Dental Ceramics for Absolute Beginners – PS013

What influences your decision when choosing ceramics?

What are the main ceramics nowadays—and do porcelain-fused-to-metal still have a place in dentistry?

Are the protocols different for various types of ceramics and crown materials?

How important is rubber dam isolation, and is a split dam good enough?

In this Back to Basics Protrusive episode, Jaz teams up again with Emma Hutchison, ‘the Protrusive Student’, to break down these critical questions and simplify the world of ceramics. From decision-making frameworks to practical rubber dam tips, this episode is packed with insights to elevate your practice.

Whether you’re a student navigating the foundations or a seasoned clinician revisiting the essentials, this discussion offers a fresh, evidence-based perspective on mastering ceramics in dentistry.

Key Takeaways:

• Understanding the role of metal ceramic crowns is crucial in modern dentistry.
• Monolithic ceramics are preferred for posterior restorations due to their strength.
• Layered ceramics can enhance aesthetics but may compromise strength.
• Proper crown preparation is essential for successful restorations.
• Communication with lab technicians is vital for successful bonding.
• The choice of ceramic material largely depends on the amount of enamel available.
• Following manufacturer protocols is key to achieving optimal results.
• Bruxism patients require careful consideration in material selection.
• Rubber dam isolation is crucial for predictable bonding.
• Digital scanning requires more aggressive tissue management.
• Impressions are still valuable, but digital methods are advancing.

Need to Read it? Check out the Full Episode Transcript below!

Highlights for this episode:

• 03:52 Emma’s Exam Experience
• 07:28 Feedback on Previous Episode
• 08:00 Discussion on Ceramics in Dentistry
• 10:51 Practical Applications and Material Choices
• 19:45 Monolithic vs. Layered Ceramics
• 24:18 Exploring Milled Cobalt Chromes and Gold Crowns
• 26:14 Challenges in Fitting Restorations and Bonding Techniques
• 30:03 Rubber Dam Techniques and Benefits
• 37:01  Intraoral Scanners vs. Traditional Impressions
• 40:14 Effective Communication with Lab Technicians
• 44:25 Conclusion and Future Plans

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes B and C.

AGD Subject Code: 010 BASIC SCIENCE (Dental materials)

Dentists will be able to –

1. Identify the suitability of ceramics based on their strength, aesthetics, and application.
2. Highlight the importance of proper crown preparation and manufacturer protocols for optimal results.
3. Emphasize the importance of rubber dam isolation and compare the benefits and challenges of analog impressions versus digital scanning.

If you love this episode, make sure to watch Composite vs Ceramic with Dr Chris Orr – PDP030 and make sure to read the Protrusive Notes! 

Click below for full episode transcript:

Teaser: I do not place lithium disilicate and I cement it. So for me, the way my mind works is if I'm cementing and not bonding, if I'm cementing just using a GIC based cement, so I'm not relying on enamel for adhesion, why would I use lithium disilicate? Using lithium disilicate posteriorly and bonding it, excellent strength, good, it's going to be fine, as long as you give it enough thickness, 1.5-2mm, you're golden, okay.

Teaser:
If you don’t respect the thickness, or if you use cement and you don’t bond it, you’re going to really compromise on the strength, you’re not going to get the high strength. So therefore, the same material, lithium disilicate, cemented is a completely different ceramic to the same ceramic lithium disilicate, bonded.

You need to know your material and the correct protocol for your material. You’re not supposed to air abrade lithium disilicate. But I know some clinicians who whatever material they get back from the lab they will air abrade it. You do introduce micro cracks. Whether it or not it’s clinically significant or not, I don’t know, but I’m one of those people that I follow the rulebook for any material I use, any bond I use, like exactly how the manufacturer wanted it, I pretty much will follow that.

The other thing to bear in mind is, how important is it to you that this molar tooth, looks absolutely gorgeous. How important is it to you? And I wait for them to say the answer. Okay, and I say, okay, you want it to look gorgeous, but what if I told you that if you accept that it’s going to look good, but not gorgeous, it will last way longer because the chance of it breaking is way less. What’s more important to you? Longevity or beauty?

Jaz’s Introduction:
When I was a student, like many things, ceramics were very confusing. And fast forward many years, when I qualified, they were still very confusing. What I present today in this back to basics series with Emma Hutchison, the Protrusive Student, is a simplified overview of ceramics and how I view them.

My views are based on the courses that I’ve been on, the evidence that I’ve read, and my daily clinical practice, which makes up a third of evidence based dentistry itself. Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. Hey, the last one on extractions. I mean, you guys loved it.

So thank you so much for everyone who liked it and commented. It really helps us to keep going. I was always unsure about this Protrusive Student series and going back to basics, but you guys are loving it. And I really appreciate that. I mean, Emma will continue to make dentistry tangible for students, but a lot of these episodes are very useful for dentists, like a back to basics, revisiting the foundations.

There’s something very validating about that. Sometimes you can only measure your growth when you look back and listen to an episode like this and feel that, you know what? I knew kind of everything and look how much I have grown. There’s a real beauty in that. So in this episode, we cover decision making in ceramics.

What influences your decision. What are the main ceramics that I’m using nowadays and do I still use porcelain fused to metal? Are the protocols different for the different types of ceramics and crown materials? How important is rubber dam isolation? Is split dam good enough? And we’ve even thrown in some rubber dam tips in there for you.

This episode, like the last one, is eligible for CE. Protrusive education is a PACE approved provider. And we also satisfy the criteria for the GDC. All you have to do to play and collect CPD is answer the five questions and get 80%. That’s only available on www. protrusive. app. Once you make an account, you can download it on Android and iOS, listen on the go, answer the questions, also answer the questions of the past episodes that you’ve listened to, and validate your learning.

An opportunity to reflect, which forms part of your personal development plan. We’ve also got the notes from this episode written by Emma, all about dental ceramics, like a cheat sheet for any student. It does go quite deep, but it’s all the stuff that you need for your exams. And that’s in the crush your exam section of Protrusive Guidance.

Once you join Protrusive Guidance, you just have to email student@protrusive.co.Uk so we can verify you’re a student and add you on there. Now let’s join the main episode and I’ll catch you in the outro.

Main Episode:
Emma Hutchison, the Protrusive Student, welcome back. You’ve just had an exam. How did it go?

[Emma]
It was okay. It was a structured clinical reasoning exam. And which was something that, it’s something that Glasgow only introduced. I think two years ago, it might’ve been last year, actually. So no one really knows what was going on. So.

[Jaz]
An example question from there that was a tough one.

[Emma]
Yeah, so you’re basically given a few cases, and you have like an assimilation time to sit in a room and look over these cases. You just get radiographs, clinical photographs, a bit about medical, social history. So you have 25 minutes per case to read over. You don’t know what questions you’re going to be asked, and then you go in, and you’ve got, for each station you’ve got two tutors or clinicians, and you sit in front of them, very closely actually, I thought they were going to be a bit further away across the room, but you were sitting right in front of them, and they just kind of grill you on your treatment plan.

If it’s oral medicine, they’ll ask you questions about histology, things about medications as well. Like, we had a patient that was on Warfarin, so they’re going to ask about all the INR, things like that.

[Jaz]
You knew that. You knew all that, right?

[Emma]
Yeah, yeah. It’s just hard because you have no idea what’s going to come up. So, a lot of it is reading over your guidelines, SDCEP, American Endodontics, things like that. So, it’s very intense. It’s very int