Meeting high functional and aesthetic demands with all-ceramic concepts

Case by Tomas Forejtek

In prosthodontics, assessing the individual needs and expectations of every patient is a crucial factor on the road to success. When it comes to producing fixed dental prostheses, the art is in tailoring the material combination, framework design and finishing concept precisely to the case-specific functional and aesthetic demands. In this context, the availability of high-performance evaluation tools and the freedom to choose between different variants of high-strength ceramics is worth gold.

CASE EXAMPLE

Take the case of a middle-aged female patient: She presented with very unsatisfactory metal-ceramic crowns (Fig. 1) and asked for an aesthetic improvement of the situation. The crowns on her maxillary central incisors and the right lateral incisor clearly needed to be replaced not only for aesthetic, but also for functional reasons. As anterior interferences were present and orthodontic treatment was not an option, the decision was made to select a ceramic material with a particularly high strength – KATANA™ Zirconia HT (Kuraray Noritake Dental Inc.) – and to opt for a design that would support the incisal edge with zirconia. Consequently, porcelain layering (with CERABIEN™ ZR, Kuraray Noritake Dental Inc.) would be limited to the vestibular region. The laboratory procedure – including shade determination and reproduction with the aid of the eLAB® shade matching system* – is illustrated in Figures 2 to 9.

^{*The eLAB® system is a registered trademark of Sascha Hein. It is an independent tool for dental shade determination and communication and is not developed or distributed by Kuraray Noritake Dental Inc.}

Fig. 1. Initial clinical situation.

Fig. 2. Situation after removal of the existing crowns and preparation of the tooth structure for the planned all-ceramic restorations.

Fig. 3. Shade determination with the eLAB® system.

Fig. 4. Layering map for the use of CERABIEN™ ZR on all three crowns.

Fig. 5. Layering procedure: Shade verification.

Fig. 6. Try-in of the crowns to assess the fit and the shade match.

Fig. 7. Palatal view of the crowns on the model.

Fig. 8. Frontal view of the crowns on the model: A natural surface texture is obtained.

Fig. 9. Natural look of the restorations.

THE RESULTS

Fig. 10. Crowns after adhesive cementation with PANAVIA™ V5 (Kuraray Noritake Dental Inc.).

Fig. 11. Aesthetic treatment outcome.

A precise reproduction of the patient’s tooth shade, despite the challenging individual aesthetics.

THE KEY TO SUCCESS: INDIVIDUAL APPROACH, HIGH-QUALITY MATERIALS

The present case is a perfect example of an aesthetically and functionally challenging situation that needed an individual treatment approach. By taking into account the patient- and case-specific requirements and using our material-related knowledge wisely, it was possible to develop an adequate treatment plan. High-quality materials and a smartly selected design concept lay the foundation for long-term success. Valuable tools used during porcelain layering (specifically the eLAB® system) – on the other hand – paved the way for a precise reproduction of the patient’s tooth shade, despite the challenging individual aesthetics: The crowns were delivered on the first attempt.

Dentist:

TOMAS FOREJTEK

Tomas Forejtek is a dental technician based in Brno, Czech Republic. After graduating top of his class in 2001, he joined a prestigious private clinic where he developed a strong focus on ceramic restorations. Within three years, he became certified in fixed prosthetics and was appointed head of the dental lab. Known for his intuitive and hands-on approach, Tomas enhanced his skills through both local and international training, drawing key inspiration from mentors such as Sascha Hein and Naoto Yuasa. In 2010, he opened his own lab in Brno, specializing in high-quality, esthetic restorations. Since 2016, he has focused on single central cases using the eLAB protocol and became an official eLAB instructor in 2018.