Cosmetic Dentistry Natural 1-Visit Porcelain Crowns/Veneers Videos

DrSimonRosenberg Says:

Jul 7, 2008 - Veneers are thin coverings of the side of the tooth facing the lips or cheek and the biting edge of the tooth. They can be made with CEREC CAD/CAM system in the office or in a lab with either stacked (layered) porcelain or an injection molded system of porcelain. Lumineers is a proprietory name (like Kleenex is to tissues)for veneers made by one lab in northern California -- they can be made with stacked or injection molded porcelains. Crowns cover all or most of the tooth structure.

allth3s4me Says:

Jul 7, 2008 - Most of my teeth have been heavily drilled and I have those ugly amalgam fillings all over them and I need (cosmetically) something like crowns to cover the teeth to resemble the natural look. What should I do?

DrSimonRosenberg Says:

Jul 7, 2008 - I don't mean to be short, but diagnosis can not be done over the internet. You should see a dentist to diagnose how much tooth is left and what your options are. You will need a full set of x-rays and a comprehensive exam. If you are near New York City, I would be happy to see you. If not the Academy of CAD/CAM Dentistry acadcamdent dot com is a good place to find dentists trained in CEREC technology. We have focused our practices on high technology and any member would be a place to start.

redflag186 Says:

Jul 7, 2008 - italian dentistry is better...nothing complicated

DrSimonRosenberg Says:

Jul 7, 2008 - But is it biocompatible, with characteristics that nearly duplicate real tooth structure in hardness, wear resistence, color, translucency and expect it to last 20+ years. With CEREC Vita Porcelain, you can expect that, as well as the closest fit of the margins, now and in the future.

Gnoknosaj Says:

Jul 7, 2008 - Hi Dr,after all your detailed answers, I know that choice of material obviously counts dealing with aesthetics. When dealing with certain dentists, most of them offer just one type of all porcelain crown/inlay, whilst another has different porcelain crowns/inlays at different prices(from about 60% of the typical cost to about 110% such as empress, zirconia, etc.)

Gnoknosaj Says:

Jul 7, 2008 - He claims that the cheaper ceramic is weaker, and that the more expensive types are stronger. However, most internet pages seem to suggest that ceramic is ceramic and that does not give any indication as to what type is stronger/weaker. Do you agree with this statement?What in your opinion, is the best brand for inlays?crowns?Does brand/make give a big difference in colour match when dealing with small/medium inlays?Thanks for your time!

DrSimonRosenberg Says:

Jul 7, 2008 - There are indeed differences in ceramics. There are porcelains that vary in characteristics of appearance and adherence to various metals that are hand stacked and condensed by the dental lab technician. The price of these porcelain to metal crowns vary from low cost from China, Taiwan, etc to 5-7 times that cost for American/European labs with highly trained technician using the finest materials from certified dental materials suppliers and with associated high overhead of urban-based labs.

DrSimonRosenberg Says:

Jul 7, 2008 - The all ceramic restorations are currently divided into all-porcelain (with many variations in formulae) to ceramic core (usually Zirconia based) with porcelain layered over it. In the all porcelain group are technician layered porcelains versus factory made porcelain blocks that are custom milled using computer aided design and manufactoring (CAD/CAM). The former group can have more individualization but is weaker as ther porcelain is not uniform and has voids which factory manufacture avoids

Gnoknosaj Says:

Jul 7, 2008 - Thank you for the quick response. I'm unsure what you mean by adherence to various metals, though?Also, many cerec websites claim that cerec material is superior to lab made ceramic-but since there are so many possibilities for cerec, doesn't this mean we need to continually ask what material the dentist is using?Also, you meantion that you are able to stain the cerec restorations.From what i've read,

Gnoknosaj Says:

Jul 7, 2008 - this is normally quite a quick job- what are the aestethic advantages for your patients having lab made restorations over cerec?

Gnoknosaj Says:

Jul 7, 2008 - Thanks, I actually posted another comment but it didn't get through.There are claims that cerec restorations are superior to lab made due to hardness,etc. What are the disadvantages from a functionality point of view?Because there are so many different materials that can be used with cerec, isn't this statement just a little too general?Also you can stain ,which is great-but what advantages do lab made restorations have over your cerec ones when you can stain them yourself?

DrSimonRosenberg Says:

Jul 7, 2008 - There are different materials are available for milling with the CEREC & inLab systems. The advantage of factory manufacted blocks that are milled, is that the porcelain is uniform throughout the restoration. If the dentist needs to adjust the porcelain he can repolish it and no voids, air bubbles or stress fracture lines are present when the crown is cemented. Expansion, wear and color stability match that of tooth. Compared to all-porcelain lab-made crowns there's no functional disadvantage

DrSimonRosenberg Says:

Jul 7, 2008 - The above relates to research and clinical experience with Vita Mark II and it's multilayered Vita Trilux blocks. Ivoclar makes Empress porcelain blocks (which used to be called Procad) and they have greater translucency as the trade-off of slightly more brittleness (prone to fracture in heavy occlusal force situations). They are excellent for Veneers/Laminates on anterior teeth as they simulate enamel more than dentin and draw the natural richness of color from the underlying tooth stucture.

DrSimonRosenberg Says:

Jul 7, 2008 - There are other blocks from 3M and Sirona that have slightly different characteristics of color, translucency and hardness and are all excellent. The individual dentist will use his judgement, training and clinical experience to select the best materials for the clinical situation. I still send selected crowns to my commercial labs when the situation would be best for the patient's situation.

DrSimonRosenberg Says:

Jul 7, 2008 - RE:staining, there is simple surface staining and characterization. The stains are painted on the surface with a glaze & the crown is fired in a porcelain oven. This technique is used routinely by labs and by select CAD/CAM dentists.A 2nd technique is to cut back porcelain & build up characterization. This is a much more involved process & is done by the finer dental labs & a more select group of CAD/CAM dentists. It's much more time consuming, more expensive, but very natural & life-like!

DrSimonRosenberg Says:

Jul 7, 2008 - Advantages of CEREC over Lab-Made Porcelain:One Visit, No Temporaries to fall off, No gloppy impression materials, no second visit anesthesia shot, no second visit travel time and time out of work, more precise margins (due to direct recording of actual teeth and no impressions to distort, models that expand on setting, lab technique variables, foil seperating layer,porcelain shrinkage, etc)and more uniform predictable material since blocks are factory made (labs add layers of powder-liquid.)

DrSimonRosenberg Says:

Jul 7, 2008 - Porcelain fused to metal crowns & restorations have a thin (.5 mm) thimble of metal that fits the tooth. Porcelain is layered over it. There is a very reflective opaque layer to hide the metal and then layers with various color density and translucency to simulate dentin and enamel of natural teeth. The bond of different brands of porcelain vary with the wide variety of metals used. The ADA generally classifies the metals according to the nonprecious, low precious and high precious metal used

DrSimonRosenberg Says:

Jul 7, 2008 - Empress is one type of porcelain that is injection molded and generally needs to be cut back with porcelain layered over it. Zirconia is very hard when fully cured, so it is fabricated in a soft state and then further fired. That can be done with stacking the zirconia or by scanning the teeth or model of the teeth and CAD/CAM milled. Zirconia cores are harder than metal, are now very esthetic, but with extra steps are more costly.What is recommended depends on patient's individual factors!

Gnoknosaj Says:

Jul 7, 2008 - Ok-One last thing.Do you believe that you are able to create restorations using cerec that are as appealing aesthetically as your typical lab made?also, is it possible for you to deal with metamerism when making cerec crowns? If so, is the type of block more important, or the painting?thanks again

fiamm100 Says:

Jul 7, 2008 - Platinum Teeth?

DrSimonRosenberg Says:

Jul 7, 2008 - We work hard to match color. Guided by our training & our experienced "eye," we evaluate the adjacent teeth we are matching & the shade of the prepared tooth "stump" that will contribute to how the final restoration looks. We also use the Vident EZ-Shade calibrated spectrophotometer, by the manufacturer of the Vita Mark II and Trilux, and their Vita Porcelain Oven to do custom staining when needed.Metamerism is a problem that varys in all crowns. Evaluation & knowing the materials is key!

DrSimonRosenberg Says:

Jul 7, 2008 - Platinum is used in many ways with crowns, but my presentation is on all-porcelain CAD/CAM precision-milled CEREC crowns, onlays and veneers. Platium foil was used to make Porcelain Jacket crowns in dental labs and there are both all-metal crowns and porcelain-fused-to-metal crowns made with alloys, where platinum is mixed with other metals to give the technician the properties he desires.

tornadosteve1 Says:

Jul 7, 2008 - dr. how long does your platinum last.. Ur work is state-of-art..

DrSimonRosenberg Says:

Jul 7, 2008 - The restorations shown are NOT Platinum, they are all porcelain ceramics.Plantinum is a white-silvery shiny metal that is "precious" because it generally does not tarnish or react with the usual chemicals.