Restoring esthetics with metal-free ceramics: a case report.

Metal–ceramic systems represent a high-strength treatment associated with long-term success, but they have several disadvantages, mainly in terms of esthetics and biocompatibility. Over the past decade, a number of novel all-ceramic crown and bridge systems have been developed, with the capability of restoring anterior, posterior and multiple units. The search for new methods has been driven, in part, by patients, who have increasingly high expectations of esthetic dentistry and who also have concerns about the intraoral biocompatibility of metals.1 Recent developments in dental materials have led to the introduction of a large number of all-ceramic systems for full-coverage restorations. Some systems use a single-layer glass–ceramic material (e.g., Dicor, Dentsply/Caulk; IPS Empress, Ivoclar/Vivadent), whereas others have a dual-layer design (In-Ceram, Vident; Procera, Nobel Biocare).2 Further improvements in high-strength all-ceramic technology have been achieved with the advent of computer-aided design and milling (CAD/CAM) systems. The Procera system first introduced in 1993 is one example.3 This type of all-ceramic crown resists fracture during function or parafunction, at both anterior and posterior sites, even under high stresses.4 The design and manufacture of these restorations involves optical scanning and digitizing of the dies (which are created from a master impression of the prepared teeth and cores), to precisely duplicate the margins of the tooth preparation. The scanned 3-dimensional images of the dies are then used to design the substructure, prompted by computer software (CAD). The CAD unit is linked to a robotic CAM centre, which creates a ceramic coping to the design specifications.1 Clinical evaluations of all-ceramic crowns have been promising, and a success rate of 98.4% over a period of 2–3.5 years has been reported.3 Recently, Haselton and colleagues4 reported 100% satisfaction among patients treated with all-ceramic crowns. The following report describes the restoration of 4 maxillary incisors with the Procera all-ceramic system.