Ceramics and Composites, a Perfect Marriage

A course showcasing adhesive dentistry using dental ceramics and dental composites for procedures such as veneers, bridges and crowns, all done using a conservative approach.

The Presenter: Dr. Javier Quiros

Dr. Javier Quiros has over 20 years’ experience doing dental restorations, and has had appointments at the University of Costa Rica and the Dental Aesthetics Program at Baylor University. Here Dr. Quiros shows several patient cases where ceramics, composites, or both were used to construct bridges, veneers, crowns, and more, all while minimizing the amount of enamel that needed to be removed in prep and ensuring a natural, beautiful smile.

Overview: Ceramics and Composites

Both ceramic and composite materials are highly aesthetic and are designed to mimic the look of natural teeth. Some restorations call for one material, some for another and some can benefit from sophisticated use of both.

In this webinar, Dr. Javier Quiros reviews cases where a conservative approach was used in restorations with ceramics, composites or both. Additionally, you will learn:

• The philosophy of conservative dentistry, and why this approach best serves patients
• The kinds of procedures that lend themselves well to a conservative approach
• The relative qualities of different dental ceramics and composites
• Tools and materials used in conservative procedures, including veneers and bridges
• How ceramics and veneers can be used together, in some cases to create long-lasting, durable solutions that are also natural looking

The webinar also includes case studies using various materials and a Q&A.

The Main Question: Ceramics, Composites, or Both?

Both ceramic and composite materials are highly aesthetic and are designed to mimic the look of natural teeth. Materials differ in terms of their relative properties such as strength, transmission of light, and ability to bond.

That said, the choice between the two is not always an “either/or” choice. An understanding of these materials and their relative benefits will help dentists to make decisions about when to use each, even for a single restoration.

Dental Ceramics that are considered include the most popular current ceramics: lithium disilicate and zirconia.

Dental Composites discussed include microhybrids, nanofills, and microfills.

A Note on Conservative Dentistry

Conservative dentistry is the philosophy that only the minimum of healthy tooth structure should be removed during the restorative process. It also emphasizes the whole mouth, recognizing that there is no point in saving a single tooth if it harms the overall system. Conservative dentistry also emphasizes a minimum of touch (“touch without touching”) and minimizing prep.

What procedures lend themselves well to conservative dentistry?

• Veneers
• Table tops, inlays, or onlays
• Implants
• Resin-bonded bridges

Why Composites?

While most dentists are familiar with amalgams and even ceramics, today’s composites are not yet as widely known. That said, composites have a number of properties that make them ideal for restorations:

• Great at blocking unwanted colors
• Great flow and adaptability
• Best tensile strength
• Best material for incisal edges
• Strong for posterior teeth

Microfill composites specifically are great for replacing facial surfaces, as they transmit light very much like the enamel itself and thus look the most natural. The webinar also discusses other advantages of microfill composites, and when they can be put to best use.

Ceramics vs. Composites: A Comparison

All materials used in a restoration differ in their properties. The most important of these are relative strength, light transmission (which affects aesthetics), and ability to bond. The choice of which material to use depends on how those properties serve the final result.

Materials and Tools Mentioned

This webinar discusses the benefits of using various tools and materials, including:

• Insure Resin cement
• Rubber dams (for isolation)
• Pick and stick
• 0.3 mm Reducing Burr
• Enamilize (composite polishing paste)
• MirrorImage (temporary crown and bridge material, here used to do mock-ups)
• Loupes for proper magnification

Case Studies: Veneers, Bridges and Restorations using Ceramics and Composites

The highlight of this webinar are the four case studies showing how each material can best be put to use.

Case Study 1: Ceramic Only, Resin-bonded Bridge (Maryland Bridge)

• Construction of a resin bonded bridge instead of an implant, to replace missing tooth
• Bridge made of zirconia
• Zirconia is bonded to the enamel using the APC approach by Dr. Marco Blatz

Case study 2: Composite Only, Veneers and Tooth Building

• Direct indirect technique to reconstruct smile after braces failed
• Smile Design Pro used to design the smile
• Several diastemas closed with just veneers, minimal removal of enamel
• Planning using several mock-ups

Case Study 3: Marrying Ceramics and Composites, Dealing with Excessive Wear

• Goal was to not just restore teeth, but give the patient his occlusion back
• Renamel Microhybrid material used to lengthen the teeth
• Finished by bonding very thin ceramic veneers

Case Study 4: Ceramics and Composites, Lingual Veneers to Combat Bruxism

• Replaced old crown with new ones made of ceramic
• Indirect direct composite resin used to replace incisal edges with micro-hybrid composite
• Renamel Microfill composite helps make the porcelain and composite blend for a natural look

The Ceramics and Composites, a Perfect Marriage webinar also includes a Q&A with the audience.