Dentaltown August 2018 - 79

by Dr. Arthur "Tony" Tomaro
Dr. Arthur "Tony" Tomaro earned his bachelor's and master's degrees
from the University of Michigan, where he also graduated from dental
school. He practiced in Grand Rapids, Michigan, for 26 years before
moving to Las Vegas, where he maintains a private practice limited to
full-mouth reconstruction, trauma and complex aesthetics.
As a member of Catapult Education, Tomaro teaches hands-on courses
on topics including full-mouth reconstruction, the business of dentistry,
smile design and occlusal procedures. A former director of clinics at
the Las Vegas Institute for Advanced Dental Studies, he is a published
author and a consultant for dental laboratories. Email: atomaro@ameritech.net

F

or years, the porcelain-fused-to-metal crown (PFM) was a dentist's
restoration of choice. The PFM crown was used in full-coverage
single restorations, bridges, implants and full-mouth reconstruction.
However, long-term aesthetics and covering the dark-colored metal coping
became a major concern, and recession of the gingival tissue because of
margin placement was not unusual, resulting in exposure of crown margins.
These issues began the pursuit of an ideal restoration consisting of the
following characteristics: beautiful aesthetics, strength, biocompatibility
with soft tissue, management of marginal integrity and the ability to be
built from an easy-to-use restorative material. This pursuit ushered in the
evolution of the all-ceramic restorations with adhesive dentistry. These
allowed for increased preservation of tooth structure with minimal invasive
care and appeared to be the direction of the future.
Leucite-reinforced and lithium disilicate ceramic with the ability to
bond were developed and aesthetic dentistry took a huge leap forward.
As with any new product and materials, dentists encountered hurdles
for clinical use: The placement of bridges and single restorations in
high-stress flexural areas, such as in the posterior, was a major hurdle for
these two materials. It was not unusual for patients, especially those with
parafunctional habits, to have breakage of restorations in the molar areas.
The pursuit of an ideal restoration continued until dental zirconia was
introduced. Originally used for frameworks and copings, this zirconia
was very opaque and strong and, for many of us, P2Z (porcelain fused to
zirconia) became a popular discussion. The original zirconia restorations
were opaque and unaesthetic while the second generation of zirconia was
more translucent. The third-generation is available in multilayered discs1
and is also used to manufacture artificial diamonds. The basic color gradient
is built into the raw material, whereas in the past, color characterizations
were added onto the crown's surface with external stains. Today, we have
aesthetic anterior zirconium restorations (multilayered).
In a 2015 survey, Makhija and others reported that the most prescribed
ceramic material for posterior crowns was monolithic zirconium, with
lithium disilicate most often prescribed for anterior crowns.2 In a recent
survey, I spoke to five dental laboratories and they reported that more
than 70 percent of their single restorations and bridges are zirconium.
The early and present challenge for clinicians with zirconium restorations
is that the restorations come off during service and create frustration for
the clinician and patient. Many clinicians seated these restorations using
the same protocol as all-ceramic restorations-total-etch or self-adhesive

dentaltown.com \\ AUGUST 2018

79


http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown August 2018

No label
Dentaltown August 2018 - No label
Dentaltown August 2018 - Cover1
Dentaltown August 2018 - Cover2
Dentaltown August 2018 - 1
Dentaltown August 2018 - 2
Dentaltown August 2018 - 3
Dentaltown August 2018 - 4
Dentaltown August 2018 - 5
Dentaltown August 2018 - 6
Dentaltown August 2018 - 7
Dentaltown August 2018 - 8
Dentaltown August 2018 - 9
Dentaltown August 2018 - 10
Dentaltown August 2018 - 11
Dentaltown August 2018 - 12
Dentaltown August 2018 - 13
Dentaltown August 2018 - 14
Dentaltown August 2018 - 15
Dentaltown August 2018 - 16
Dentaltown August 2018 - 17
Dentaltown August 2018 - 18
Dentaltown August 2018 - 19
Dentaltown August 2018 - 20
Dentaltown August 2018 - 21
Dentaltown August 2018 - 22
Dentaltown August 2018 - 23
Dentaltown August 2018 - 24
Dentaltown August 2018 - 25
Dentaltown August 2018 - 26
Dentaltown August 2018 - 27
Dentaltown August 2018 - 28
Dentaltown August 2018 - 29
Dentaltown August 2018 - 30
Dentaltown August 2018 - 31
Dentaltown August 2018 - 32
Dentaltown August 2018 - 33
Dentaltown August 2018 - 34
Dentaltown August 2018 - 35
Dentaltown August 2018 - 36
Dentaltown August 2018 - 37
Dentaltown August 2018 - 38
Dentaltown August 2018 - 39
Dentaltown August 2018 - 40
Dentaltown August 2018 - 41
Dentaltown August 2018 - 42
Dentaltown August 2018 - 43
Dentaltown August 2018 - 44
Dentaltown August 2018 - 45
Dentaltown August 2018 - 46
Dentaltown August 2018 - 47
Dentaltown August 2018 - 48
Dentaltown August 2018 - 49
Dentaltown August 2018 - 50
Dentaltown August 2018 - 51
Dentaltown August 2018 - 52
Dentaltown August 2018 - 53
Dentaltown August 2018 - 54
Dentaltown August 2018 - 55
Dentaltown August 2018 - 56
Dentaltown August 2018 - 57
Dentaltown August 2018 - 58
Dentaltown August 2018 - 59
Dentaltown August 2018 - 60
Dentaltown August 2018 - 61
Dentaltown August 2018 - 62
Dentaltown August 2018 - 63
Dentaltown August 2018 - 64
Dentaltown August 2018 - 65
Dentaltown August 2018 - 66
Dentaltown August 2018 - 67
Dentaltown August 2018 - 68
Dentaltown August 2018 - 69
Dentaltown August 2018 - 70
Dentaltown August 2018 - 71
Dentaltown August 2018 - 72
Dentaltown August 2018 - 73
Dentaltown August 2018 - 74
Dentaltown August 2018 - 75
Dentaltown August 2018 - 76
Dentaltown August 2018 - 77
Dentaltown August 2018 - 78
Dentaltown August 2018 - 79
Dentaltown August 2018 - 80
Dentaltown August 2018 - 81
Dentaltown August 2018 - 82
Dentaltown August 2018 - 83
Dentaltown August 2018 - 84
Dentaltown August 2018 - 85
Dentaltown August 2018 - 86
Dentaltown August 2018 - 87
Dentaltown August 2018 - 88
Dentaltown August 2018 - 89
Dentaltown August 2018 - 90
Dentaltown August 2018 - 91
Dentaltown August 2018 - 92
Dentaltown August 2018 - 93
Dentaltown August 2018 - 94
Dentaltown August 2018 - 95
Dentaltown August 2018 - 96
Dentaltown August 2018 - 97
Dentaltown August 2018 - 98
Dentaltown August 2018 - 99
Dentaltown August 2018 - 100
Dentaltown August 2018 - 101
Dentaltown August 2018 - 102
Dentaltown August 2018 - 103
Dentaltown August 2018 - 104
Dentaltown August 2018 - Cover3
Dentaltown August 2018 - Cover4
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-january-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-december-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-november-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-new-grad-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-october-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-september-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-august-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-july-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-june-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-may-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-january-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-december-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-november-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-october-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-new-grad-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-september-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-august-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-july-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-june-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-may-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-january-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-december-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-november-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-new-grad-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-october-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-september-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-august-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-july-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-june-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-may-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2021
https://www.nxtbook.com/farran/dentaltown/2021January
https://www.nxtbook.com/farran/dentaltown/2020December
https://www.nxtbook.com/farran/dentaltown/2020November
https://www.nxtbook.com/farran/dentaltown/2020NewGrad
https://www.nxtbook.com/farran/dentaltown/2020October
https://www.nxtbook.com/farran/dentaltown/2020September
https://www.nxtbook.com/farran/dentaltown/2020August
https://www.nxtbook.com/farran/dentaltown/2020July
https://www.nxtbook.com/farran/dentaltown/2020June
https://www.nxtbook.com/farran/dentaltown/2020May
https://www.nxtbook.com/farran/dentaltown/2020April
https://www.nxtbook.com/farran/dentaltown/2020March
https://www.nxtbook.com/farran/dentaltown/2020February
https://www.nxtbook.com/farran/dentaltown/2020January
https://www.nxtbook.com/farran/dentaltown/2019December
https://www.nxtbook.com/farran/dentaltown/2019November
https://www.nxtbook.com/farran/dentaltownuk/2019OctoberNovember
https://www.nxtbook.com/farran/dentaltown/2019October
https://www.nxtbook.com/farran/dentaltown/2019NewGrad
https://www.nxtbook.com/farran/dentaltown/2019September
https://www.nxtbook.com/farran/dentaltown/2019August
https://www.nxtbook.com/farran/dentaltown/2019July
https://www.nxtbook.com/farran/dentaltownuk/2019JuneJuly
https://www.nxtbook.com/farran/dentaltown/2019June
https://www.nxtbook.com/farran/dentaltown/2019May
https://www.nxtbook.com/farran/dentaltownuk/2019AprilMay
https://www.nxtbook.com/farran/dentaltown/2019April
https://www.nxtbook.com/farran/dentaltown/2019March
https://www.nxtbook.com/farran/dentaltown/2019February
https://www.nxtbook.com/farran/dentaltownuk/2019FebruaryMarch
https://www.nxtbook.com/farran/dentaltown/2019January
https://www.nxtbook.com/farran/dentaltownuk/2018Winter
https://www.nxtbook.com/farran/dentaltown/2018December
https://www.nxtbook.com/farran/dentaltown/2018November
https://www.nxtbook.com/farran/dentaltownuk/2018November
https://www.nxtbook.com/farran/dentaltown/2018October
https://www.nxtbook.com/farran/dentaltownuk/2018October
https://www.nxtbook.com/farran/dentaltown/2018NewGrad
https://www.nxtbook.com/farran/dentaltown/2018September
https://www.nxtbook.com/farran/dentaltownuk/2018September
https://www.nxtbook.com/farran/dentaltown/2018August
https://www.nxtbook.com/farran/dentaltownuk/2018July
https://www.nxtbook.com/farran/dentaltown/2018July
https://www.nxtbook.com/farran/dentaltownuk/2018June
https://www.nxtbook.com/farran/dentaltown/2018June
https://www.nxtbook.com/farran/dentaltownuk/2018May
https://www.nxtbook.com/farran/dentaltown/2018May
https://www.nxtbook.com/farran/dentaltownuk/2018April
https://www.nxtbook.com/farran/dentaltown/2018April
https://www.nxtbook.com/farran/dentaltown/2018March
https://www.nxtbook.com/farran/dentaltownuk/2018March
https://www.nxtbook.com/farran/dentaltown/2018February
https://www.nxtbook.com/farran/dentaltownuk/2018February
https://www.nxtbook.com/farran/dentaltown/2018January
https://www.nxtbook.com/farran/dentaltown/2017December
https://www.nxtbook.com/farran/dentaltownuk/2017Winter
https://www.nxtbook.com/farran/dentaltown/2017November
https://www.nxtbook.com/farran/dentaltown/2017October
https://www.nxtbook.com/farran/dentaltownuk/2017october
https://www.nxtbook.com/farran/dentaltown/NewGrad2017
https://www.nxtbook.com/farran/dentaltown/2017September
https://www.nxtbook.com/farran/dentaltownuk/2017September
https://www.nxtbook.com/farran/dentaltownuk/2017August
https://www.nxtbook.com/farran/dentaltown/2017August
https://www.nxtbook.com/farran/dentaltown/2017July
https://www.nxtbook.com/farran/dentaltownuk/2017July
https://www.nxtbook.com/farran/dentaltown/2017June
https://www.nxtbook.com/farran/dentaltownuk/2017may
https://www.nxtbook.com/farran/dentaltown/2017May
https://www.nxtbook.com/farran/dentaltownuk/2017April
https://www.nxtbook.com/farran/dentaltown/2017April
https://www.nxtbook.com/farran/dentaltown/2017March
https://www.nxtbook.com/farran/dentaltownuk/dentaltownuk/2017march
https://www.nxtbook.com/farran/dentaltown/February2017
https://www.nxtbook.com/farran/dentaltown/2017January
https://www.nxtbook.com/farran/dentaltown/2016December
https://www.nxtbook.com/farran/dentaltown/2016November
https://www.nxtbook.com/farran/dentaltown/2016October
https://www.nxtbook.com/farran/dentaltown/2016nge
https://www.nxtbook.com/farran/dentaltown/2016september
https://www.nxtbook.com/farran/dentaltown/2016august
https://www.nxtbook.com/farran/dentaltown/2016july
https://www.nxtbook.com/farran/dentaltown/2016june
https://www.nxtbook.com/farran/dentaltown/2016may
https://www.nxtbook.com/farran/dentaltown/2016april
https://www.nxtbook.com/farran/dentaltown/2016march
https://www.nxtbook.com/farran/dentaltown/2016february
https://www.nxtbook.com/farran/dentaltown/2016january
https://www.nxtbook.com/farran/dentaltown/2015december
https://www.nxtbook.com/farran/dentaltown/2015november
https://www.nxtbook.com/farran/dentaltown/2015october
https://www.nxtbook.com/farran/dentaltown/2015nge
https://www.nxtbook.com/farran/dentaltown/2015september
https://www.nxtbook.com/farran/dentaltown/2015august
https://www.nxtbook.com/farran/dentaltown/2015july
https://www.nxtbook.com/farran/dentaltown/2015june
https://www.nxtbook.com/farran/dentaltown/2015may
https://www.nxtbook.com/farran/dentaltown/2015april
https://www.nxtbook.com/farran/dentaltown/2015march
https://www.nxtbook.com/farran/dentaltown/2015february
https://www.nxtbook.com/farran/dentaltown/2015january
https://www.nxtbook.com/farran/dentaltown/2014december
https://www.nxtbook.com/farran/dentaltown/2014decemberb
https://www.nxtbook.com/farran/dentaltown/2014november
https://www.nxtbook.com/farran/dentaltown/2014october
https://www.nxtbook.com/farran/dentaltown/2014newgrad
https://www.nxtbook.com/farran/dentaltown/2014september
https://www.nxtbook.com/farran/dentaltown/2014august
https://www.nxtbook.com/farran/dentaltown/2014july
https://www.nxtbook.com/farran/dentaltown/2014june
https://www.nxtbook.com/farran/dentaltown/2014may
https://www.nxtbook.com/farran/dentaltown/2014april
https://www.nxtbook.com/farran/dentaltown/2014march
https://www.nxtbook.com/farran/dentaltown/2014february
https://www.nxtbook.com/farran/dentaltown/2014january
https://www.nxtbook.com/farran/dentaltown/2013december
https://www.nxtbook.com/farran/dentaltown/2013november
https://www.nxtbook.com/farran/dentaltown/2013october
https://www.nxtbook.com/farran/dentaltown/2013newgrad
https://www.nxtbook.com/farran/dentaltown/2013september
https://www.nxtbook.com/farran/dentaltown/2013august
https://www.nxtbook.com/farran/dentaltown/2013july
https://www.nxtbook.com/farran/dentaltown/2013june
https://www.nxtbook.com/farran/dentaltown/2013may
https://www.nxtbook.com/farran/dentaltown/2013april
https://www.nxtbook.com/farran/dentaltown/2013march
https://www.nxtbook.com/farran/dentaltown/2013february
https://www.nxtbook.com/farran/dentaltown/2013january
https://www.nxtbook.com/farran/dentaltown/2012december
https://www.nxtbook.com/farran/dentaltown/2012November
https://www.nxtbookmedia.com