Procera

Procera® is a high strength all-ceramic restoration that combines translucent, metal-free esthetics with increased flexural strength, biocompatibility and precision fit.

High Strength All-Ceramic Restorations

CAD/CAM High Strength All-Ceramic Utilizing Procera AllCeram

Procera AllCeram offers you a proven all-ceramic restoration that combines the vital, translucent esthetics of an all-ceramic restoration with the strength and durability of a PFM.

Since 1989, over 2,000,000 units have been delivered throughout the world with a 99% success rate. Because of Procera's all-ceramic esthetics, its high strength and its conventional cementation procedures, we have given Procera the Select Award for Cementable High Strength All-Ceramic Restorations.

The Procera AllCeram restoration consists of two levels of technology - a CAD/CAM high strength sintered aluminum oxide ceramic core combined with a translucent veneering porcelain. The alumina cores are produced using CAD/CAM technology for accurate marginal fit and are available in two levels of thickness (.4 mm) for anteriors and (.6 mm) for anteriors, posteriors and bridgework.

The Procera patented sintering process ensures that each coping is exceptionally strong (687 MPa's - twice the strength of other all-ceramics), and gives the coping a semi-translucent color. This translucency provides the veneering porcelain with a natural warm dentin-colored base to establish a natural shade blend without opacity. A special veneering ceramic with a CTE specifically designed for Procera gives the final restoration a natural vital appearance, making it virtually impossible to distinguish the Procera restoration from the natural tooth.

Procera AllCeram can be used as a single crown restoration in any position in the mouth.

Indications and Material Benefits

• Single-unit for the anterior/posterior region
  
  
• An all-ceramic option where greater strength is required
  
  
• An all-ceramic option where conventional cementation is required - can be conventionally cemented or bonded to tooth structure
  
  
• Excellent choice for cementation on implant abutments

Contraindications

• Not to be used for single units when tooth reduction space is limited
  
  
• Difficult to use in ultra high value ("Hollywood White") cases due to the opacity of the core material
  
  
• Do not use if multiple adjacent pontics are required Bruxism and/or periodontal problems Tilted molars Temporary cementation

Cementation/Bonding

Because of its high flexural strength, Procera can be conventionally cemented with your choice of conventional or resin-ionomer luting cements. Procera can also be bonded to tooth structure if required.

Insurance Codes

Single Unit
D2740 Crown - Porcelain/Ceramic Substrate

Bridgework

D6740 Crown - Porcelain/Ceramic
D6245 Pontic - Porcelain/Ceramic

Prep Design

1,0 - 1.5 mm circumferential, moderate chamfer;
1.5 - 2.0 mm incisal reduction

Choosing the right material for anterior restorations

Dentistry continues to roll through an "esthetic revolution," with more restorative choices than ever to take better care of your patients. This multitude of information provides you with a tremendous opportunity to provide optimum care from an esthetic, functional and disease prevention standpoint, however, it can also lead to confusion when deciding upon which option is best for your patients.

"Factors Affecting Restoration Selection"

By Dr. John C Cranham

Choose the material that's right for your patient

Perhaps nothing is more confusing than sifting through the myriad of esthetic materials to choose the right product for any given situation. As practitioners, we have a tendency to get comfortable with one or two materials, and then make our patients fit the material. But that is not the best way to practice dentistry.

Know your options

A much wiser method is to spend time studying the advantages of as many materials as possible so you can consistently choose the right material to meet the demands of each individual patient. The purpose of this selection guide is to provide you with pertinent information necessary to assist you when considering the optimum treatment plan for your patients.

Material Selection Criteria

There are at least six factors to consider when choosing a restorative material. Let's take a look at each factor briefly.

1. Esthetic Risk

   Typically 1.0-3.0 mm of maxillary incisal tooth structure shows at rest in a youthful smile. From this position, if the patient has a high esthetic demand and shows a great deal of tooth structure (more than 7 mm of lip hypermobility when smiling), choose a material that is as cosmetic as possible.1 If the patient is not as driven by esthetics and the teeth are not too visible, it is more sensible to choose a more durable material - even though there may be a slight esthetic compromise.
   
   Another consideration is whether the underlying color of the anterior teeth needs to be blocked or if the color is to be visible through the restoration. A material should be used with enough translucency to allow the natural color to shine through or enough opacity to block out unesthetic underlying chroma.
   
   

2. Occlusal Risk

   When working up the patient's case, make sure to note any evidence of intra-articulator TMJ signs or symptoms, occlusal-muscle disorders, masticatory muscle soreness or fatigue (tension headaches), tooth wear, tooth mobility without periodontal breakdown, or tooth migration. These issues should be considered indicative of a high occlusal risk patient.2 Esthetic restorations may still be an option, but extra attention to detail is essential to develop an occlusal scheme that ensures a harmonious stomatognathic system - minimizing stress on the restoration.
   
   

3. Quantity of Remaining Enamel

   One of the best reasons to preserve tooth structure during an adhesive procedure is to conserve a maximal amount of remaining enamel, since the crystalline structure of enamel is far less variable than dentin. Recent reviews of porcelain veneers during the past ten years suggest that, of the restorations that failed (4%), six of seven were only partially bonded to dentin.3 While the success rate shows the wonderful results of porcelain veneers, it also indicates a need to preserve as much enamel as possible.
   
   

4. Quantity and Quality of Remaining Dentin

   Recent studies also look at how bonding to sclerotic and carious dentin can affect bond strength.4,5 While predictable bonding success is hard enough to obtain inside the mouth, it seems that bond strengths may also vary depending on the kind of dentin that exists. A good rule of thumb is to consider a traditional cemented restoration if areas of discolored dentin are present that lack sensitivity to cold water, air blast or to preparation without anesthesia. This evidence may indicate that the wet collagen network within the dentin has been significantly altered, affecting the necessary optimum bond strengths.
   
   

5. Ability to Maintain 100% Isolation

   If 100% isolation cannot be obtained during an adhesive procedure, failure is imminent.6 Deep subgingival restorations, patients with limited openings (TMJ), or any area that is impossible to isolate are pure examples of clinical situations where traditionally cemented restorations may be indicated.
   
   

6. Desire for Maximum Tooth Conservation

   Generally, it is recommended to only remove the amount of tooth structure necessary to maximize esthetics, obtain the necessary retention and resistance form, and preserve remaining tooth structure.
   

If you would like more information on Procera or our full-service dental lab, contact Sun Dental Labs today!

References

1. Spear F: The maxillary central incisor edge: a key to esthetic and functional treatment planning. Compend Cant Educ Dent 20 (6): S 12-S 16, 1999.9. Garber DA: Porcelain laminate veneers: ten years later. Part I: Tooth preparation. J Esthet Dent 5(2):56-S9, 1993.
   
   

2. Dawson P: Evaluation, Diagnosis, and Treatment of Occlusal Problems. C.V. Mosby, 1989.
   
   

3. Dumfahrt H, Schaffer H: Porcelain laminate veneers, a retrospective evaluation after 1 to 10 years of service: Part II: Clinical results. Int J Prothodont 13(I):9-I 8, 2000.
   
   

4. Yoshiyama M, Urayama A, Kimoch T, et al: Comparison of conventional vs self-etching adhesive bonds to caries-affected dentin. Oper Dent 25 (3): 163-169, 2000.
   
   

5. Nakajima M, Ogata M, Okuda M, et al: Bonding to caries-affected dentin using self-etching primers. Am J Dent 12(6):309-3 14, 1999.
   
   

6. Nakabayashi N, Pashley D: Hybridization of Dental Hard Tissues. Quintessence Publishing Co., 1998.