Metal-ceramic: a chip on the crown. Chips of cermet Restoration of a tooth with a ceramic crown

By stages.

Photo report of work

Grigoriev Alexander Vitalievich

Supervisor training center"Dental Academy" (Irkutsk). Active member of the American Dental Academy since 2003. International lecturer on adhesive dentistry and an interdisciplinary approach to complex restoration.

We will not go into details why this should be done. So it is necessary. This is the desire of both the patient and the situation. I want to talk about a differentiated approach in this type of work. Since we have both an exposed ceramic layer down to the metal and the actual ceramic layer itself with a defect.

By stages.

1. The bridge structure itself does not stand up to criticism. Overhanging edge of the prosthesis -- inflamed gum. On the first visit, I performed a correction of the contour of the inflamed gums using the curettage method. Appointed aseptic solution- chlorhexidine 0.12% for 2 minutes 2 times a day.

2. Working visit on the 3rd day. As we can see, the gum is already calmer and it is possible to work, but nevertheless, to protect the working field from the biological environment, a Teflon tape was introduced along the contour of the edge of the crowns. As you can see the result is excellent.

3. Isolation of the working field due to the Peipe-damm method and a flowable rubber dam.

4. Carried out a bevel on ceramics and sandblasted metal and ceramics (aluminum oxide 50 microns).

5. The surface to be cleaned was treated with phosphoric acid for 20 seconds. Washed off with water, dried.

6. An adhesive coat of All Bond Universal (Bisco) was applied to the exposed metal.

7. After polymerization of the adhesive, a layer of metal opaquer was applied to the exposed metal and polymerized. This is a very important step and it is very important that the metal opaquer only covers (blocks) the exposed metal. Otherwise, the opaquer will show through the composite layer.

9. Apply 4% hydrofluoric acid to the ceramic layer for 4 minutes (because this ceramic layer is a feldspar ceramic) and wash off with copious amounts of water after 4 minutes. Etching feldspars of ceramics leads to the formation of etching salts and in order to clean the surface, it is necessary to apply phosphoric acid for 20 seconds. After rinsing, apply the ceramic primer Porcelan Primer (Bisco) in a good layer for 1 minute. Dry and wipe the surface with alcohol. This stage is very important - the interaction of the silane with the hydrophilic active layer of ceramics occurs as a condensation reaction with the formation of a by-product - water, so it is very important to remove it using alcohol and thorough evaporation (you can also use a warm air stream).

10. After priming, applied All Bond Universal adhesive (Bisco) and completed the restoration with composite material. In this clinical situation, I used the material Capo Natural (Shutz-Dental) color A3, A3.5 (this is a very strong highly filled composite).

11. Processing and polishing of the restoration.

This type of work, given that we have chipped ceramics to metal, should be carried out in a differentiated way. On metal we work through an adhesive, on ceramics through a silane and an adhesive.

This type of work will achieve good long-term results (relative to this clinical case we will insist on the replacement of the bridge in the future (possibly planned), given its failure as a prosthesis. But the timing of the replacement will, of course, be determined by the patient himself).

The main problem when installing metal-ceramic crowns is chipping on them. Is it possible to repair if a piece has broken off ceramic-metal crown And is it possible to avoid this trouble?

Raw materials for crowns

Basically, when a piece of a metal-ceramic crown broke off, it is observed in cases where they are made from combined raw materials.

Cleavage options for different raw material composition:

If the composition includes a metal base and a plastic coating, then chips are quite common. This is explained by the poor connection of the plastic with the base. It is advisable to use this restoration option as a temporary structure.
If the composition includes ceramics with metal, chipping is less common, since ceramics break only under the condition of excessive load.

Chips are also possible on conventional metal-ceramic crowns if the patient prefers solid food.

Why is this happening?

There are several main causes of damage to cermets:

the difference in the coefficients of thermal expansion of different materials that make up the crown is not taken into account;
if the patient has bruxism, and the specialist did not take this into account;
with an excessively long prosthesis, which is subjected to increased external and internal pressure;
application for fixing the cement structure;
when a foreign body gets into the gap between the crown and the tooth on which it is installed;
the required frame height is not taken into account, as a result, the ceramic layer is quite large and less reliable;
incorrect tooth modeling;
processing violation;
hole in the base
violation of technology in the process of firing;
the human factor, when the patient himself treats the structure with negligence.

Recovery steps

Of all types of dental restoration, metal-ceramic crowns are practically the only structures that rarely need restoration. The reason for this is their rare breakdown.

If, nevertheless, there was a chipping of the ceramic coating from the base, then the following must be done:

Polish the surface. Then the tooth will take on a different shape, but remain intact and retain its aesthetic appeal. This option is appropriate only in cases where the tooth is outside the smile zone.
Restoration with composite materials. The damage is built up to the original shape of the crown. But it should be understood that this option is more of a temporary solution.
A costly option is the replacement of cermets. But this method is one of the most reliable.

Due to the fact that the structure and the tooth are connected with reliable cement, it is almost impossible to remove it from the place of fixation without damage, therefore, the restoration is out of the question. oral cavity does not apply.

On a note: The process of repairing porcelain-fused-to-metal crowns is quite complicated, so it is very important to follow the technology.

The first step is to dry the recovery area. This is done by applying a rubber dam.

The breakage area is processed with a diamond bur. Thus, the required roughness is achieved. Formation of a bevel on a ceramic surface.

After that, the entire surface layer is cleaned with a brush. Silane treatment, which dries in a couple of minutes.

The defect is covered with opaque material. Carrying out polymerization with a halogen lamp.

Finally, the doctor applies layer after layer of the composite material of the desired shade. All layers polymerize as they are applied. Completion of work - final grinding.

Video review of the patient about the restoration of teeth using a fixed denture

Basically, when a piece of a metal-ceramic crown broke off, it is observed in cases where they are made from combined raw materials.

Cleavage options for different raw material composition:

If the crown consists of a metal base and a plastic coating, then chips are quite common. This is explained by the poor connection of the plastic with the base. It is advisable to use this restoration option as a temporary structure.
If the composition includes ceramics with metal, chipping is less common, since ceramics break only under the condition of excessive load.

Chips are also possible on conventional metal-ceramic crowns if the patient prefers solid food.

Why is this happening?

There are several main causes of damage to cermets:

the difference in the coefficients of thermal expansion of different materials that make up the crown is not taken into account;
if the patient has bruxism, and the specialist did not take this into account;

with an excessively long prosthesis, which is subjected to increased external and internal pressure;
application for fixing the cement structure;
when a foreign body gets into the gap between the crown and the tooth on which it is installed;
the required frame height is not taken into account, as a result, the ceramic layer is quite large and less reliable;
incorrect tooth modeling;
processing violation;
hole in the base
violation of technology in the process of firing;
the human factor, when the patient himself treats the structure with negligence.

Recovery steps

Of all types of dental restoration, metal-ceramic crowns are practically the only structures that rarely need restoration. The reason for this is their rare breakdown.

If, nevertheless, there was a chipping of the ceramic coating from the base, then the following must be done:

Polish the surface. Then the tooth will take on a different shape, but remain intact and retain its aesthetic appeal. This option is appropriate only in cases where the tooth is outside the smile zone.
Restoration with composite materials. The damage is built up to the original shape of the crown. But it should be understood that this option is more of a temporary solution.
A costly option is the replacement of cermets. But this option is one of the most reliable.

Due to the fact that the structure and the tooth are connected with reliable cement, it is almost impossible to remove it from the place of fixation without damage, therefore, restoration outside the oral cavity is not used.

On a note: The process of repairing porcelain-fused-to-metal crowns is quite complicated, so it is very important to follow the technology.

The first step is to dry the recovery area. This is done by applying a rubber dam.

The breakage area is processed with a diamond bur. Thus, the required roughness is achieved. Formation of a bevel on a ceramic surface.

After that, the entire surface layer is cleaned with a brush. Silane treatment, which dries in a couple of minutes.

The defect is covered with opaque material. Carrying out polymerization with a halogen lamp.

Finally, the doctor applies layer after layer of the composite material of the desired flow. All layers polymerize as they are applied. Completion of work - final grinding.

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Why do chips appear on ceramic-metal teeth?

Despite the fact that metal-ceramic crowns are accompanied by high strength, sometimes patients complain that they suddenly found a chip in metal-ceramic. Of course, everyone is interested in why such a problem arose and how it can be prevented.

A chip on a metal-ceramic crown may appear due to a mistake that the doctor made if he used an alloy of incompatible metals. Also, a technical error can be made when installing a metal-ceramic crown. In any case, chips look terrible on metal-ceramic teeth and seriously spoil the appearance, as a result of which communicative complexes begin to appear in a person.

Cleavage of the cermet crown is most often observed on the cusps of the molars. This may be due to the fact that the lateral component of Bennett's movement was not accurately recreated.

Articulators are used both adjustable and non-adjustable. Non-adjustable articulators are very often the reason that a piece of a metal-ceramic crown has broken off. Non-adjustable articulators are not able to convey the natural movement of teeth in the oral cavity, so dentists recommend using only adjustable and, in extreme cases, partially adjustable articulators.

Treatment of large chips on metal-ceramic

If a metal-ceramic crown has broken off, the patient should immediately contact the clinic so as not to provoke further deterioration of the tooth. Premier Clinic doctors initially establish the cause that provoked such a problem. It is very important to establish the cause, because, without eliminating it, relapses will definitely occur later. Dentists often identify such a cause as chronic occlusal trauma.

Unfortunately, ceramics, having high strength, are able to withstand high compression loads, but they are not able to withstand narrowly directed impacts resulting from improper occlusion of teeth.

If the cermet has broken off, the doctor develops a treatment plan:

elimination of the cause;
fixation in the oral cavity of the articulator;
selection of materials that will provide high adhesion;
increase in the connection area (it is no secret that the larger the cultivated area, the stronger the connection will be much higher). For this reason, the dentist deliberately expands the area and also makes the surface uneven to ensure good adhesion of materials.

In order to eliminate chipping and restore the shape of the tooth, dentists use composite filling materials, which are endowed with good masking characteristics. Using them, you can be sure that the metal will not shine through. After restoring the shape of the tooth, a polishing system is used. This method allows you to provide a tooth appearance identical to natural. After carrying out such work, no one will be able to detect traces of the restoration. Experienced dentists will quickly and efficiently put the tooth in order, once again providing it with strength and external beauty.

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Advantages and disadvantages

The advantages of the design include:

Simple and safe process of prosthetics;
The use of only hypoallergenic and biocompatible materials;
Effective restoration of chewing function;
High aesthetic performance of crowns;
Long service life;
High strength;
Protecting the tooth from further damage;
Artificial teeth are not different from natural ones;
A wide palette of colors to select the desired shade;
Uniform distribution of chewing pressure;
Strong fixation;
Lack of special care;
Affordable design cost.

The disadvantages of ceramic crowns include:

Risk of ceramic chipping or structural failure;
The need to prepare the tooth, which includes the removal of nerves and significant grinding of the tooth;
In the absence of depulpation of the teeth, complications arise in the form of pulpitis;
The risk of an allergy to a metal frame or ceramics;
Erasure of opposing teeth;
Translucence of the metal frame from under the gums, especially in the area of the front teeth.

Kinds

The structures consist of a frame 0.3-0.5 mm thick and a ceramic layer 1.2-2 mm. Crowns have several types, depending on the material of the frame:

Based on metal and its alloys. Such crowns are the most common and affordable;
Based on cobalt-chromium and nickel. Alloys have been developed specifically for use in orthopedic dentistry;
Based on precious metals (gold) - these are the most expensive designs. Their advantages are increased aesthetics, the possibility of using in the frontal region of the jaw, and the absence of allergic reactions.

Manufacturing steps

Treatment can be divided into two large stages: therapeutic and orthopedic. At the therapeutic stage, the organs of the oral cavity are sanitized and the necessary teeth are prepared. Sanitation includes the treatment of caries, pulpitis, periodontitis, non-carious lesions of the teeth, as well as gum diseases: gingivitis, periodontitis and stomatitis.

Tooth preparation consists of nerve removal (depulpation). To begin with, an x-ray is taken to make sure that there is no inflammatory process on the root of the tooth. In the presence of inflammation, the doctor uses a slightly different treatment tactic to eliminate the pathogenic focus. When depulping a tooth, the dentist performs anesthesia, removal of the nerve, cleaning of the root canals with instruments and antiseptics, and filling the canals. The treatment ends with permanent fillings made of photopolymer materials.

Feedback (Anna, 38 years old): “After the treatment of the canals of the lateral tooth, there was a strong destruction of the tooth and I decided to install an artificial crown. After a careful choice, I settled on metal-ceramic crowns and do not regret my choice. The crown does not differ from natural teeth and does not require special care. The dentist gave a guarantee for 1 year, but promised that the crown would last more than 5 years.”

At the orthopedic stage of treatment, the hard tissues of the tooth are ground to a thickness of 1.5-2 mm from all sides. After turning, a small stump of the tooth is obtained, from which the doctor takes impressions with a special material. At this stage, the anatomical shape of the teeth and color are selected using the Vita scale.

At the time of crowns manufacturing (7-10 working days), provisional temporary crowns are put on the turned teeth to preserve the aesthetics and integrity of the teeth. After the fabrication of the structure, the procedure for fixing the finished metal-ceramic crowns is carried out.

In the absence of a tooth crown, an additional stage of treatment is the manufacture of a stump tab. An inlay is a metal rod that consists of a root part and a crown part. The root part is fixed in the canal of the tooth, and the root part looks like a stump, on which the crown will be fixed. The laboratory stages of crown manufacturing include:

Casting a plaster model of the tooth;
Making temporary crowns;
Production of a cast metal frame;
Facing the frame with ceramic mass;
Baking ceramics at high temperature to give the necessary properties;
Grinding and polishing of the finished structure.

Installation (before and after)

After manufacturing the product, the dental technician sends the work to the clinic for further installation. The dentist checks the crowns for serviceability, absence of defects and proceeds to installation in the oral cavity. To do this, the teeth and crowns are treated with antiseptics, a special glue is prepared and the product is fixed on it.

Sometimes a temporary fixation is carried out, and then permanent materials are used. This stage is used to check the crown in the bite, so that the design does not interfere with eating or talking. After installing metal-ceramic crowns, the doctor gives recommendations about proper care, operating rules and the need for preventive examinations.

Preparation for metal-ceramic crown

One of the most important stages of successful treatment is the preparation of the tooth for a crown. Fixation and stabilization of the structure, aesthetic appearance and service life will depend on how the tooth is turned. To properly form a tooth stump, it is necessary to remove hard tissues by 1.5 -2 mm (0.4-0.6 for a metal frame and 0.8 -1.3 for ceramic cladding).

Removal of a large layer of tissue is painful and can provoke the development of inflammation of the nerve, therefore depulpation is recommended. The preparation is carried out using a bur of the required shape and a water-cooled tip. Preparation steps for a metal-ceramic crown:

Creation of grooves of the required thickness to control the removal of hard tissues;
Grinding the vestibular and oral sides of the tooth;
Preparation of the chewing surface or cutting edge;
Turning the contact surface on both sides;
Installing a retraction thread and pushing back the gums;
Formation of a circular ledge for a strong fixation of the future structure and the correct distribution of chewing pressure;
Final processing of the tooth stump.

Caring for metal-ceramic dental crowns

Hygienic care for metal-ceramic crowns includes regular brushing in the morning and evening. During hygiene, it is necessary to carry out sweeping movements from the gum to the cutting edge. In this case, attention should be paid to the area of transition of the crown to the gum. The stiffness of the brush bristles can be chosen to be comfortable for natural teeth. It is also not recommended to use the brush for more than three months.

It is mandatory to use dental floss to clean the interdental spaces. The remains of food between the teeth provoke decementation of the crowns and the occurrence of a carious process. To prevent complications, it is necessary to use floss every day after brushing your teeth, the procedure is recommended to be carried out before going to bed.

If necessary, it is recommended to use dental brushes to clean the space between the teeth. Every six months, you need to visit a doctor to inspect structures, treat diseases and professionally clean your teeth. In case of periodontal tissue diseases, treatment is necessary, since chronic inflammation gums reduces the quality and service life of crowns.

Life time

The service life of metal-ceramic crowns is 6-10 years, but doctors give a guarantee for 1-2 years. The service life of structures depends on the following factors:

The quality of the therapeutic stage of treatment. A common cause of crown removal is inflammation and pain at the top of the tooth. Such situations arise with poor-quality root canal treatment and a decrease in human immunity;
Proper preparation of hard tissues. If the tooth is not properly turned, the crown will not be fixed well and will constantly fall off the stump;
Professionalism of the dental technician;
Quality of dental materials;
Hygienic oral care;
chewing pressure. Excessive pressure (opening bottles, nuts) can lead to structural failure.

How much does a crown cost for a tooth

The price of metal-ceramic crowns depends on many factors:

Location and prestige of the clinic;
Pricing policy of dentistry;
The choice of materials;
Experience of a doctor and dental technician;
production time;
The quality of the ceramic mass;
The presence of temporary crowns;
The presence of the stage of therapeutic preparation of the tooth.

A crown made from materials of domestic manufacturers will cost 4-5 thousand rubles. When using high-quality German ceramics, the price will be about 6-8 thousand rubles. When using a precious metal alloy for the frame, the price of the crown will be 15-50 thousand rubles. In the manufacture of temporary crowns, the cost of the structure will increase by about a thousand rubles.

Question answer

Is it possible to do an MRI with metal-ceramic crowns

Previously, it was impossible to conduct studies with a magnetic resonance tomograph in the presence of metal inclusions in the oral cavity, including metal-ceramic crowns. In the presence of metal elements, the results of the examination are distorted and the study is not effective. Modern technologies allow you to conduct examinations in the presence of crowns, pins, braces, plates and other elements. New tomographs equipped with special features that allow examinations of almost everyone. Before the MRI, you need to warn the doctor about the state of health and the presence of crowns.

Can crowns be whitened?

Over time, crowns can slightly darken, become saturated with pigments from the oral cavity, and many are interested in the question: is it possible to whiten? Whitening products are designed to affect enamel, so using them on ceramics will be ineffective. So that the structures do not change color, you need to regularly carry out hygiene procedures, visit a doctor for professional cleaning. If necessary, a polishing procedure can be carried out, in which traces of dark plaque and tartar are eliminated.

Review (Evgeny, 45 years old): “I had a large prosthesis made of metal-ceramic crowns on upper jaw. Crowns were placed on the front and side teeth. I am very pleased with the result of the treatment, my teeth look beautiful and now I can fully eat. Immediately after installation, there was a slight discomfort in the mouth, but after a few days I got used to it and the discomfort disappeared. ”

Which crowns are better metal-ceramic or zirconium

Zirconium crowns are orthopedic structures that are made from zirconium dioxide. Compared to cermets, they are made without a metal frame, which has many advantages. High-quality material provides high aesthetics, strength, reliability, durability.

There is no translucence of the metal in the cervical region and the occurrence of allergic reactions is excluded. It can be concluded that zirconium crowns are much better than metal-ceramic ones. The only disadvantage of the products is the high cost.

A piece of a metal-ceramic crown broke off: what to do

A very common complication in the treatment of metal-ceramic crowns is the occurrence of chips and breakage of ceramics. A piece of material can break off with excessive chewing pressure on an artificial tooth, with the use of nuts, crackers, etc. If a complication occurs, it is necessary to contact the attending orthopedic doctor and eliminate the defect.

It is quite difficult to damage metal ceramics. But if you set yourself a goal and "make friends" with some solid product, or even with metal, then everything is possible. There are several options for repairing cermets:

If the chip occurred on chewing tooth, then you can leave everything as it is and, if necessary, polish the sharp edges of the chip. In this case, the tooth is securely closed with a metal frame and will not collapse. Or repair crowns. Here is an example - the repair of chips of a metal-ceramic crown of a chewing tooth by us.

The second option is the most reliable, but for this we do not repair cermets, but completely redo it anew.

It is possible to completely remove, repair metal-ceramic crowns and fix them again. But, when removing crowns, there is a high probability of destruction of the teeth and the cermet itself. Then the repair of metal-ceramic teeth will be impossible.

There is a fourth option. Repair of porcelain-fused-to-metal crowns without removing them. In this case, the repair of ceramic-metal occurs due to special materials and components that create good adhesion to ceramics and metal. The strength of such crown repairs will turn out to be lower than that of conventional ceramics, therefore, after repairing metal ceramics, it is better not to overload this area. Repair of metal-ceramic crowns takes about one hour.

An example of metal-ceramic repair.

Repair of ceramic-metal anterior tooth.

Repair of metal-ceramic crowns on several teeth at once.

This repair of dental crowns takes about an hour.

Repair of cermet teeth is obtained even with a high degree of complexity.

When there is little space for the material, after the repair of chipped metal-ceramic crowns, the metal may be slightly translucent. As in this case.

This is not a ceramic-metal repair, but a plastic-lined crown repair.

After such a repair of cermets, it is not advisable to load the front teeth with hard food.

There is no guarantee for the repair of cermets. But, in case of repeated chipping of the same area, during the year, we carry out repairs once free of charge.

Good luck to you and your teeth.

For the restoration of the dentition, prosthetics with crowns are used. They are made from different materials. The main problem during prosthetics with metal-ceramic crowns is chipping on the metal-ceramic crown. What to do if a piece of a ceramic-metal crown has broken off, is it possible to repair the structure, and also, is it possible to prevent such a situation, such issues should be dealt with in more detail.

A crack in a ceramic-metal product most often occurs if the ceramic-metal crown is made from combined raw materials. There are such options for chipping:

if the device consists of a metal frame and plastic cladding, cracks and breakage are common. This is due to the fact that plastic does not bond well with other materials. In this case, the design should only be temporary;
if the apparatus consists of ceramic and metal, chips are not observed so often, since ceramics can only break under excessively high loads or mechanical damage.

Causes of damage

Damage to the metal-ceramic crown can be due to the following reasons:

If the difference in the coefficients of thermal expansion of different materials from which metal-ceramic crowns are made is not taken into account.
If a particle has broken off on the crown, bruxism may be the cause.
If the prosthesis is excessively long, it is subjected to increased external and internal compression.
If a foreign body gets into the space between the structure and the tooth.
If during installation the specialist does not take into account the height of the frame, the result is a large layer of ceramic coating and the lack of its necessary reliability.
When the device is modeled incorrectly.
In case of violation of processing, errors in the production process.
The human factor is the use of too hard foods.
If there are holes in the base of the element.
If the technology is broken during firing.
A particle of the structure can break off with a careless attitude to the prosthesis.

Restoration stages

Among all dental products, it is very rarely necessary to repair a breakaway metal-ceramic device. Repair of a metal-ceramic crown in the mouth is necessary in very rare cases since failure is extremely rare. Restoration of a metal-ceramic crown is carried out with the following steps:

The surface of the cleavage of the metal-ceramic crown and other parts of the device is polished. So you can create another form of construction, it will remain intact. This option is suitable for the chewing group of units. You can restore the device without removing it. Is it possible to turn the design on anterior tooth? Such a chip repair is not carried out on the frontal group.
Is it possible to build up a broken piece of an artificial tooth? Restoration of an artificial tooth is carried out using dental cement. In this case, you can build up the crown without removing it. But this method is rather temporary, the dental structure will break off again in the future, it will need to be removed.
Another option on how to repair a product is a complete replacement of cermets. This method is the most reliable.

Since the artificial tooth is fixed using a reliable composite material, it cannot be removed from its permanent place without damage, therefore, restoration outside the oral cavity is impossible.

Building stages

If the product breaks down, it can be restored using the extension method. No need to worry, this procedure is painless, does not take much time - about half an hour. You can repair the damage in the following way:

First you need to thoroughly dry the product and fabrics. To do this, the specialist covers the site of intervention with a rubber dam.
Next, a careful grinding is carried out using a diamond burr. It is important to create a rough surface, which is needed to ensure adhesion.
A bevel is formed on the device, for this you need to grind the product, remove excess microparticles.
After the doctor has undermined the surface of the device, it is cleaned with a special brush and treated with silane. After a few minutes, the absolute dryness of the surface of the product is ensured.
The cleavage area is covered with an opaque substance, which solidifies during polymerization.
Layer-by-layer application of a composite material is carried out, which is pre-selected to match the tone of the enamel. Mandatory polymerization of each layer is carried out.
The final step is grinding the surface.

The extension procedure is not complicated, but it can only be done in the dentist's office, it is impossible to repair an artificial structure in this way on your own.