The enamel on the crown broke off what to do. Repair of dental crowns. Can a chipped tooth crown be repaired?

The crown of the tooth can be subjected to "attacks" by various pathological factors - mechanical damage, carious processes, etc. In this case, the question arises of how to restore the "affected" tooth: put a filling on a pin or install a prosthesis (tooth crown made of metal-plastic, metal-ceramic , ceramics).

It happens that an already fixed artificial structure breaks - chips, cracks, and other defects appear on it. In this case, the patient has to make a choice - to repair the prosthesis or replace it with a "fresh" one.

materials

In dentistry, to restore the crown of a tooth, the following are used:

Metal-plastic. The most "traumatic", fragile structures. They are usually used as temporary dentures or for implantation, if artificial teeth cannot be excessively loaded.
cermet(metal base with ceramic coating). The probability of chipping on such crowns is lower than in the previous case, but with improper care, such structures can also be destroyed.
Ceramics. Under heavy load, structures can crumble, chipping occurs.
Zirconium or aluminum dioxide. When prosthetics using these crowns, the risk of various flaws during wear is minimized.

Causes of defects

Protective crowns can break:

with bruxism (the habit of strongly clenching the jaw, grinding the teeth);
if during the creation of the prosthesis, the master did not take into account the difference in thermal expansion of the materials that make up the structure;
when the prosthesis has an irregular shape and is constantly subject to intense functional load of the opposite jaw;
in the event that plaque "lies" in a thick layer between the crown and the natural unit;
in case of violation of the firing technology;
repair of metal-ceramic crowns is inevitable when the patient himself carelessly treats the prostheses, does not properly care for them (“injures” the structures with solid food, opens bottles with his teeth).

More than half of the destruction of “one’s own” dental crown is a direct indication for prosthetics

Modern technologies

Prosthetics is a modern dental technique for restoring “affected” dental units. It happens that even on the highest quality ceramic-metal crown a chip appears - in this case, the product is subject to restoration. Restoration of crowns is a difficult painstaking work that requires a highly qualified specialist, accuracy, and caution. Restoration of metal-ceramic crowns, by the way, is the least practiced in modern dentistry (the prosthesis is replaced with a new one).

If the doctor decides to restore the “damaged” structure, then all manipulations are carried out by him only after removing the crown from the tooth. Is it possible to restore ceramic, zirconium, plastic products: such work is carried out by a dentist (the doctor performs the procedure without removing the prosthesis from the dental unit). Restoration of the crown part of the tooth in this situation involves:

surface polishing. The tooth remains intact, its aesthetics improves, the shape changes slightly. Such work is carried out on units located in the smile zone, if a slight chip has formed on them;
Repair of a ceramic-metal crown can also be carried out with the help of composite materials. The destroyed part of the prosthesis is filled with filling material, restoring its original size and shape. This method, however, is most often used in the restoration of plastic prostheses, but with a high qualification of the doctor and when working with other structures, it gives a good aesthetic result.

Recovery steps

Repair of cermets (ceramics) is carried out in several successive stages:

the chipped area is thoroughly dried;
the area to be restored is treated with boron (the roughness necessary for reliable fixation of the composite is achieved);
then it is necessary to clean, sharpen the surface layer and treat the structure with a special liquid solution;
a defect in a ceramic, metal-ceramic crown is covered with special insulating gaskets;
a composite of the desired shade is selected (the filling material is applied in layers, polymerized with light lamps as the work is performed);
The last step in the restoration of the crown of the front tooth is the final grinding.

Restoration of the crown part of the tooth is also carried out using composite materials - photopolymer fillings, which are fixed on the pins

Important: if it is not possible to repair the prosthesis "in place", the dentist removes it from the tooth (drills or softens it with a special compound). Next, the doctor makes an impression and, on its basis, a new prosthesis is made in the laboratory.

Crown repair with composite

Restoration of damaged units using filling materials and fiberglass pins is carried out only with a slight destruction of the crown. So, if the patient is missing more than half of "his" tooth, the use of this method is not rational. After the pulp has been removed, the dentin loses most of its nutritional properties - the adhesion (adhesion) of the bone tissue with the composite will be minimal.

Before starting work, the doctor assesses the condition of the damaged tooth (the most informative method is radiography). In the presence of carious foci, inflammatory processes, the dentist conducts appropriate treatment. On the basis of the X-ray, selects the size (thickness, depth) of the pin, removes the pulp, cleans, prepares the dental canals for implantation, and rinses them with an antiseptic solution.

Next, the factory (individual) pin is placed in the canal, the remnants are removed with a special dental instrument, the remaining cavity is filled with cement. The next stage is the restoration of the crown part of the tooth: the photopolymer composite is applied in layers, processed with an ultraviolet lamp.

So gradually the doctor manages to restore the original size (shape) of the damaged tooth. The advantages of the composite method: the integrity of the structure, when working with a pin and a filling, there is no mechanical effect on adjacent units of the dentition, the procedure is painless, the tooth enamel is not destroyed.

The main disadvantage of such a restoration is the risk of developing repeated caries (the tooth itself darkens, but the filling remains unchanged).

Installation of the prosthesis

The main indication for the use of ceramics, cermets is a strong tooth root, but a large area of the absence of the crown part. Other clinical cases in which prosthetics are required: severe pigmentation of tooth enamel, progressive dentin diseases of a non-carious nature, destruction of enamel under the influence of external or internal factors.

The preparatory stage is similar to the work on installing the composite, then the prosthetic tooth is ground, a pin is placed in the canal. With a strong root, but the almost complete absence of "one's own" tooth crown, a stump (inlay) is installed. This design strengthens the dental canals and allows you to securely fix the prosthesis. Obviously, dental crowns are more reliable and stable (compared to composite restoration), but only a dentist should decide how best to “save” a damaged unit.

Damaged metal-plastic and ceramic crowns are restored "in place", metal-ceramic structures, as a rule, must be replaced

Prevention and care

So that the restoration of milk (permanent) teeth is not needed, it is recommended to visit the dental office once every six months for a professional examination. In addition, it is recommended to evenly distribute the functional load on the jaw while eating (chewing on both sides). Care for "repaired" teeth should be even more thorough than for living units.

So, if a tooth with a filling (pin, inlay) has changed color, a chip or other flaws has appeared on it, this is a clear signal that it is necessary to install a prosthesis (crown). So, it is not always possible to restore a damaged dental crown, in this case it is better to remove the prosthesis and replace it with a new one. In some cases, dentists prefer to use composite materials (fillings with pins) or stump inserts (if the natural crown of the tooth is badly damaged) for tooth restoration.

The decision on whether to put metal-ceramic, ceramic, metal-plastic crowns or “resuscitate” teeth with the help of photopolymer materials is made by the doctor after a comprehensive assessment of the state of the oral cavity (and the most affected unit) of a particular patient.

Metal-ceramic crowns and bridges are strong enough structures and can withstand heavy loads. However, if errors in prosthetics are made or if care is not taken in good faith, a chip (crack) of the ceramic layer is possible, while the metal frame retains its original appearance.

Why does cermet chipping occur?

The practice of using metal-ceramic prostheses revealed several main reasons:

- The discrepancy between the coefficients of thermal expansion of the porcelain coating and the metal alloy of the frame.

- Installation of metal ceramics in patients suffering from bruxism.

- External loads and internal stresses of an overly long bridge.

- Fixation of the crown on thick cement.

- Foreign body in the space between the crown and the stump of the tooth.

- Insufficient height of the metal frame and, as a result, an increased volume of the ceramic layer.

- Incorrectly modeled tooth relief.

- Violation of metal surface treatment technology.

- The presence of holes in the frame.

- Non-compliance with the temperature regime when firing ceramic cladding,

- Negligence or carelessness of the patient when wearing cermets.

Cermet broke off - what to do?

How does the removal process take place?

- Polishing the edges of the chip. Suitable exclusively for those areas that are not visible when talking or smiling.

- Replacement of cermets. The most reliable, but also the most time-consuming and financial option.

- Repair of the prosthesis after removal from the tooth. Strong fixation on cement practically excludes this option from the list of possible ones. Most likely, during the removal operation, the crown will be too badly damaged.

- Repair of cermet chip directly in the mouth. This option is used more often than others and gives a very good result. How can ceramic cladding be restored to its former appearance?

Stages of restoring chipped cermets

The crown to be restored must be absolutely dry, therefore, a rubber dam is placed on the area of the surgical field.

For the restoration of the dentition, prosthetics with crowns are used. They are made from different materials. The main problem during prosthetics with metal-ceramic crowns is chipping on the metal-ceramic crown. What to do if a piece of a ceramic-metal crown has broken off, is it possible to repair the structure, and also, is it possible to prevent such a situation, such issues should be dealt with in more detail.

A crack in a ceramic-metal product most often occurs if the ceramic-metal crown is made from combined raw materials. There are such options for chipping:

if the device consists of a metal frame and plastic lining, cracks and breakage are common. This is due to the fact that plastic does not bond well with other materials. In this case, the design should only be temporary;
if the apparatus consists of ceramic and metal, chips are not observed so often, since ceramics can only break under excessively high loads or mechanical damage.

Causes of damage

Damage to the metal-ceramic crown can be due to the following reasons:

If the difference in the coefficients of thermal expansion of different materials from which metal-ceramic crowns are made is not taken into account.
If a particle has broken off on the crown, bruxism may be the cause.
If the prosthesis is excessively long, it is subjected to increased external and internal compression.
If a foreign body gets into the space between the structure and the tooth.
If during installation the specialist does not take into account the height of the frame, the result is a large layer of ceramic coating and the lack of its necessary reliability.
When the device is modeled incorrectly.
In case of violation of processing, errors in the production process.
The human factor is the use of too hard foods.
If there are holes in the base of the element.
If the technology is broken during firing.
A particle of the structure can break off with a careless attitude to the prosthesis.

Restoration stages

Among all dental products, it is very rarely necessary to repair a breakaway metal-ceramic device. Repair of a metal-ceramic crown in the mouth is necessary in very rare cases, since breakage is extremely rare. Restoration of a metal-ceramic crown is carried out with the following steps:

The surface of the cleavage of the metal-ceramic crown and other parts of the device is polished. So you can create a different form of construction, it will remain intact. This option is suitable for the chewing group of units. You can restore the device without removing it. Is it possible to grind the design on the front tooth? Such a chip repair is not carried out on the frontal group.
Is it possible to build up a broken piece of an artificial tooth? Restoration of an artificial tooth is carried out using dental cement. In this case, you can build up the crown without removing it. But this method is rather temporary, the dental structure will break off again in the future, it will need to be removed.
Another option for how to repair a product is a complete replacement of cermets. This method is the most reliable.

Since the artificial tooth is fixed using a reliable composite material, it cannot be removed from its permanent place without damage, therefore, restoration outside the oral cavity is impossible.

Building stages

If the product breaks down, it can be restored using the extension method. No need to worry, this procedure is painless, does not take much time - about half an hour. You can repair the damage in the following way:

First you need to thoroughly dry the product and fabrics. To do this, the specialist covers the site of intervention with a rubber dam.
Next, a careful grinding is carried out using a diamond burr. It is important to create a rough surface, which is needed to ensure adhesion.
A bevel is formed on the device, for this you need to grind the product, remove excess microparticles.
After the doctor has undermined the surface of the apparatus, it is cleaned with a special brush and treated with silane. After a few minutes, the absolute dryness of the surface of the product is ensured.
The cleavage area is covered with an opaque substance, which solidifies during polymerization.
Layer-by-layer application of a composite material is carried out, which is previously selected to match the tone of the enamel. Mandatory polymerization of each layer is carried out.
The final step is grinding the surface.

The extension procedure is not complicated, but it can only be done in the dentist's office, it is impossible to repair an artificial structure on your own in this way.

By stages.

Photo report of work

Grigoriev Alexander Vitalievich

Head of the training center "Dental Academy" (Irkutsk). Active member of the American Dental Academy since 2003. International lecturer on adhesive dentistry and an interdisciplinary approach to complex restoration.

We will not go into details why this should be done. So it is necessary. This is the desire of both the patient and the situation. I want to talk about a differentiated approach in this type of work. Since we have both an exposed ceramic layer down to the metal and the actual ceramic layer itself with a defect.

By stages.

1. The bridge structure itself does not stand up to criticism. The overhanging edge of the prosthesis is an inflamed gum. On the first visit, I performed a correction of the contour of the inflamed gums using the curettage method. An aseptic solution was prescribed - chlorhexidine 0.12% for 2 minutes 2 times a day.

2. Working visit on the 3rd day. As we can see, the gum is already calmer and it is possible to work, but nevertheless, to protect the working field from the biological environment, a Teflon tape was introduced along the contour of the edge of the crowns. As you can see the result is excellent.

3. Isolation of the working field due to the Peipe-damm method and a flowable rubber dam.

4. Carried out a bevel on ceramics and sandblasted metal and ceramics (aluminum oxide 50 microns).

5. The surface to be cleaned was treated with phosphoric acid for 20 seconds. Washed off with water, dried.

6. An adhesive coat of All Bond Universal (Bisco) was applied to the exposed metal.

7. After polymerization of the adhesive, a layer of metal opaquer was applied to the exposed metal and polymerized. This is a very important step and it is very important that the metal opaquer only covers (blocks) the exposed metal. Otherwise, the opaquer will show through the composite layer.

9. Apply 4% hydrofluoric acid to the ceramic layer for 4 minutes (because this ceramic layer is a feldspar ceramic) and wash off with copious amounts of water after 4 minutes. Etching feldspars of ceramics leads to the formation of etching salts and in order to clean the surface, it is necessary to apply phosphoric acid for 20 seconds. After rinsing, apply the ceramic primer Porcelan Primer (Bisco) in a good layer for 1 minute. Dry and wipe the surface with alcohol. This stage is very important - the interaction of the silane with the hydrophilic active layer of ceramics occurs as a condensation reaction with the formation of a by-product - water, so it is very important to remove it using alcohol and thorough evaporation (you can also use a warm air stream).

10. After priming, applied All Bond Universal adhesive (Bisco) and completed the restoration with composite material. In this clinical situation, I used the material Capo Natural (Shutz-Dental) color A3, A3.5 (this is a very strong highly filled composite).

11. Processing and polishing of the restoration.

This type of work, given that we have chipped ceramics to metal, should be carried out in a differentiated manner. On metal we work through an adhesive, on ceramics through a silane and an adhesive.

This type of work will achieve good long-term results (with regard to this clinical case, we will insist on the replacement of the bridge in the future (possibly planned), given its failure as a prosthesis. But the timing of the replacement will, of course, be determined by the patient himself).

Cermet chipping occurs from time to time, despite the fact that this is a fairly durable type of construction. Sometimes the cause is the negligence of patients, at times the mistakes of doctors, sometimes unforeseen circumstances (trauma due to a blow or fall). Let's figure out why this is happening.

The reasons

installation of a prosthesis for persons with a history of bruxism (teeth grinding)
violation of the operation of the prosthesis (opening beer bottles with teeth, biting wires)
non-compliance with the technology by the dental technician at the laboratory stages
doctor's mistake in preparation for a metal-ceramic crown
installation of a prosthesis in patients with certain occlusal disorders, when a greater load falls on the artificial tooth than originally planned

Price

The cost of repairing a chipped cermet will be 2500-4000 rubles. Much depends on the size and location of the defect. If the cause is a mistake by a doctor or technician, the patient does not pay anything. Otherwise (accidental impact, the warranty period has passed), the patient pays for everything himself.

Treatment

First of all, it is important to determine the cause of the cermet chip. If it arose as a result of the patient's careless actions, then a preventive conversation is needed; if due to incorrect formation of the stump by a doctor or violations in the laboratory, then it is necessary to remove and redo the entire prosthesis; if due to a missed or developed bite pathology, then the patient is first referred to an orthodontist and so on. If the cause is not identified and eliminated, the defect will reappear. There are 4 basic principles for the repair of metal-ceramic crowns, of which dentists most often resort to the last two. We list them all, and then we will analyze each separately.

remove and restore only the chipped area
leave everything as it is, fixing sharp and uneven areas
remove and completely redo the prosthesis, maybe even make a new one from scratch
eliminate the defect in the mouth with the help of special filling and restorative materials

Restoration of a separate site

The orthopedist decements the crown, gives the technician and already in the laboratory they are trying to add the missing veneer. This method is the least effective, most often after it a relapse occurs and the structure breaks again.

Leave as is

When it comes to the teeth of the chewing group and a small piece has broken off on the lingual or palatal side, in some cases they prefer the “do not itch - do not scratch” tactic, that is, repair of metal-ceramic crowns is mono and not carried out as such. The uneven edge is ground, rounded off, the roughness is removed and left alone. However, this carries the risk of further destruction of the structure. Pluses when metal is exposed in the mouth, pain and burning sensation (galvanosis) may appear.

Complete restoration of the prosthesis

It is necessary to carefully decement the crown in the mouth, this is a rather difficult stage, because it is firmly fixed. After extraction, the doctor evaluates the damage and determines whether the resulting stump can be reused or whether everything needs to be done all over again. Then he cleans the stump, takes an impression, transfers the technique, he prepares a second crown, gives it to the doctor, the doctor plants the structure. This is the most expensive way, but it is the most reliable.

Restoration in the mouth with filling material

Previously, this method was rarely used for chipping cermets due to the lack of sufficiently high-quality materials and the insufficient development of technology; recently it has become increasingly popular.

Install rubber dam. Not all doctors know how to use it, but it provides reliable isolation of the working field from liquids.
Prepare the exposed metal with a diamond burr to create retention points (they will improve physical adhesion to the filling)
Remove irregularities, create a bevel on the edge of ceramics at an angle of 45˚
Etching (30-60 sec), washing, drying. Etch not with phosphoric acid (she does not take ceramics), but with another, for example, hydrofluoric. It does not cause a reaction on the skin, but it strongly irritates the mucous membrane, therefore careful isolation from soft tissues is needed.
Apply silane, just wait 1-2 minutes (see material instructions)
Application of opaque material (opaquer) for 30-40 seconds, illumination with a halogen lamp
Composite material is applied in layers (first dentine, then enamel layers), illuminating each new portion