Статья Dr. Claudia Cia Worschech

CERAMIC MICROLAMINATES

Claudia Cia Worschech, DDS, PhD, AMED Member

In recent years the development of seemingly countless new and exciting materials and techniques in dentistry are producing beautiful results. These same materials and techniques are tested for accuracy, for precision and for the ability to achieve great mechanical and clinical results. Used properly, they are able to copy or mimic the natural contour, shape, resistance and aesthetics of teeth. At the same time that I share in our excitement over these advances, I have found that most of my attention must still be given to conservative procedures that preserve healthy tissues. Sometimes it is possible to achieve esthetic results with a minimal reduction of tooth structure.

Ceramic Microlaminates, for example, are a type of veneer that are extremely thin and can be fixed over natural teeth requiring minimally invasive preparations; sometimes no preparation is needed. Specific surface preparations are applied to both tooth and ceramic substrates using acid, silane, an adhesive system and resin cement. This procedure allows fixation of the microlaminates while providing ceramic resistance and promoting aesthetic results.

Indications for using Ceramic Microlaminates to solve aesthetic problems include:

  • the unsatisfactory contours of teeth in terms of size & form (fig. 1, 3);
  • diastema closure (fig. 2);
  • small color alterations (fig. 4).

These examples all allow healthy dental structure to be maintained for the duration of planning and treatment (fig. 1-4).

Fig. 1 Inappropriate countour of incisal
Fig. 2 Diastema, color alterations and incorrect arrangements of teeth
Fig. 3 Worn teeth by occlusion before orthodontic treatment
Fig. 4 Small color alteration on the left central incisor

An additive-reductive wax up is important to determine the exact amount of dental structure that needs to be removed in specific areas and where ceramic can be added. Silicone guides are used to simplify checking spaces in the mouth and identify necessary tooth reduction (Fig. 5, 6).

Fig. 5 Silicon guide in position (incisal view) Fig. 6 Silicon guide in position (lateral view)

The preparation technique itself is not complicated. Often only a minimally invasive preparation is necessary to round angles or open a small diastema to improve the adaptation of microiaminates, but occasionally no prep is necessary. I have found the magnification to be mandatory, however, for achieving a regular smooth surface and for checking the smallest details before the final impression.

Because of the complexity and fragility of each step, during LAB fabrication, a microscope must also be used to avoid damage (Fig. 7-10). Microscope magnification and light intensity improves the technician's visibility and final result.

Fig. 7-10 Lab phase where the microlaminates are done under magnification in order to achieve excellent results. These microlaminates were made by Marcos Celestnno TPD, São Paulo, Brazil

This treatment option is very special; it avoids unnecessary dental wear to create a beautiful smile. Like all treatments, it needs to be planned according to appropriate indications. Patients with diseases such as grinding must be treated in the other ways. It is also necessary to check the occlusal condition; if parafunctional habits exist special care is required to avoid complications after treatment conclusion.

As you can see in this clinical case, it is possible to fulfill the patient's expectations and, at the same time, preserve maximum of dental health structure.

Fig. 11 Look at this smile. There is no disease, just aesthetic problems
Fig. 12, 13 Before and after minimal invasive preparation. Note that the angles are rounded and the little diastemas are opened between the lateral and central ingsors on both sides
Fig. 14, 15 Note the harmonious smile after conservative treatment with bleaching and microlaminates is finalized
Fig. 16, 17 This is the final result

Conclusion

When working with thin ceramic structure, manipulation is very important. Dentists must pay special attention in rounded angles, to promote smooth surfaces using discs and special rubber polishing cups. The moment we receive these laminates from the LAB, great care must be taken to avoid cracks and superficial fractures, the microlaminates do not resist major stress. During cementation, flow resin or flow cement is used and a little pressure is necessary to fix them. In this way, magnification must be used. (See Clinical cases to illustration below)

Clinical Cases to illustrate:

Fig. 16 Lateral and central incisors after microiaminates
Fig. 17 After microlaminates on the lateral and central incisors.

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