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Case Study
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Pseudo Realignment of Maxillary Anterior Teeth Utilizing All-Ceramic Components

Learning Objectives:

After reviewing this case study, the reader should:

  • Understand the process of realigning anterior teeth with all-ceramic materials
  • Understand the methods and alternatives to using and placing all-ceramic restorations

 

In optimal circumstances, orthodontic therapy should be utilized to move teeth within the jaws and place them in an aesthetic, functional position. The principal limitation of this treatment modality is the unaesthetic appearance of the orthodontic appliances, although the maintenance of oral hygiene and potential relapse of treatment are also relevant concerns. In these instances, a restorative approach that permits repositioning or "pseudo" realignment may provide an effective alternative to conventional orthodontic therapy, moving the tooth crown only without altering the position of the root.

Minor discrepancies in tooth position can be corrected by veneer restorations in a relatively conservative approach. In severe instances of malposition, a more radical treatment is necessary. In order to achieve the desired position for the definitive crown restoration, this procedure may require intraradicular support and repositioning of the core of the post/core complex to a specified angle. If severe malalignment is present in unfilled roots, elective endodontic (eg, post and core procedures) treatment may be required. Since a metal core imparts a low value on a restoration, a conventional post and core cannot be utilized in the anterior dentition with all-ceramic prostheses without compromising the patient's aesthetics.

The recent introduction of a zirconium oxide post may provide a suitable alternative to the use of metal intraradicular posts. The improved aesthetic and mechanical properties of this post allow it to be cemented directly to a tooth-colored core and enable its use with all-ceramic crown restorations.

 

*Private practice, North Harrow, United Kingdom.

 

Related Reading:

  1. Kilinc E, Antonson SA, Hardigan PC, Kesercioglu A. Resin cement color stability and its influence on the final shade of all-ceramics. J Dent. 2011 Jan 14.
  2. Ozkurt Z, Işeri U, Kazazoğlu E. Zirconia ceramic post systems: a literature review and a case report. Dent Mater J. 2010 May;29(3):233-45. Epub 2010 May 13.
  3. Coelho CS, Biffi JC, Silva GR, Abrahão A, Campos RE, Soares CJ. Finite element analysis of weakened roots restored with composite resin and posts. Dent Mater J. 2009 Nov;28(6):671-8.
  4. Gonzalo E, Suárez MJ, Serrano B, Lozano JF. A comparison of the marginal vertical discrepancies of zirconium and metal ceramic posterior fixed dental prostheses before and after cementation. J Prosthet Dent. 2009 Dec;102(6):378-84.
  5. Terzioğlu H, Yilmaz B. Restoration of endodontically compromised anterior teeth with fiber posts and zirconia all-ceramic system. Case study. N Y State Dent J. 2009 Apr;75(3):46-8.
  6. Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Effect of zirconia type on its bond strength with different veneer ceramics. J Prosthodont. 2008 Jul;17(5):401-8.
  7. Canullo L. Clinical outcome study of customized zirconia abutments for single-implant restorations. Int J Prosthodont. 2007 Sep-Oct;20(5):489-93.
  8. Friedel W, Kern M. Fracture strength of teeth restored with all-ceramic posts and cores. Quintessence Int. 2006 Apr;37(4):289-95.
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