures vs permanent. In addition, liquids can loosen the denture reducing its overall functionality, and some patients report attenuation in their sense of taste.

Cost – As they are not strictly necessary, immediate dentures incur cost in addition to that of surgery and permanent restoration. 

The immediate dentures workflow

In the last few years, technology has fundamentally changed the possibilities for taking dental impressions, visualizing fitting, and fabricating oral appliances–immediate dentures are no exception. Below, the traditional, analogue workflow that you most-likely learned in school is outlined versus the newer digital alternative. 

Note: With both digital and traditional workflows, the process begins with the same initial step: a patient undergoes a full preoperative assessment including a cleaning, evaluation of present overall oral health, imaging both for evaluative and aesthetic reference purposes, and a full medical history. This assessment culminates in the dentist making a recommendation for a long-term solution (i.e. permanent dentures, implants, snap-ons, etc).

The traditional workflow for immediate dentures

1. Teeth are prepped.
2. Upper and lower dental impressions are taken using trays and alginate (or other comparable material) from which a stone cast is made. 
3. Custom trays are fabricated for wash impressions (aka border molding). Wash impressions are taken. 
4. All impressions are inspected for any inclusions or defects–if any are present, Steps 1, 2, 3 must be repeated as needed. 
5. Impressions are shipped to the lab. 
6. Lab technicians hand fabricate occlusal wax rims. 
7. Wax rims are shipped back to the dentist.
8. The patient returns for evaluation of the wax rims and tooth selection, the dentist noting any/all adjustments that must be made. 
9. Wax rim is shipped back to the lab. 
10. Using the notes from Step 5, reference images, and all dental impressions, the wax rim is fitted with acrylic teeth for a try-in.
11. The wax try-in is shipped back to the dentist.
12. The patient returns for an evaluation of the wax try-in. Notes and adjustments are made.
13. The wax try-in is sent back to the lab.
14. The immediate denture is hand crafted. Once finished, the immediate denture is inspected 
15. The immediate denture is shipped back to the dentist.
16. The surgical appointment takes place.
17. The immediate denture is placed and fitted.

The digital workflow for immediate dentures

1. A scan of the patient’s mouth is taken using an intraoral scanner. This scan records the patient’s entire mouth including occlusal surfaces, gingiva, and bite in precise detail. These scans are automatically converted into a 3D model. Patient notes and/or feedback can be included as well. The scan is immediately sent electronically from the chairside to the dental lab.
2. Scans are inspected by a lab technician observing any notes made on the 3D scan. Upon approval, the immediate denture is 3D printed. Once finished, the digital denture is refined and inspected for quality control. 
3. Immediate dentures are shipped back to the dentist.
4. The surgical appointment takes place, and the immediate denture is fitted.

As you can see, the traditional workflow for immediate dentures necessitates at least four of patient visits over the course of months whereas the digital workflow can be completed in just two visits with a possible turnaround of a single week.

How long should a patient have immediate dentures? 

A patient should have immediate dentures for the duration of their full convalescence, allowing all tissue to completely heal and natural shrinkage to take place–typically 6-8 months. During this timeframe, relining is common to maximize patient comfort and function. After a patient is deemed fully recovered, the switch to a more durable, more permanent prosthesis can safely be made.

Indications and contraindications for immediate dentures

Immediate dentures are not appropriate for all cases. Below, we will outline indications and contraindications for temporary/immediate dentures.

Indications for temporary dentures

Immediate dentures are ideal for any patient who will undergo complete upper, lower, or full mouth extractions and is otherwise healthy with no underlying conditions. While they are not a medical necessity and do not significantly increase bite strength, temporary dentures can reduce post-extraction pain and promote healing. They are a great choice for people who have concerns about facial aesthetics, speech clarity, and/or want to get used to the feeling of life with an oral prosthetic. 

Contraindications for temporary dentures

Immediate dentures may not be suitable for patients who

• Only require extraction of a minimal number of teeth. 

• Have active oral infections, severe periodontal disease, or suffer from uncontrolled systemic conditions or other significant medical issues/conditions that may complicate full post-operative recovery. 

• Have inadequate bone support in the oral cavity. 

• Have poor overall oral hygiene habits and/or a lack of willingness to adhere to post-operative care/follow-up appointments.

• Women in the late stages of pregnancy.

• Fully dentulous patients seeking a purely cosmetic measure.

Patient FAQs

Q: What do immediate dentures look like?

A: Immediate dentures look almost exactly like permanent dentures i.e. like the patient’s natural teeth.

Q: How long will it take to get used to temporary dentures? 

A: This depends on the individual, but most patients report an initial adjustment time of two-three weeks.

Q: How long is the immediate dentures recovery time? 

A: Immediate dentures should stay in place for 24 hours following extraction. Full recovery time depends on the progress of post-extraction healing; approximately six-eight weeks.

Q: How do immediate dentures stay in place?

A: Immediate dentures stay in place primarily using suction and liners. Commercially available oral fixatives may also be used.

Immediate dentures: A temporary solution

Immediate dentures are worn from the day of tooth extraction until the day you get your permanent new dentures, but not every patient is the right candidate for temporary dentures. If you’re a dentist, patient education is the best course of action to ensure that your patients know their options when they are getting teeth extracted for partial dentures or full dentures.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

Explore all glossary

The post Immediate dentures appeared first on Dandy.

Composite veneers materials

There are two main materials of composite veneers, each using a different type of resin.

• Bisphenol A-glycidyl methacrylate (Bis-GMA): This is the most common type of resin used for composite veneers. It is a strong and durable material that can be bonded well to teeth. However, Bis-GMA can release small amounts of BPA, a chemical that has been linked to some health concerns.
• Urethane dimethacrylate (UDMA): This is a newer type of resin that is less likely to release BPA (Bisphenol A) than Bis-GMA. It is also a strong and durable material, and it can be bonded well to teeth.

Other materials that may be used in composite veneers include:

• Silica is a filler that helps to strengthen the composite resin and make it more resistant to wear.
• Zirconium is another filler that is sometimes used in composite veneers. It is similar to silica, but it is stronger and more resistant to chipping.
• Glass is sometimes used as a filler in composite veneers. It can help to make the veneers more translucent and give them a more natural appearance.

The specific materials used in composite veneers will vary depending on the manufacturer and the dentist’s preferences. However, all of the materials used in composite veneers are safe and effective.

Workflow for composite veneers

Applying composite veneers is a relatively simple, four-step process. 

1. Consultation: During the consultation, the patient will discuss their goals for their smile with you. After an examination of the patient’s teeth and gums, it can be determined if they are a good candidate for composite veneers. You, the dentist will also determine which type of composite veneer is the most apt for the patient during the consultation.
2. Veneer Preparation: On the day of the procedure, you will begin by preparing the patient’s teeth for the veneers by removing a thin layer of enamel to create space for the veneers and to ensure a good bond between the veneers and the teeth. 
3. Application: Once the teeth are prepared, apply the composite resin to the front surface of the teeth. The resin will be sculpted to the desired shape and size, and it will be cured with a special light.
4. Polishing: Once the resin is cured, polish the veneers to give them a natural shine. 

Direct composite veneers

Once known as “day savior fillings,” as they can be done in one patient visit, direct composite veneers have evolved into becoming reliable, durable and minimally invasive solutions for smile makeovers for the right patient. A study published by the National Library of Medicine showed that after two years direct composite ventures proved themselves to be one of the most promising treatment options for patients.

Direct composite veneers workflow

The workflow for direct composite veneers can be summarized in the following steps:

Preoperative evaluation and diagnosis

1. Initial consultation: Gather patient’s history, expectations, and aesthetic concerns. Perform a thorough clinical examination to assess oral health, tooth alignment, and bite function.
2. Diagnostic records: Take dental impressions (digital preferred), photographs, and radiographs to evaluate tooth structure, occlusion, and underlying bone support.
3. Treatment planning: Discuss treatment options with the patient, considering factors such as patient preference, budget, and severity of aesthetic defects.

Tooth preparation and etching

1. Anesthesia: Apply local anesthesia to the treatment area to numb the teeth and surrounding tissues.
2. Rubber dam isolation: Place a rubber dam to isolate the treatment area, preventing saliva contamination and ensuring a dry field.
3. Tooth preparation: Minimal enamel preparation is required to create a bonding surface for the composite resin. This involves using fine burs to remove a thin layer of enamel, typically 0.5-1.0 millimeter.
4. Acid etching: Etch the enamel surface with phosphoric acid for 30 seconds to create microscopic pores, enhancing the adhesion of the composite resin to the tooth structure.

Bonding and layering composite resin

1. Primer application: Apply a primer to the etched enamel surface to increase bonding strength.
2. Adhesive application: Apply a thin layer of adhesive resin to both the tooth surface and the composite resin.
3. Light curing: Polymerize the adhesive resin using a curing light to create a strong bond between the tooth and the composite resin.
4. Composite resin layering: Build up the composite resin in incremental layers, starting with an opaque dentin shade to mask the underlying tooth color.
5. Coloration and characterization: Use different shades and translucency levels of composite resin to create natural-looking tooth contours, mamelons, and incisal edges.
6. Additional light curing: After each layer of composite resin is placed, it is carefully cured with a curing light to ensure proper polymerization and prevent premature bonding failure.

Finishing and polishing

1. Initial shaping: Use fine diamond burs or carbide burs to shape the composite resin into the desired tooth anatomy.
2. Finishing: Refine the surface texture of the composite resin using polishing discs and polishing strips to achieve a smooth and natural-looking finish.
3. Occlusal adjustment: Evaluate and adjust the occlusion to ensure proper bite function and prevent premature tooth wear.
4. Final polishing: Apply polishing paste with a polishing wheel to achieve a high-gloss finish that mimics the natural shine of enamel.

Postoperative care and follow-up

1. Postoperative instructions: Provide the patient with postoperative care instructions, including dietary recommendations and oral hygiene guidelines.
2. Follow-up appointments: Schedule follow-up appointments to monitor the healing process, evaluate the aesthetics and function of the veneers, and provide any necessary adjustments or maintenance.

Direct composite veneers indications

• Mild to moderate tooth discoloration: Composite veneers can effectively mask tooth discoloration caused by tetracycline staining, fluorosis, or mild general staining.
• Minor tooth misalignment: Direct composite veneers can be used to correct minor tooth misalignment, such as crowding, spacing, or mild rotations.
• Chipped or fractured teeth: Composite veneers can restore the aesthetics and function of chipped or fractured teeth, especially in the anterior region.
• Abraded or eroded teeth: Direct composite veneers can protect abraded or eroded teeth from further wear and enhance their appearance.
• Diastemas: Composite veneers can effectively close diastemas, which are gaps between teeth.
• Aesthetic contouring: Direct composite veneers can be used to improve the overall appearance of teeth by modifying their shape, size, and contour.

Direct composite veneers contraindications

• Severe tooth discoloration: Direct composite veneers may not be able to adequately mask severe tooth discoloration caused by factors such as endodontic treatment or extensive metallic restorations.
• Significant tooth misalignment: For moderate to severe tooth misalignment, orthodontic treatment is often a more appropriate option.
• Major tooth wear or loss of tooth structure: Direct composite veneers may not be strong enough to restore teeth with significant wear or loss of tooth structure.
• Poor oral hygiene: Patients with poor oral hygiene are at increased risk of composite veneer fracture or failure.
• Bruxism: Patients with bruxism, or excessive grinding of teeth, may require protective nightguards to prevent damage to the composite veneers.
• High bite forces: Direct composite veneers may not be suitable for patients with high bite forces, especially in the posterior region.
• Unrealistic expectations: Patients should have realistic expectations about the aesthetic outcome of direct composite veneers.
• Allergy to composite resin materials: Patients with a known allergy to composite resin materials should not undergo this procedure.

Indirect composite veneers

Indirect composite veneers are a type of cosmetic dental restoration that is used to improve the appearance of teeth. They are made from a composite resin material that is layered onto a model of the patient’s teeth. The veneers are then bonded to the teeth, providing a durable and natural-looking restoration.

Indirect composite veneers workflow

The workflow for indirect composite veneers typically involves the following steps:

Preoperative evaluation and diagnosis

1. Initial consultation: Gather the patient’s history, expectations, and aesthetic concerns. Then perform a thorough clinical examination to assess oral health, tooth alignment, and bite function.
2. Diagnostic records: Take dental impressions (digital preferred), photographs, and radiographs to evaluate tooth structure, occlusion, and underlying bone support.
3. Treatment planning: Discuss treatment options with the patient, considering factors such as patient preference, budget, and severity of aesthetic defects.

Tooth preparation and impression

1. Anesthesia: Apply local anesthesia to the treatment area to numb the teeth and surrounding tissues.
2. Rubber dam isolation: Place a rubber dam to isolate the treatment area, preventing saliva contamination and ensuring a dry field.
3. Tooth preparation: Minimal enamel preparation is required to create a bonding surface for the composite resin. This involves using fine burs to remove a thin layer of enamel, typically 0.5-1.0 millimeter.
4. Impression: Take a high-quality impression of the prepared teeth.

Laboratory fabrication of the veneer

1. Model creation: Pour the impression material into a stone cast to create a working model of the patient’s teeth.
2. Wax-up: Wax is sculpted onto the model to create the desired shape and anatomy of the veneer.
3. Investing: The wax-up is covered in an investment material and placed in a furnace to create a mold.
4. Composite resin application: Composite resin is carefully layered into the mold, following the contours of the wax-up.
5. Pressurization: The mold is pressurized to ensure proper compaction of the composite resin.
6. Curing: The composite resin is cured under ultraviolet light to harden the material.
7. Finishing and polishing: The veneer is finished and polished to achieve a natural-looking surface.

Veneer placement

1. Try-in: The veneer is placed on the tooth to check for fit and aesthetics.
2. Bonding: The tooth surface is etched with acid to create a micromechanical bond.
3. Adhesive application: A bonding agent is applied to both the tooth and the veneer.
4. Luting: The veneer is bonded to the tooth using a light-cured composite resin.
5. Marginal adaption: Excess composite resin is removed, and the margins are polished to create a smooth transition between the veneer and the natural tooth.
6. Occlusal adjustment: Evaluate and adjust the occlusion to ensure proper bite function and prevent premature tooth wear.
7. Final polishing: Apply polishing paste with a polishing wheel to achieve a high-gloss finish that mimics the natural shine of enamel.

Postoperative care and follow-up

1. Postoperative instructions: Provide the patient with postoperative care instructions, including dietary recommendations and oral hygiene guidelines.
2. Follow-up appointments: Schedule follow-up appointments to monitor the healing process, evaluate the aesthetics and function of the veneers, and provide any necessary adjustments or maintenance.

Indirect composite veneers indications

• Moderate to severe tooth discoloration: Indirect composite veneers can effectively mask moderate to severe tooth discoloration.
• Significant tooth misalignment: Indirect composite veneers can be used to correct significant tooth misalignment, such as moderate to severe crowding, spacing, or rotations.
• Major tooth wear or loss of tooth structure: Indirect composite veneers can restore teeth with significant wear or loss of tooth structure.
• High bite forces: Indirect composite veneers are stronger than direct composite veneers and may be a better option for patients with high bite forces.

Indirect composite veneers contraindications

• Poor oral hygiene: Patients with poor oral hygiene are at increased risk of composite veneer fracture or failure.
• Bruxism: Patients with bruxism may require protective nightguards to prevent damage to the composite veneers.
• Unrealistic expectations: Patients should have realistic expectations about the aesthetic outcome of indirect composite veneers.
• Allergy to composite resin materials: Patients with a known allergy to composite resin materials should not undergo this procedure.

How long do composite veneers last? 

Composite veneers can typically last for five-to-seven years. However, several factors can affect their longevity, including:

• Oral hygiene: Good oral hygiene is essential for prolonging the life of composite veneers. This includes brushing your teeth twice a day, flossing daily, and using a mouthwash.
• Diet: A diet that is high in sugar and acid can damage composite veneers. Limit your intake of sugary drinks, candy, and acidic foods.
• Grinding your teeth: If you grind your teeth, you may need to wear a nightguard to protect your veneers from damage.
• Smoking: Smoking can stain and damage composite veneers. If you smoke, quitting is the best way to protect your veneers.

The material used in composite veneers can significantly impact their longevity. Composite veneers are made from a resin-based material that is bonded to the tooth surface. The type of resin used, as well as the quality of the bonding process, can affect how long the veneers last.

• Microfill: Microfill composite resins have very fine particles, which makes them more durable and less likely to chip or crack. However, they are also more difficult to polish to a high shine. 
• Macrofill: Macrofill composite resins have large particles, which makes them less durable and more likely to chip or crack. However, they are also the easiest to polish to a high shine. 
• Hybrid: Hybrid composite resins are a mixture of microfill and macrofill particles. They are more durable than macrofill resins, but they are less durable than microfill resins. They are also easier to polish than microfill resins. 

Composite veneers vs. porcelain veneers longevity

Composite veneers have an average lifespan between five and seven years, whereas porcelain veneers have a lifespan between 10 and 15 years. If longevity is the main factor in consideration, porcelain veneers are generally a better choice for patients who want the most natural-looking, durable, and long-lasting veneers. However, composite veneers are a good option for patients who are on a budget or who want a less invasive procedure.

Comparison between direct composite and indirect composite workflows

There are many factors to be considered when choosing which type of composite veneers are right for a patient. Among them are price, aesthetics, and complexity of the procedure. The best workflow for you will depend on your individual needs and preferences. Indirect composite veneers require multiple steps more than the direct composite option, including the lab fabrication from an intraoral scan dental impression. The application of indirect composite veneers will often take at least two-to-three visits while direct composite veneers can be installed within a matter of a couple of hours during a single visit. The extended process is often worth it as indirect composite veneers are more aesthetically pleasing and more durable than direct composite veneers. 

What are composite veneers made out of? 

Composite veneers are made out of a tooth-colored resin material. This resin is composed of several different components, including:

• Fillers: Fillers are the main component of composite resin. They are typically made of glass or ceramic particles and give the resin its strength and durability.
• Monomer: Monomer is the liquid component of composite resin. It is responsible for bonding the fillers together and creating a hard, durable surface.
• Initiator: Initiator is a chemical that is used to start the polymerization reaction. This reaction hardens the resin and makes it more durable.
• Inhibitor: Inhibitor is a chemical that is used to slow down the polymerization reaction. This is important because it allows the dentist to sculpt the resin before it hardens.
• Pigments: Pigments are added to the resin to give it a natural tooth-like color.

The specific composition of composite resin varies depending on the manufacturer. However, all composite resins contain these basic components.

What are porcelain veneers? 

Porcelain veneers are thin, custom-made shells of tooth-colored material designed to cover the front surface of teeth to change their appearance. They are made of a high-grade ceramic material that is strong, durable, and resistant to staining. Porcelain veneers are often considered to be the best option for cosmetic dental restorations because they can provide a natural-looking and long-lasting solution for a variety of dental problems.

Benefits of porcelain veneers

• Natural-looking appearance: Porcelain veneers are very closely matched to the natural color and translucency of teeth, so they can give teeth a very natural-looking appearance.
• Durability: Porcelain veneers are very strong and durable, and they can resist chipping and cracking.
• Stain resistance: Porcelain veneers are resistant to staining, so they can help to keep teeth looking white and bright.
• Versatility: Porcelain veneers can be used to correct a variety of dental problems, including:
  • Chipped or cracked teeth
  • Discolored teeth
  • Gaps between teeth
  • Crooked or misaligned teeth
  • Shortened teeth

Workflow for porcelain veneers

The procedure for installing porcelain veneers involves the following steps:

1. Consultation: The first step is to have a consultation with the patient to discuss their goals for treatment and determine if porcelain veneers are the right option.
2. Tooth preparation: The dentist will remove a small amount of enamel from the front of the teeth to make room for the veneers.
3. Impressions: Impressions will be taken of the teeth to create custom-made veneers.
4. Temporary veneers: While the permanent veneers are being made, the patient may be given temporary veneers to wear.
5. Veneer placement: The permanent veneers will be bonded to the teeth using a special adhesive.
6. Final touches: The dentist will trim and polish the veneers to ensure they look natural and fit perfectly.

Porcelain veneers vs. composite veneers

The best type of veneer for you will depend on the individual needs and goals of the patient. Porcelain veneers are the best choice if the patient prioritizes durability and the most natural look. However, if they are on a budget or want a less time-consuming procedure, then composite veneers may be the better option.

Here is a summary of the key differences between porcelain veneers and composite veneers:

• Material: Porcelain veneers are made of a ceramic material, while composite veneers are made of a tooth-colored resin.
• Appearance: Porcelain veneers are generally considered to be more natural-looking than composite veneers.
• Durability: Porcelain veneers are more durable than composite veneers.
• Stain resistance: Porcelain veneers are more stain resistant than composite veneers.
• Cost: Porcelain veneers are more expensive than composite veneers.
• Procedure: The procedure for getting porcelain veneers is more time-consuming than the procedure for getting composite veneers.
• Reversibility: Porcelain veneers are less reversible than composite veneers as the latter bonds to the teeth but does not remove enamel.

Are composite veneers right for your practice? 

Composite veneers offer a couple of benefits over porcelain veneers. Porcelain veneers are more durable and natural-looking than composite veneers, but those benefits come with a cost—the process is far more time-consuming and expensive. You will most likely want to nudge patients who are looking to have a less invasive, more reversible, and less expensive procedure toward composite veneers.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

Explore all glossary

The post Composite veneers appeared first on Dandy.

Sometimes hybrid dentures are referred to as “All-on-4,” a reference to the (usually) four implanted pillars the dentures sit upon. These four implants are strategically placed in the jawbone, with two in the front and two in the back. This placement allows the implants to support a full arch of teeth, even if there is not enough bone for traditional implants. The number of implants can vary from two to six, but “All-on-4” is a catchy moniker, so it has become commonplace. 

Pros and cons of hybrid dentures

Like all dental procedures, there are a lot of different factors to consider before choosing which one is right for the patient. Let’s go over all of the pros and cons associated with hybrid dentures. 

The pros of hybrid dentures

• Improved stability and support: Hybrid dentures are anchored to dental implants, providing significantly greater stability compared to traditional dentures. This allows the patient to eat, speak, and laugh confidently without worrying about the dentures slipping or falling out.
• Enhanced chewing function: The improved stability of hybrid dentures allows for more effective chewing, leading to improved digestion and a better overall eating experience.
• Natural-looking appearance: High-quality hybrid dentures are crafted to closely resemble natural teeth, offering a more natural and aesthetically pleasing appearance than traditional dentures.
• Improved oral health: Hybrid dentures can help prevent bone loss in the jaw, a common concern with traditional dentures. This is because the implants stimulate the jawbone, promoting its health and density.
• Reduced risk of gum irritation: Unlike traditional dentures, which can irritate the gums due to friction, hybrid dentures distribute pressure more evenly, reducing the risk of irritation.
• Easier cleaning: Hybrid dentures can be easily removed for cleaning, allowing for more thorough and effective cleaning compared to traditional dentures.

The cons of hybrid dentures

• Higher cost: All-in hybrid dentures are significantly more expensive than traditional dentures due to the additional cost of dental implants and the more complex fabrication process.
• Surgical procedure required: Placing dental implants involves surgery, which requires healing time and carries certain risks associated with any surgical procedure.
• Longer treatment time: Compared to traditional dentures, the process of getting hybrid dentures typically takes longer due to the surgical procedure and the time required for the implants to heal.
• Maintenance requirements: While hybrid dentures are easier to clean than traditional dentures, they still require regular brushing, flossing, and professional cleanings to maintain their appearance and function.
• Not suitable for everyone: Certain medical conditions or bone health issues may make individuals ineligible for dental implants, thus disqualifying them for hybrid dentures.

The hybrid dentures workflow

The process of installing hybrid dentures typically involves multiple appointments spread over several months. Here’s a breakdown of each appointment and what to expect:

Appointment 1: Consultation and planning

• Consultation: Being with a discussion of the patient’s dental history, expectations, and concerns.
• Examination: Then you will examine the patient’s teeth and gums to assess their suitability for hybrid dentures.
• X-rays and scans: These tools will help determine the amount of bone available for implant placement.
• Planning: Based on the assessment, you will develop a personalized treatment plan, including the number and location of implants needed, the type of hybrid denture, and the estimated timeline.
• Financial discussion: Please do discuss the costs involved and payment options before beginning work.

Appointment 2: Implant placement

• Surgery: The dentist or oral surgeon will place the dental implants in the jawbone.
• Healing time: Following implant placement, several months are required for the bone to heal and integrate with the implants.
• Temporary restoration: In some cases, temporary dentures may be provided to wear during the healing period.

Appointment 3: Impression and bite registration

• Impressions: After the healing period, the dentist will take impressions of the patient’s mouth and jaw to create a custom-made hybrid denture.
• Bite registration: This will record the correct bite position for optimal chewing function and aesthetics.

Appointment 4: Denture fitting and adjustments

• Initial fitting: The dentist will place the custom-made hybrid denture and check for fit, comfort, and function.
• Adjustments: Minor adjustments may be needed to ensure a perfect fit and address any concerns.
• Instructions and care: You will provide instructions on how the patient should care for hybrid dentures and schedule follow-up appointments.

The overall timeline for installing hybrid dentures can vary depending on individual needs and healing abilities. However, it typically takes four-nine months from the initial consultation to the final denture placement.

Materials used for hybrid dentures

Like with many dental procedures, there are a variety of different materials available for constructing hybrid dentures. Each different method has its own set of pros and cons.

Acrylic with titanium

Acrylic with titanium hybrid dentures are a popular choice for patients who are missing teeth and want a more stable and natural-looking alternative to traditional dentures. These dentures combine the affordability and ease of use of acrylic with the strength and durability of titanium. They are a particularly good choice for people with limited bone support and are easy to care for. However, they may not be as natural-looking as other options and may need to be replaced more often.

Composite

This form of hybrid dentures features a composite base made of a mixture of acrylic resin and fibers. Typically these fibers are made of materials such as glass, carbon, or aramid. The composite material can be custom-colored to match a patient’s existing teeth. Composite hybrid dentures are a good option for people who want a strong, durable, and natural-looking denture that is comfortable to wear. They are a good choice for patients with allergies to nickel and can be repaired easily. However, they are more expensive than traditional dentures and may not be as readily available.

PFM

Porcelain-fused-to-metal (PFM) hybrid dentures offer a unique blend of strength, durability, and aesthetics. Porcelain provides superior aesthetics compared to other materials, so PFM dentures are especially popular among patients hoping to have a natural-looking smile. The metal framework of PFM hybrid dentures gives them superior strength and durability. This is one of the more costly options.

Milled zirconia

Milled zirconia hybrid dentures, also known as monolithic zirconia dentures, are a cutting-edge solution for individuals seeking a strong, natural-looking, and long-lasting alternative to traditional dentures. These dentures are crafted from a single block of high-quality zirconia, a ceramic material known for its exceptional strength, biocompatibility, and aesthetic properties. The entire structure is milled using computer-aided design and manufacturing (CAD/CAM) technology, ensuring a precise fit and customized appearance.

How long do hybrid dentures last? 

The longevity of hybrid dentures is dependent on two key factors: the material they are created with and how well they are taken care of. Different materials are more durable than others, which can shorten their lifespan. For example, acrylic hybrid dentures typically last from five-seven years, while PFM or milled zirconia hybrid dentures can last 10-15 years or even longer. 

Regardless of the material used in the hybrid denture implants, maintaining proper care and maintenance, including regular brushing, flossing, and professional cleanings will significantly extend the lifespan of the dentures. Avoiding hard foods and chewing habits that damage the dentures will also go a long way to maintaining a long life out of the hybrid dentures. It also can’t be understated how important craftsmanship and a properly aligned bite are to the long-term success of hybrid dentures. 

What is the survival rate for All-on-4?

The survival rate for All-on-4 implant systems is quite high, with most studies indicating success rates exceeding 90% over several years. In the short-term, studies have shown a survival rate of 99.8% after 24 months. In the long-term, research has found a success rate of 98.1% after five years and 94.8% after 10. 

Hybrid dentures are a great long term solution for some patients. We hope this helps dental professionals make more informed decisions when prescribing fixed restoratives to their patients and helps patients identify the procedures they need for their specific case. 

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

Explore all glossary

The post Hybrid dentures appeared first on Dandy.

What is the purpose of a wax rim? 

This denture tool serves three purposes: determining the position and arrangement of artificial teeth, verifying the correct jaw alignment and bite, and delivering an evaluation of the aesthetics of the denture before finalization. 

Why are wax rims important? 

Wax rims play a crucial role in occlusal correction within the denture fabrication process. They serve as a diagnostic and therapeutic tool, helping dentists achieve optimal bite and jaw function for the patient.

One of the most important roles of wax rims is in providing verification of jaw alignment. Confirmation of the correct vertical dimension of occlusion (VOD) and the relationship between the upper and lower jaws ensures proper biting and chewing function. The wax rim also provides a stable base for the final denture, preventing it from moving around in the mouth.

This allows patients to be involved in the denture creation process. They can provide feedback on the appearance of the denture, including the smile line, lip support, and overall facial aesthetics. 

The bite rim workflow

There are two different ways to create wax rims: analog and digital. Let’s take a look at the workflow for both methods. 

The analog bite rim workflow

The analog bite rim workflow involves several steps to create and utilize wax rims for accurate denture fabrication. Here’s a detailed breakdown:

• Step 1: Preparation
  • Preliminary impressions: Take preliminary impressions of the patient’s upper and lower jaws to create study models.
  • Jaw relation records: Depending on the patient’s needs, record jaw relations using methods like face-bow transfer or visual analysis.
  • Mounting casts: Mount the upper and lower study casts on an articulator according to the recorded jaw relations.
• Step 2: Base plate fabrication
  • Select prefabricated baseplates: Choose appropriate baseplates based on the patient’s jaw size and ridge anatomy.
  • Trim and adapt baseplates: Trim the baseplates to fit the patient’s gums and adapt them for proper extension and border molding.
  • Heat and adapt baseplates: Heat the baseplates and adapt them to the patient’s gums for a comfortable and accurate fit.
• Step 3: Wax rim construction
  • Apply wax to baseplates: Apply a thin layer of softened wax to the baseplates, ensuring even coverage and appropriate thickness.
  • Sculpt the wax rims: Sculpt the wax rims to create the desired shape and contour of the gums and lips, considering aesthetics and function.
  • Establish vertical dimension: Adjust the vertical dimension of occlusion (VDO) by manipulating the wax rims vertically based on measurements and patient feedback.
• Step 4: Tooth positioning
  • Select and arrange teeth: Choose appropriate artificial teeth based on size, shade, and morphology.
  • Position teeth on the wax rims: Arrange the teeth on the wax rims in the desired position and angulation, ensuring proper alignment and occlusion.
  • Evaluate aesthetics and function: Assess the smile line, lip support, and overall aesthetics—making adjustments to the tooth position and wax rim shape as needed.
• Step 5: Bite registration
  • Instruct the patient: Guide the patient to bite together gently but firmly on the wax rims to register the bite.
  • Verify bite registration: Check for any occlusal discrepancies or premature contacts and refine the wax rims accordingly.
  • Secure the bite registration: Cool the wax rims and secure them in a stable position for transportation to the dental laboratory.
• Step 6: Laboratory processing
  • Cast preparation: The dental technician prepares the casts and mounts them on an articulator using the bite registration.
  • Denture fabrication: The technician fabricates the final denture base and incorporates the teeth based on the wax rim configuration.
  • Finishing and polishing: The technician finishes and polishes the denture after ensuring proper fit, aesthetics, and occlusal function.
• Step 7: Delivery and adjustments
  • Denture fitting: Place the final denture in the patient and evaluates the fit, comfort, and aesthetics.
  • Occlusal adjustments: Fine-tune the occlusion if necessary to ensure optimal chewing function and patient comfort.
  • Patient instructions: Provide the patient with instructions on denture care and maintenance.

The analog bite rim workflow was the best method for years, however, advancements in digital technologies are increasingly offering alternative workflows with potential benefits in terms of accuracy, efficiency, and patient experience. Which brings us to…

The digital bite rim workflow

The digital bite rim workflow is far quicker. Let’s go over the process. 

• Take upper and lower intraoral scans
  • Select the arch (or arches) that need a full denture to be fabricated.
  • If facing difficulty scanning, doctors may take a standard impression and scan either the impression or the model.
• Register bite via wax bite rim and take 360 extraoral scan of wax rim
  • After receiving the wax bite rim, guide it into the patient’s mouth to get an accurate bite impression.
  • Apply a light amount of body wash to the bite rim for border molding and accuracy.
  • Clearly mark the bite rum with the patient’s smile lines, canine lines, and midlines.
  • Add blue mousse to register bite.
  • It is highly recommended to take photos of the patient:
    • Head on with patient smiling naturally with wax bite rim in place
    • Two profile pictures (one from each side) with the patient smiling naturally with wax bite rim in place
    • A head on photo of the patient with cheek retractors and wax bite rim in place if possible
• Set up case and scan the denture
  • Select the arch (or arches) that need a full denture to be fabricated.
  • When scanning an arch (or arches) with wax bite rims, select “denture” from pop-up.
  • Perform 360 extraoral scan of the wax bite rims
  • To obtain bite registration:
    • If scanning a single arch, scan with wax bite rim in mouth (from molar to midline) with blue mousse.
    • If scanning a dual arch, scan both arches in occlusion outside of the mouth (full arch from molar to molar) with blue mousse.

Using wax rims in denture cases

Whether you’re practicing analog dentistry or leveraging digital dentistry, wax rims are a crucial part of the full denture bite registration process. 

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Types of removable dentures

Partial dentures

Description: Removable partial dentures, also known as “RPDs,” are prosthetic devices for patients with some missing teeth. Long-term partials are common for patients who can’t afford implants or don’t have the proper underlying bone structure to get implants.

Lifespan: Studies of the lifespan for RPDs has shown there are many different variables to be considered, but on the whole, they are quite durable with many studies showing a survival rate of 90% or greater over a period of 5-10 years. 

Complete dentures

Description: This is the type of denture used when a patient does not have any teeth in one or both arches at the beginning of the denture process.

Lifespan: Studies have shown that removable complete dentures have a lifespan of roughly 10 years, with most complete dentures lasting at least five years.

Immediate dentures

Description: An immediate denture is made to be placed into a patient’s mouth on the same day that the dentist extracts any remaining teeth that are in the patient’s mouth. Sometimes, these are called “temporary dentures” because they are ultimately replaced by better-adhering dentures at some point in the future. These are often used to allow the patient’s mouth to heal before fabricating a more permanent denture. The patient has teeth at the start of this process, therefore the dentist can record notes and make measurements about the patient’s current bite and the length and size of the patient’s teeth. These records and measurements are used and incorporated into the denture to replicate the patient’s original teeth and bite. They look just like complete dentures. 

Lifespan: Immediate dentures are intended to be temporary, thus a patient isn’t expected to be using them for longer than four to six months giving their gums time to heal before a more permanent option is implemented. 

Implant supported overdenture

Description: A removable denture that uses implants to provide more stability. These implant supported dentures click in either to locators or to a bar in the patient’s mouth. These dentures can at times be supported by less than four implants and are used whenever a patient isn’t a good candidate for all-on-X but requires additional retention. An implant overdenture sits on gums so any vertical biting force is dispersed on gums similar to a standard denture.

Lifespan: In a study of 650 implants, implant overdenture showed a survival rate of 95.3%.

Removable dentures vs. fixed dentures

Both removable and fixed dentures are solutions for replacing missing teeth, but they offer distinct advantages and disadvantages. Each process has its own pros and cons, let’s compare the two to help determine when each should be utilized. 

Removable dentures offer many different advantages for the patient, most notably that they are a more cost-effective option. Since they do not require surgery to install, they are also a less invasive procedure. Removable dentures are also easy to clean and a good option for patients with limited jawbone. 

Most of the drawbacks with removable dentures are related to the fact that they are, well, removable. Removable dentures can slip around in the mouth while eating and speaking, which can sometimes lead to speech problems, as well as the need for adhesives to prevent further slipping. They can also cause a patient discomfort as they sometimes feel bulky and unnatural in the mouth. Over time, removable dentures can also contribute to bone loss. 

The main advantage of fixed dentures is that they feel much more natural in the mouth than removable dentures do. This natural feel leads to improved chewing and speaking, and because they are fixed, there are no issues with slippage. With proper care, fixed dentures can last for many years. 

The process of installing fixed dentures is both more invasive and more expensive than with removable dentures, which can be a significant drawback for some patients. Fixed dentures are more difficult to clean as well. Fixed dentures require a significant amount of jawbone support, so they are not suitable for all patients. 

Further suggested reading: Implant-supported dentures vs. implant retained dentures.

There are many factors to discuss with a patient before deciding upon removable dentures or fixed dentures: cost, invasiveness, comfort, and more. A thorough discussion between you and the patient can help decide the best way to move forward with their restoration.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

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Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

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Firstly, what are the components of a dental implant? The three dental implant parts are the implant fixture, the abutment, and the implant crown. The implant fixtures and abutments are most often made from metal, while crowns come in a range of materials.

Dental implant fixture

The implant fixture is a screw-shaped metal rod that is inserted into the jaw bone to serve as a replacement for the tooth root. It is typically made of titanium, a biocompatible material that fuses well with bone. In some instances zirconia is used, particularly for patients who may have an allergy to titanium.

Dental implant abutment

The abutment is a small connector piece that is attached to the implant fixture. It provides a foundation for the implant crown to be placed on. Abutments can be made of a variety of materials, most commonly titanium and zirconia. 

There are a few different types of abutment—screw retained, cement retained and screwmentable—with each having its own benefits. 

• Screw retained abutments are delivered as a single unit from the lab with the crown (which includes an access hole) cemented to the abutment. 
• Cement retained abutments are delivered from the lab in two separate units and without an access hole in the crown. 
• Screwmentable abutments arrive in two units with the crown not cemented to the abutment, but with an access hole in the crown. The doctor will need to seat the abutments first, then cement the crown over the abutments in the mouth. The doctor can then unscrew the and remove the crown to clean and remove excess cement before final torque into place.

Dental implant crowns

The implant crown is the visible part of the dental implant. Crowns are used to replace single teeth, with other dental implant components used if more extensive work is needed. A bridge is used to replace multiple teeth, and dentures are used to replace all of the teeth in the arch. Implant crowns can be made of a variety of materials including zirconia, metal, porcelain fused to metal (PFM), and ceramics like lithium disilicate (eMax).

The crown is the most expensive part of the dental implant.

How the dental implant parts work together

The implant post, abutment, and implant crown work together to create a strong and durable replacement for a missing tooth. The implant post provides a stable foundation for the restoration, while the abutment connects the implant post to the implant crown. The implant crown is the visible part of the dental implant and it is what gives you a natural-looking smile.

How implants are retained in the mouth

Dental implant parts are retained in the mouth in two ways:

Osseointegration: Osseointegration is the process by which the implant post fuses with the jaw bone. The bone cells grow around and adhere to the implant post, creating a durable bond. The process of osseointegration occurs over the span of several months. This is the primary way that dental implants are retained in the mouth.

Abutment screw: The abutment screw is a small screw that attaches the abutment to the implant post. This provides additional retention and stability for the dental implant.

Benefits of dental implants

Dental implants offer a number of benefits over other tooth replacement options, including:

• Improved function: Dental implants allow your patients to eat, speak, and smile with confidence.
• Enhanced aesthetics: Dental implants look and feel like natural teeth.
• Durability: Dental implants can last a lifetime with proper care.
• Improved oral health: Dental implants help to preserve your patient’s jaw bone and prevent gum disease.

Parts of dental implants

Implant parts stay consistent across retention styles and through the digital process. If you’re looking to learn more about the tooth extraction and implant timeline, read more of our glossary definitions relating to the dental implant process.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

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What is an implant crown?

An implant crown is a type of dental restoration that is used to replace a missing or damaged tooth. It is a cap that is attached to a dental implant, which is a surgical post that is inserted into the jawbone. The implant crown restores the function and appearance of the missing tooth.

An implant crown consists of two main components:

• Abutment: The abutment is a small connector that is attached to the dental implant. It acts as a bridge between the implant and the crown.
• Crown: The crown is the visible part of the implant restoration. It is made to look and function like a natural tooth.

Implant crown materials

Implant crowns can be made out of multiple different materials including zirconia, eMax, porcelain fused with metal (PFM), and gold. Each material offers distinct benefits for a patient’s needs. 

Zirconia

Zirconia is a versatile and highly desirable material for implant crowns due to its exceptional properties and suitability for a wide range of dental applications. Here are some compelling reasons why zirconia should be considered for implant crowns:

• Superior strength and durability: Zirconia is renowned for its exceptional strength and resistance to wear and tear. This makes it an ideal choice for implant crowns, especially for posterior teeth that bear more significant biting forces. 
• Biocompatibility and reduced risk of allergies: Zirconia is highly biocompatible with the human body, making it an excellent option for patients with metal allergies or sensitivities. Unlike traditional metal-ceramic crowns, zirconia crowns do not trigger allergic reactions or gum tissue irritation, ensuring a comfortable and well-tolerated restoration.
• Natural aesthetics and seamless integration: Zirconia’s translucent properties allow it to mimic the natural appearance of teeth. The crown can be customized to match the exact color, shape, and shade of your patient’s surrounding teeth, resulting in a natural-looking smile that enhances your patient’s overall appearance.
• Metal-free design and elimination of dark gum lines: Zirconia implant crowns are completely metal-free, eliminating the potential for dark gum lines or metal discoloration. This is particularly beneficial for patients with thin gum tissue or those who prefer a more natural-looking restoration. 
• Reduced risk of peri-implant infections: Zirconia’s smooth surface is less prone to bacterial adhesion, reducing the risk of peri-implant infections. This is crucial for maintaining implant health and long-term stability.
• Long-term longevity: Zirconia implant crowns are known for their exceptional longevity, often lasting for many years with proper care and maintenance.

Zirconia crown best use cases

Zirconia crowns are versatile and suitable for a wide range of dental applications. Here are some specific instances where zirconia crowns are particularly beneficial:

• Posterior teeth replacement: Zirconia crowns are an excellent choice for replacing posterior teeth, particularly those subjected to significant biting forces. Their strength and durability make them well-suited for these demanding areas.
• Patients with metal allergies or sensitivities: For patients with metal allergies or sensitivities, zirconia crowns offer a metal-free alternative that eliminates the risk of allergic reactions or gum tissue irritation.
• Aesthetically demanding situations: Zirconia crowns are ideal for patients seeking a natural-looking tooth replacement solution. Their ability to mimic the natural appearance of teeth enhances aesthetics and blends seamlessly with surrounding teeth.
• Patients with thin gum tissue: Zirconia crowns are a good option for patients with thin gum tissue as they eliminate the risk of dark gum lines and metal discoloration.
• High-Risk Patients for Peri-Implant Infections: Zirconia crowns are beneficial for patients at higher risk of peri-implant infections due to their smooth surface that reduces bacterial adhesion.

eMax

eMax, also known as lithium disilicate, is a highly regarded material for implant crowns due to its exceptional properties and suitability for a wide range of dental applications. Here are some compelling reasons why eMax should be considered for implant crowns:

• Superior aesthetics and natural appearance: eMax is renowned for its ability to mimic the natural appearance of teeth, making it an excellent choice for implant crowns. Its translucent properties allow light to pass through the crown, replicating the natural light transmission of dentin, the tooth’s inner layer. This results in a crown that blends seamlessly with surrounding natural teeth, creating a natural-looking smile.
• High strength and durability: eMax is a strong and durable material, making it suitable for implant crowns that need to withstand significant biting forces. While not as strong as zirconia, eMax offers sufficient strength for most applications, particularly for anterior teeth that are less subjected to wear and tear.
• Biocompatibility and reduced risk of allergies: eMax is highly biocompatible with the human body, making it an ideal option for patients with metal allergies or sensitivities. 
• Conservative tooth preparation: eMax crowns require minimal preparation of the underlying tooth structure, preserving healthy tooth tissue. This is particularly beneficial for patients with limited tooth structure or those who want to minimize tooth damage.
• Bonding strength and secure attachment: eMax crowns can be bonded to the implant abutment with a strong and reliable adhesive, ensuring a secure and stable attachment. This prevents the crown from loosening or falling off over time.

eMax crowns best use cases

eMax crowns are versatile and suitable for a wide range of dental applications. Here are some specific instances where eMax crowns are particularly beneficial:

• Anterior teeth replacement: eMax crowns are an excellent choice for replacing anterior teeth, particularly those in the smile zone. Their superior aesthetics and natural appearance enhance the overall aesthetics of the smile.
• Patients with metal allergies or sensitivities: For patients with metal allergies or sensitivities, eMax crowns offer a metal-free alternative that eliminates the risk of allergic reactions or gum tissue irritation.
• High Aesthetic Demands: eMax crowns are ideal for patients seeking the most natural-looking tooth replacement solution. Their ability to mimic the natural appearance of teeth is unmatched by other materials.
• Minimally invasive procedures: eMax crowns require minimal tooth preparation, making them a good option for patients who prefer a more conservative approach to tooth restoration.
• Secure attachment and long-term stability: eMax crowns are securely bonded to the implant abutment, ensuring long-term stability and preventing crown loosening or loss.

Porcelain fused to metal (PFM)

Porcelain fused to metal (PFM) is a type of dental crown that combines the strength of metal with the aesthetics of porcelain. It has been used for many years and is still a popular choice for implant crowns. ​​Here are some reasons why an implant crown should be made of porcelain fused to metal:

• Strength and durability: PFM crowns are very strong and durable, making them ideal for implant crowns that need to withstand significant biting forces. The metal substructure provides the strength and support, while the porcelain layer provides a natural-looking appearance.
• Biocompatibility: PFM crowns are made of biocompatible materials that are well-tolerated by the body. This is important for implant crowns, which need to be well-integrated with the surrounding bone and gums.
• Aesthetics: PFM crowns can be made to match the color and shape of your patient’s surrounding teeth, resulting in a natural-looking smile. The porcelain layer can be customized to achieve the desired level of translucency and brightness.
• Cost-effectiveness: PFM crowns are more affordable than some other types of implant crowns, such as all-zirconia crowns.

PFM crown best use cases

PFM crowns are versatile and suitable for a wide range of dental applications. Here are some specific instances where PFM crowns are particularly beneficial:

• Posterior teeth: PFM crowns are a good choice for replacing posterior teeth, such as molars and premolars. These teeth are subjected to more biting forces than anterior teeth, so it is important to choose a crown that is strong and durable.
• Patients on a budget: PFM crowns are a more affordable option than some other types of implant crowns. 
• Patients who want a natural-looking smile: PFM crowns can be made to match the color and shape of your patient’s surrounding teeth, resulting in a natural-looking smile. This makes them a good choice for patients who are concerned about their appearance.

Gold

Gold has been used in dentistry for centuries due to its unique properties, making it an excellent choice for implant crowns. Here are some compelling reasons why gold should be considered for implant crowns:

• Superior strength and durability: Gold is one of the strongest and most durable materials available for dental crowns. It is highly resistant to wear and tear, even when subjected to significant biting forces.
• Biocompatibility and reduced risk of allergies: Gold is a highly biocompatible material, meaning it is well-tolerated by the body and unlikely to cause allergic reactions or gum tissue irritation. This makes it a suitable option for patients with metal allergies or sensitivities.
• Long-term longevity: Full gold crowns are known for their exceptional longevity, often lasting for many years with proper care and maintenance. 
• Conservative tooth preparation: Gold crowns require minimal preparation of the underlying tooth structure, preserving healthy tooth tissue. This is particularly beneficial for patients with limited tooth structure or those who want to minimize tooth damage.
• Versatile aesthetics: Gold crowns can be customized to match the color and shade of surrounding natural teeth, resulting in a natural-looking smile. They can also be designed to have a more traditional gold appearance, if desired.

Gold crown best use cases

Gold crowns are versatile and suitable for a wide range of dental applications. Here are some specific instances where gold crowns are particularly beneficial:

• Patients with metal allergies or sensitivities: For patients with metal allergies or sensitivities, gold crowns offer a safe and reliable solution for tooth replacement.
• High-risk patients for peri-implant infections: Gold’s smooth surface is less prone to bacterial adhesion, reducing the risk of peri-implant infections. This is crucial for maintaining implant health and long-term stability.
• Patients with limited tooth structure: Gold crowns require minimal preparation of the underlying tooth structure, making them a good option for patients with limited tooth structure.
• Patients seeking a traditional gold appearance: Some patients prefer the look of a visible gold crown.

How long do implant crowns last?

Implant crowns can last for many years with proper care and maintenance. On average, implant crowns last between 10 and 15 years. However, some implant crowns can last for up to 25 years or more.

The lifespan of an implant crown depends on a number of factors, including:

• The type of material used: Some materials, such as gold and zirconia, are more durable than others, such as porcelain fused to metal.
• The quality of the workmanship: The skill and experience of the dentist who places the implant crown can also affect its lifespan.
• The patient’s oral hygiene: Patients who practice good oral hygiene and see their dentist for regular checkups and cleanings are more likely to have implant crowns that last longer.
• The patient’s bite: Patients with a strong bite or who grind their teeth are more likely to damage their implant crowns.

How implant crowns are retained in the mouth

There are three main ways that dental implant parts are retained in the mouth:

Screw retention: A screw is threaded into the implant fixture to hold the abutment and crown in place. This is the most common type of implant retention because it is strong and secure. It is also relatively easy to place and remove, which is helpful if the implant needs to be repaired or replaced.

Cement retention: Cement is used to bond the abutment and crown to the implant fixture. It is less common than screw retention, but cement retention can be a good option for patients with limited bone height or who have difficulty with screws. Cement retention is also a good option for patients who want a more natural-looking restoration, as the cement can be used to create a smooth transition between the implant and the surrounding teeth.

Friction retention: The abutment and crown are designed to fit tightly over the implant fixture, creating a friction-based retention. This is the least common type of implant retention, but it can be a good option for patients with limited space in their mouth or who have difficulty with screws or cement. Friction retention is also a good option for patients who want a more conservative restoration, as it requires less tooth preparation.

Which type of retention is best for your patient will depend on their individual needs and circumstances.

How implant crowns are used

Implant crowns are used to replace missing or damaged teeth. They are attached to dental implants, which are surgical posts that are inserted into the jawbone. Implant crowns are used to restore the function and appearance of a missing tooth, to improve chewing and speaking ability, to prevent the shifting of surrounding teeth, to maintain bone density in the jaw and to enhance the overall smile. 

• The installation of an implant crown can be a collaboration between a dentist and an oral surgeon. Recently technology like intraoral scanners and 3D printed surgical guides have give general dentists more confidence in the outcome of an implant procedure.
• It is up to the dentist to determine the best material to use for the dental implant crown.
• It is up to the dentist to determine the best retention style and abutments for the implant crown.

We hope this information gives you a good introduction or refresh into implant crowns with an understanding of the different options for your patients.

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

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What is an impression coping?

An impression coping is a pre-manufactured component that helps to situate and measure the implant in the mouth when impressions are being taken for a dental implant. When using impression coping or implant copings, a transfer cap is placed over the new fixture or implant, so that it can be transferred to a surgical guide for cleaner and easier crown installation.

The different types of impression copings

Impression copings are available in two main types:

Closed tray impression copings: This technique requires a clinician to capture the post within the impression. Then after curing, the impression is removed and the clinician unscrews the post from the dental implant and replaces it into the impression.

Open tray impression copings: This technique involves using impression copings attached to implants where a retaining screw extends past the tray, thus embedding it into the impression. Prior to moving the impression, the coping is unscrewed by a clinician through an opening in the tray. 

Once the impression is taken, the impression copings are removed and sent to the dental laboratory. The laboratory uses the impression to create a master cast of the implant site. The master cast is then used to fabricate the final dental implant restoration, such as a crown, bridge, or denture.

What is an implant analog and coping?

Implant analogs and copings are both important tools in the dental implant process. They help to ensure that the final restoration is accurate, precise, and fits perfectly.

An implant analog is a replica of an implant post or abutment used in the dental laboratory to create a master cast of the implant site. The master cast is then used to fabricate the final dental implant restoration, such as a crown, bridge, or denture.

An implant impression coping is a temporary abutment that is attached to the implant post or abutment while the final restoration is being fabricated. It is typically made of plastic or metal and is used to protect the implant site and to maintain the proper spacing between the implants.

How do you take impressions with an impression coping? 

There are two different methods of taking an impression coping, each with their own benefits, let’s look at the techniques and see how they differ. 

How to take open tray impressions

• Use adhesives to coat the impression tray and retain impression material.
• Take heavy-body impression material and load it into the tray, then capture the soft tissue by placing light-body impression material around the copings.
• Once the custom tray is inserted into the patient’s mouth, expose the coping to facilitate access by removing excess material around the occlusal opening.
• After polymerization, the screws should be loosened from the temporary copings.
• Remove the impression.

How to take impressions with the closed tray technique

• Place closed tray impression copings on the dental implants.
• Fill the tray with impression material and seat it within the patients’ mouth.
• After polymerization, extricate the closed tray impression copings.
• Affix the implant or abutment analogs to the copings.
• Finish by placing the coping-analog assembly into the definitive impression.

Taking digital impressions with impression copings

You cannot take a digital impression with a traditional impression coping. Instead, you use scan bodies. Scan bodies are intraoral implant-positioning-transfer devices utilized in the digital Implant restoration workflow. They play an essential role in successfully designing and fabricating accurately fitting implant-supported restorations. Learn more about how scan bodies are used when taking digital impressions for implants.

Implant impression copings

Implant copings are an important part of the dental implant workflow. We hope this article helped you better understand how impression copings are used when restoring and placing implants. Now we recommend taking some time to learn about the essential dental implant parts and how they work together to restore a patient’s teeth in a natural way. 

Explore related glossary terms

Implant Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Denture Terms

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Crown & Bridge Terms

Composite veneers

Implant Terms

Denture Terms

Crown & Bridge Terms

Dental implant systems

Implant crowns

Dental implant parts

Impression Coping

Removable dentures

Wax rim for dentures

Hybrid dentures

Immediate dentures

Composite veneers

Explore all glossary

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