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Dawson Quick Tips: Choosing Restorative Materials

How to Select Dental MaterialsHello everybody. For this quick tip, I want to talk a little bit about how we choose different restorative materials and align them with our patients. I want to share with you this grid that we came up with a number of years ago that assesses esthetic risk with functional risk.

Now, esthetic risk has to do with subjectively analyzing your patient depending on how good they need it to look. Like how high does their lip go when they smile? How much are they driven by aesthetics? Do they pull VITA shade guides out of their purse? Things like that.

We also want to look at functional risks. Are the teeth wearing? Are they loose? Do they have evidence of other restorative dentistry failing?

When you start putting the esthetic risk and functional risk together, we can now put our patients into one of these quadrants. Low esthetic risk, low functional risk is quadrant one, all the way up to high esthetic risk, high functional risk - which is the most challenging type of patient - which is quadrant four.

The key is to first understand your patient and then understand the different benefits of various restorative materials and align the restorative material to the patient.

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As a general rule, the materials that are the most beautiful - that are the most translucent -  also happen to be the weakest materials. The materials that are most opacious tends to be the materials that are strongest that may challenge us with regard to aesthetics. If you can get that concept that the weak materials are often the ones that look the best, they can also be challenging for us when we need them for maximum strength.

Differences in Dental MaterialsContact Lens

If we think about contact lens - a stacked porcelain veneer-- we call it the contact lens because when we lay that material on a bracket table floating in water, the color comes from underneath, and we can get a phenomenal result with this, and it's ideal for highly aesthetically driven patients.

The problem with it is, it's not always the strongest we can have.

IPS Empress

The next option is IPS Empress. We don't do a lot of this anymore because we've had some improvements with regard to strength, but here again, this tends to be a little stronger than the stacked material, and we can get phenomenal aesthetic results with this material.

Lithium Disilicate or E.Max

Lithium disilicate or e.max, this is one of the mainstays of our practice where we now have something that's about three to four times stronger as the original Empress, but it also allows us to create really incredibly beautiful results that can look very life-like.

Zirconia

Then, our strongest all-ceramic material is zirconia. While zirconia has made some strides recently, making it look better and better, traditionally the challenge with it is that you do get some brightness, an increase in value particularly into the cervical areas. So we can do a nice reconstruction, but it's not going to be quite as beautiful as some of the other materials that we've mentioned.

The one thing to realize though - as you're hearing that zirconias are becoming more translucent - as they become more translucent though, we lose some strengths, so keep that in mind.

Here's my quick tip for you as we look at it today. What I want you to do is recognize that the various materials that we have out there have strengths. As I put the materials that we've mentioned into our grid, this is how we think about it when I work with my various ceramists that do my work.

Quick tip for you is, before you do a case, assess the aesthetic and functional risk of your patient. Then sit down with the ceramist that's going to do your work and talk about what materials work best in his or her hands that can give you that result.

I think if you do that, you're going to find much more success meeting the expectation, both functionally and aesthetically, of every one of your individual patients. Good luck!

Confessions of a Dental Lab Tech

John C. Cranham, DDS has an esthetic oriented practice in Chesapeake, Virginia. An honors graduate of the Medical College of Virginia in 1988, Dr. Cranham maintains a strong relationship with his alma mater as an Associate Clinical Professor. He is an internationally recognized speaker on the Esthetic Principles of Dentistry, Contemporary Occlusal Concepts, Treatment Planning, Restoration Selection, Digital Photography, Laboratory Communication, and Happiness and Fulfillment in dentistry. As a published author, Dr. Cranham has a strong commitment to developing sound educational programs that exceed the needs of today’s dental professional. He is an active member of numerous professional organizations including the American Dental Association, The American Academy of Cosmetic Dentistry, The American Academy of Fixed Prosthodontics, and The American Equilibration Society. Dr. Cranham is co-chair of Advanstar Dental Media’s CE Advisory Board (Advanstar is the publisher of Dental Products Report). Dr. Cranham is the Clinical Director of The Dawson Academy where he is involved with many of the lecture and hands-on courses within the curriculum. As an active educator, he has provided over 650 days of continuing education for dental professionals throughout the world.