Bonded repair of fractured porcelain fused to metal bridge?

I really dislike repairing broken porcelain fused to metal restorations. It seems like a fair amount of effort for a sometimes not predictably long lasting result. Also billing for this repair can be tricky, since often the crowns are crowns that I have made in the first place and would better be replaced at a discount rather than bonded. I am more likely to repair a restoration that is part of a larger splinted restoration with multiple units

If the break soley involves procelain and no metal is exposed, it may work better. I also usually will not attempt replacing chipped contact areas, since they usually are under the most stress and hard to achieve sufficient bulk of the repair to withstand the forces of mastication. That being the case what do  you do when its's the week before Christmas and you're extremely busy and a patient calls with a chipped lateral incisor that is part of an eight unit bridge?.... Tell him to come in an we'll see what can be done.

This is what essentially happened to me yesterday. My retired associate called and asked me to repair her husbands implant supported 8 unit bridge. Not knowing what I would have to do, I scheduled a large block of time. Luckily, a patient had just cancelled a two hour appointment and my afternoon had a lot of time available for his repair, no matter what needed doing.

My former associate came along with him and made my decision easier, since she wasn't ready to have me remove the bridge and fabricate a temporary. She asked me to repair his chipped #7 with bonding and it seemed that it might work for a while, at least long enough to get him through the holidays.

Fortunately he had save the piece that had come off and it slid back into place nicely. The only real problem was that about a .5 mm portion on the buccal was missing and on the lingul the porcelain had come off in such away that the lingual metal was fully exposed.

I excepted the challenge and gave it about 5 minutes of thought before proceeding.  I came up with the following plan. I would lightly sandblast the exposed metal,nd make a short bevel on the buccal procelain ( on both the fractured piece and the part that remained. Afterwards I treated the exposed roughened porcelain with hydroflouric acid for 5 minutes. Aferwards I carefully washed it away in such away as not expose any tissue to the acid and then I dried the restoration and the loose piece.  I placed silane coupler on the acid treated porcelain and left it in place for a minute and then dried. Now for the "tricky part" . I used a microbrush to lightly coat the lingual metal with cynoacrylate glue and then dried with my suction in place. This step coats the metal structure with a plastic film that adheres to the metal and bonds to my composite luting cement. Now I used Multilink following the manufacturer's instructions for cementing porcelain or emax restorations. The yellow luting cement filled the buccal void and the resulting repair was almost undetectable. I made sure the bite on my repair was "light"  and I was pleased with the result.

Both my patient and my former colleague left happy. If the repair lasts over the holidays I have accomplished my mission. I am keeping my fingers crossed, but for now I am a hero and only time will tell how long this repair will last.






from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2017/12/bonded-repair-of-fractured-porcelain.html - http://lspindelnycdds.blogspot.com/