In-Office Porcelain Correction and Repair:
An Alternative Technology
by Ian E. Shuman, DDS

The final surface layer applied is EZ Contact Composite, (Fig 9) which

	9. The final EZ Contact Incisal shade composite is added as the final layer and is then light cured. The final outcome offers a newly created occlusal surface that is durable and highly aesthetic.
FIGURE 9

creates the masterful illusion of natural shading and camouflage of the repaired surface. The restoration is then adjusted with finishing diamonds, the judicious use of finishing carbide burs and porcelain/ composite polishing cups and paste. Case 3: Pontic site correction The patient, a 73 year old female presented with a failing anterior bridge. (FIG 10) The patient reported

	10. The fractured root of an upper left central incisor is one of the supporting abutment teeth beneath a failing anterior bridge.
FIGURE 10

that she had fallen several years ago fracturing several of her maxillary anterior teeth with complete avulsion of the left lateral incisor. Endodontic therapy was performed on the upper right central incisor and a fixed PFM bridge was placed from the upper right lateral incisor to the upper left canine. The root of tooth #8 was completely resorbed as verified radiographically. In addition, there were several carious lesions detected at various margins. It was decided to extract tooth #8, restore tooth #7-11 with a new fixed bridge and place a porcelain veneer on tooth #6 to improve overall aesthetics. In cases requiring extraction and immediate tooth replacement, provisional restorations offer an excellent interim solution during the healing phase. Provisionals can be highly aesthetic, but do not offer long-term stability in terms of durability, color change and overall wear. When a higher degree of aesthetics is required during long-term healing, soft/hard tissue architectural changes

can create a restorative dilemma in the new pontic site. However, it would be imprudent to permanently cement a lab fabricated porcelain-to-metal restoration prematurely. However, a lab fabricated definitive PFM bridge can be cemented with provisional cement and the pontic enhanced periodically in order to maintain an intimate tissue contact and create an ideal emergence profile. Following extraction of tooth #8, a provisional bridge was created. A definitive PFM bridge was then cemented to place with temporary cement (Tempocem NE, Zenith DMG, Englewood, NJ). (Fig 11) and the

	11.Following 12 weeks post-extraction, a porcelain-to-metalbridge is luted using a temporary cement.
FIGURE 11

pontic site of tooth #8 monitored. Once it was determined that the tissue had significantly remodeled, the pontic gap was “filled” by bonding composite resin to the porcelain pontic surface. In this case, the pontic porcelain was etched, silanated and resin bonded. (Fig 12)

	12. The pontic porcelain can now be enhanced in-office to exactly match the gingival contours. After porcelain etching and priming, a bonding resin is applied and light cured.
FIGURE 12

The pontic was enhanced with the application of EZ Contact Composite (Fig 13), and seated to place.

	13. EZ Contact Composite Resin is then applied to the pontic surface and built up to the general shape of the site.
FIGURE 13

Sufficient finger pressure was applied to allow excess composite to be expressed and removed. The remaining composite was sculpted to the desired shape and light cured from both the facial Fig 14) and lingual aspects.

	14. The bridge is seated to place allowing the uncured composite resin to adapt to the gingival pontic site and is light cured.
FIGURE 14

The bridge was removed, carefully so as not to disturb any uncured portions of the composite resin. The entire pontic area was light cured extraorally,

	15. The bridge is removed, careful not to disturb any uncured resin at the most apical area and light cured.
FIGURE 15

(Fig 15) and finished and polished. (Fig 16) The bridge was recemented with a

	16. The corrected composite is trimmed, and a final polish is applie with EZ Diamond Paste and a goat-hair brush.
FIGURE 16

provisional cement with continued evaluation for any further pontic tissue site changes. (Fig 17) Once it has been

	17. The bridge now offers the patient a harmonious and healthy tissue bearing surface.
FIGURE 17

determined that the tissue level has undergone any major changes, the PFM can be luted with a long-term crown and bridge cement. With this technique, one has the ability to improve the health of the tissue site, create a perfect pontic-to-issue interface and be in complete control of the outcome without having to recreate a new provisional or reappointing the patient for repeated laboratory try-ins.

CONCLUSION
Repair or correction of intraoral ceramic restorations can be an alternative to complete replacement. Repairing ceramic based restorations can increase the clinical longevity of failed restorations and offer the dentist and patient a cost effective alternative to replacement.