Defective dental restorations: to repair or not to repair? part 2: all–ceramics and porcelain fused to metal systems Igor R Blum Daryll C Jagger Nairn H F Wilson Dental Update 2024 38:3, 707-709.
Clinical Lecturer/Hon Specialist Registrar in Restorative Dentistry, University of Bristol Dental Hospital & School at Guy's, King's College and St Thomas' Hospitals, London, UK
Professor of Restorative Dentistry and Dean and Head of King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, UK
With the increasing use of ceramics in restorative dentistry, and trends to extend restoration longevity through the use of minimal interventive techniques, dental practitioners should be familiar with the factors that may influence the decision either to repair or replace fractured metal-ceramic and all-ceramic restorations and, also, the materials and techniques available to repair these restorations. This second of two papers addresses the possible modes of failure of ceramic restorations and outlines indications and techniques in this developing aspect of restoration repair in clinical practice.
Clinical Relevance: The repair of metal-ceramic and all-ceramic restorations is a reliable low-cost, low-risk technique that may be of value for the management of loss or fracture of porcelain from a crown or bridge in clinical practice.
Article
Ceramics are widely used in dentistry given their favourable aesthetic properties, excellent biocompatibility and chemical durability. The diversity of colour and translucency enable ceramics to ‘mimic the optical properties of enamel and dentine’.1 Not surprisingly, the popularity of all-ceramic restorations and the number of all-ceramic materials and systems commercially available for clinical use, including in stress-bearing areas, have been reported to be increasing.2–4
Despite the clear trends towards the use of minimally interventive, direct restorative techniques, the use of all-ceramic restorations, including ceramic inlays, onlays, veneers, all-ceramic crowns and all-ceramic bridges, is anticipated to continue to expand. The reasons for this anticipated growth may be attributed to patients' increasing aesthetic expectations, advancements in ceramic technologies, developments in computer-aided design and computer-aided manufacturing (CAD/CAM) and the further development of all-ceramic adhesive systems.
Ceramic restorations may fail in clinical service and, in common with all other types of restorations, should not normally be considered to be permanent. Next to secondary caries, as diagnosed clinically, porcelain fracture and chipping have been reported to be the major cause for the replacement of both all-ceramic and ceramic fused to metal restorations.5–7 The literature, however, includes conflicting data on the incidence of failure as a consequence of fracture or chipping. A retrospective study6 on the longevity of porcelain fused to metal bridges reported the five-year failure as a result of fracture of the porcelain facing to be 8%. Other studies that have investigated longevity of metal–ceramic restorations have reported failure rates resulting from fracture of the porcelain facing to be in the range of 2.3–18%, over a seven-year period.5,8 Recent systematic reviews reported the five-year failure as a result of chipping of the porcelain facing to be 3.7% and 5.7% for all-ceramic and metal-ceramic single crowns, respectively, and 13.6% and 2.9% for all-ceramic and metal-ceramic fixed-fixed bridges, respectively.9,10
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