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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 34-37

Chairside ceramic repair


1 Department of Prosthodontics, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India
2 Department of Oral Pathology, Panineeya Mahavidyalaya Institute of Dental Sciences, Hyderabad, Telangana, India
3 Department of Prosthodontics, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
4 Department of Orthodontics, KNR University of Health Sciences, Warangal, Telangana, India

Date of Submission28-Sep-2019
Date of Acceptance30-Sep-2019
Date of Web Publication24-Jan-2020

Correspondence Address:
Vimal Bharathi Bolloju
Department of Prosthodontics, Panineeya Mahavidyalaya Institute of Dental Sciences, Kamala Nagar, Hyderabad - 500 060, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_34_19

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  Abstract 


Metal–ceramic restorations are used for fixed restorations very commonly, and sometimes, failure of these may need a removal and making a new restoration. It may destroy the abutment. Three categories of repair techniques are available for fractured metal–ceramic restorations, of which the treatment is chosen depending on the clinical acceptability. If the defects are small, these can be repaired intraorally with a ceramic repair kit without remaking the restoration. This article presents one such case report.

Keywords: Bond failure, ceramic repair, ceramic repair kit


How to cite this article:
Bolloju VB, Naishadham P P, Kumar A G, Jadhav S, Praveen M. Chairside ceramic repair. J Oral Res Rev 2020;12:34-7

How to cite this URL:
Bolloju VB, Naishadham P P, Kumar A G, Jadhav S, Praveen M. Chairside ceramic repair. J Oral Res Rev [serial online] 2020 [cited 2020 Mar 31];12:34-7. Available from: http://www.jorr.org/text.asp?2020/12/1/34/276708




  Introduction Top


Metal–ceramic restorations are the common restorations for the replacement of missing teeth. These restorations are durable and have long-term clinical success. At times, there may be smaller metal to ceramic bonding failures due to various causes. The ceramic's brittle nature renders fractures occasionally. This case report explains the causes for failure of metal–ceramic bonding and technique for intraoral chairside clinical repair of the same.

Metal–ceramic bond strength depends on (1) molecular bonding between the oxide layer and on the metal substrate to the porcelain, (2) mechanical bonding by creating surface roughness by sandblasting, and (3) compression bonding which is created by thermal contraction, wherein the coefficient of thermal expansion of the substrate metal is slightly more than that of the porcelain.[1]

The bond failures between the porcelain and metal can be seen as porcelain delamination due to incompatible materials, over or under oxidation, and contamination.[2] Delamination of porcelain can be due to loss of the bonding of the oxide layer that is poorly adherent to the metal or was too thick. This type of failure is seen between the metal and oxide layers. Incompatibility in terms of the coefficients of thermal expansion of the metal and porcelain is too great and also causes cracking of the ceramic veneer. Over or underoxidation can lead to the formation of an oxide layer that is either too thick or weak. The contamination of the substrate also may lead to debonding causing fracture of porcelain which affects the esthetics and causes a clinical problem. Fabrication of new prosthesis requires its removal that may destroy the abutment teeth. Therefore, it is preferable to repair the fractured prosthesis[3] which increases the durability of the prosthesis and also offers the patient and the clinician a treatment that is economical.[4]

The various techniques used for repair of fractured ceramic restorations (facings) include re-bonding of the fractured chip to the fixed restoration, bonding a porcelain veneer to the fractured porcelain, or using a resin-based composite (RBC) to restore the fractured porcelain, among which easier, faster, and less expensive technique is the use of RBCs.[5],[6]

The intraoral technique that was implemented to repair the fractured porcelain restoration was using a RBC.[7],[8]


  Case Report Top


A 27-year-old male patient reported to the department of prosthodontics with chipped metal–ceramic restoration on the retainer of maxillary left lateral incisor of a four-unit anterior fixed partial denture. The bonding failure was seen at the margin showing the metal underneath [Figure 1]. As the defect was small and the fixed partial denture was recently fabricated, the treatment decided was to repair the ceramic intraorally using a ceramic repair kit. The ceramic repair kit (IVOCLAR) consists of a silane coupling agent (Monobond Plus), bonding agent (Heliobond), opaque to masque the metal (IPS Empress), and composite in different shades (TETRIC EVOCERAM).
Figure 1: Fractured ceramic

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The repair procedure included removal of any unsupported ceramic, and the metal was abraded slightly using medium grit diamond point. Then, the area was isolated and silane coupling agent was applied on the metal and air-dried for 1 min. It was followed by the application of bonding agent which was light cured [Figure 2]. Over this, a layer of opaque material was applied and light cured for 20 s [Figure 3]. The selected shade of the repair material was applied on the opaque layer and light cured [Figure 4]. After the material was cured, it was finished using a fine grit diamond point and was polished with polishing discs [Figure 5]. The patient was satisfied with the result, as the repair was done chairside without refabricating the fixed partial denture and the esthetic outcome was satisfactory [Figure 6].
Figure 2: Application of silane coupling agent

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Figure 3: Application of opaque on exposed metal

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Figure 4: Composite material applied

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Figure 5: Finishing of the composite material

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Figure 6: Postoperative picture

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  Discussion Top


According to the literature available, the anterior porcelain-fused-to-metal fixed partial dentures are subjected to shear stresses that lead to fracture of porcelain[9],[10] commonly in clinical practice.

After dental caries, the second greatest cause for replacement of restorations is failure of ceramics.[4] The other causes for fracture of ceramics include trauma, inadequate occlusal adjustment, parafunctional habits, flexural fatigue of the metal substructure, incompatibility of the coefficient of thermal expansion between the ceramic and the metal structure, failures in the adhesive bonding, inadequate tooth reduction during dental preparation, porosities in the ceramic, and inappropriate coping design.[9] The treatment of choice for smaller defects is to utilize intraoral repair systems as they are convenient, effective, less time consuming, restore the esthetics and function, inexpensive, and does not necessitate fabrication of new prosthesis.[3] The intraoral repair systems act by increasing the surface area mechanically, decreasing the surface tension, and enhancing the adhesion between the porous metal–ceramic surface and the resin, thus improving the bond between the metal substructure and the resin[11],[12],[13],[14] and durability of the prosthesis. The bond between the composite and ceramic surface is contributed by the silane coupling agent while enhancing the wettability of the ceramic surface. The penetration of monomers into the composite surface is contributed by the bonding agent.[15] Therefore, composite resins with their greater viscosity are suitable for the repair of fractured ceramics in such clinical scenarios.


  Conclusion Top


Although metal–ceramic restorations are widely used in indirect restorations, these materials can also fail at times. These bonding failures if small can be repaired intraorally without remaking the whole fixed partial dentures using a ceramic repair kit.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McLean JW. The Science and Art of Dental Ceramics. Vol. 2. Hyderabad: Quintessence Pub., Co., Inc.; 1980.  Back to cited text no. 1
    
2.
Naylor WP. Introduction to Metal-Ceramic Technology. 2nd ed. Hyderabad: Quintessence Pub., Co., Inc.; 2009.  Back to cited text no. 2
    
3.
Galiatsatos AA. An indirect repair technique for fractured metal-ceramic restorations: A clinical report. J Prosthet Dent 2005;93:321-3.  Back to cited text no. 3
    
4.
Latta MA, Barkmeier WW. Approaches for intraoral repair of ceramic restorations. Compend Contin Educ Dent 2000;21:635-9, 642-4.  Back to cited text no. 4
    
5.
Yanikoglu N. The repair methods for fractured metal-porcelain restorations: A review of the literature. Eur J Prosthodont Restor Dent 2004;12:161-5.  Back to cited text no. 5
    
6.
Malhotra N, Acharya SR. Conservative approach for esthetic repair of fractured ceramic facing in ceramic-fused-to-metal crowns: A case series. Compend Contin Educ Dent 2012;33:E123-9.  Back to cited text no. 6
    
7.
Al-Moaleem MM, Al-Ahmari NM, Al-Dosari MK, Abdulla HA, et al. Repairing of fractured metal ceramic restorations: Techniques review. Int Journal of Contemporary Dentistry 2013;4.  Back to cited text no. 7
    
8.
AlMoaleem MM. Evaluation of Bonding Strength of the Intra Oralporcelain Repairing System with Different Surface Treatments 2011. p. 537.  Back to cited text no. 8
    
9.
Ozcan M, Niedermeier W. Clinical study on the reasons for and location of failures of metal-ceramic restorations and survival of repairs. Int J Prosthodont 2002;15:299-302.  Back to cited text no. 9
    
10.
Ozcan M. Fracture reasons in ceramic-fused-to-metal restorations. J Oral Rehabil 2003;30:265-9.  Back to cited text no. 10
    
11.
Kalra A, Mohan MS, Gowda EM. Comparison of shear bond strength of two porcelain repair systems after different surface treatment. Contemp Clin Dent 2015;6:196-200.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Pameijer CH, Louw NP, Fischer D. Repairing fractured porcelain: How surface preparation affects shear force resistance. J Am Dent Assoc 1996;127:203-9.  Back to cited text no. 12
    
13.
Chung KH, Hwang YC. Bonding strengths of porcelain repair systems with various surface treatments. J Prosthet Dent 1997;78:267-74.  Back to cited text no. 13
    
14.
Chen JH, Matsumura H, Atsuta M. Effect of etchant, etching period, and silane priming on bond strength to porcelain of composite resin. Oper Dent 1998;23:250-7.  Back to cited text no. 14
    
15.
Berry T, Barghi N, Chung K. Effect of water storage on the silanization in porcelain repair strength. J Oral Rehabil 1999;26:459-63.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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