Care & Maintenance of Dental Restorations
Types of Materials Used in Esthetic Restorations

The demand for esthetics in dentistry has created an amazing variety of ceramic, composite and porcelain restorative materials that are available for dental restorations (Table 1). For instance, ceramic restorations are so natural looking that even the dental professional may need to carefully evaluate what they observe in the patient’s mouth. While ceramic restorations have a natural appearance and are pleasing esthetically, there are also limitations that must be considered when the restorations are placed. Ceramics are quite strong, but the occlusal forces of mastication and bruxism increase the risk of failure due to the brittle nature of the material.⁶ It is important for dental hygienists to perform an evaluation of marginal and occlusal integrity of esthetic restorations at each recall appointment.

There are various types of restorations that the dental professional may observe in a typical day. They range from slightly radiopaque (i.e., lithium disilicate, composite) to completely radiopaque (i.e., gold, zirconia) on a radiographic image. Figure 1 shows an example of the radiographic appearance of the following restorations:

• Tooth #13 exhibits a CEREC ceramic restoration comprised of lithium disilicate, that was milled in-office.
• Tooth #14 has a PFM (porcelain-fused-to-metal) restoration and gutta percha in the root canals from endodontic therapy.
• Teeth #15, 18 and 19 have been restored with gold crowns and have smooth contours that follow the anatomical crown closely. They are completely radiopaque.

Figure 2 shows an intraoral photo of the maxillary restorations present in the radiograph. It is very helpful to compare radiographic findings with a clinical evaluation when determining the patient’s existing restorations. For example, some newer esthetic materials appear very similar to metal restorations on radiographs alone. In Figure 3, zirconia crowns are present on teeth #5, 28, 29 and 30. However, they look like they could be metal, but a visual inspection would reveal an esthetic, tooth-colored restoration (Figure 4).

Figure 5 demonstrates an implant and crown (#10) made of zirconia with porcelain layered on the facial to give it a more natural appearance. The porcelain makes the incisal edge look more translucent in the radiograph. The image contrasts the different radiopacities of the metal titanium implant base, the opaque zirconia core and the translucent layered porcelain. Figure 6 is a clinical photo of the zirconia crown with porcelain on the facial surface. The dentist who performed the procedure gave a lot of credit to the talented ceramist who created the restoration.

Hopefully, the radiographs and clinical photos presented in this section will be helpful as clinicians review the existing restorations of their patients. There is a wide variety of restorative materials available and that creates opportunities and challenges as well.