Restoration Identification

There are various types of restorations that the dental professional may observe in a typical day. They range from slightly radiopaque (i.e., lithium disilicate, composite) to completely radiopaque (i.e., gold, zirconia) on a radiographic image. Figure 1 shows an example of the radiographic appearance of the following restorations:

• Tooth #13 exhibits a CEREC ceramic restoration comprised of lithium disilicate, that was milled in-office.

• Tooth #14 has a PFM (porcelain-fused-to-metal) restoration and gutta percha in the root canals from endodontic therapy.

• Teeth #15, 18 and 19 have been restored with gold crowns and have smooth contours that follow the anatomical crown closely. They are completely radiopaque.

Figure 1. Various restorative materials visible in radiographs.

Figure 1. Various restorative materials visible in radiographs.

Figure 2. Intraoral photo of the maxillary restorations shown in Figure 1.

Figure 2. Intraoral photo of the maxillary restorations shown in Figure 1.

Images courtesy of Dr. Luke Iwata, Loma Linda, CA

Figure 2 shows an intraoral photo of the maxillary restorations present in the radiograph. It is very helpful to compare radiographic findings with a clinical evaluation when determining the patient’s existing restorations. For example, some newer esthetic materials appear very similar to metal restorations on radiographs alone. In Figure 3, zirconia crowns are present on teeth #5, 28, 29 and 30. However, they look like they could be metal, but a visual inspection would reveal an esthetic, tooth-colored restoration (Figure 4).

Zirconia Restorations

Figure 3. Zirconia crowns that appear very radiopaque and similar to a metallic restoration.

Figure 3. Zirconia crowns that appear very radiopaque and similar to a metallic restoration.

Image courtesy of Dr. Brian Goodacre, Loma Linda, CA.

Figure 4. Zirconia esthetic restoration.

Figure 4. Zirconia esthetic restoration.

Retrieved from Zircolabo.com

Zirconia Restorations

Figure 5 demonstrates an implant and crown (#10) made of zirconia with porcelain layered on the facial to give it a more natural appearance. The porcelain makes the incisal edge look more translucent in the radiograph. The image contrasts the different radiopacities of the metal titanium implant base, the opaque zirconia core and the translucent layered porcelain. Figure 6 is a clinical photo of the zirconia crown with porcelain on the facial surface. The dentist who performed the procedure gave a lot of credit to the talented ceramist who created the restoration.

Figure 5. Titanium implant made with Zirconia crown and porcelain on the facial.

Figure 5. Titanium implant made with Zirconia crown and porcelain on the facial.

Figure 6. Porcelain crown on #10 to give it a more natural appearance.

Figure 6. Porcelain crown on #10 to give it a more natural appearance.

Images courtesy of Dr. Brian Goodacre, Loma Linda, CA.

Hopefully, the radiographs and clinical photos presented in this section are helpful as clinicians review their patients' existing restorations of their patients. There is a wide variety of restorative materials available, which creates opportunities and challenges as well.