Fracture of the porcelain or aesthetic veneer material: thoughts?

Some ideas on an interesting question? I've had a few patients over the years with histories of tooth and restoration fracture. It would help me choose screw-retained solutions that can be taken off and repaired. With warning signs present, we discuss them and recommend nightguards. It's been interesting to observe the return of forgotten grinding in patients who've had no natural teeth for many years and who remember that they once were bruxists. So, soft night guards seems like inexpensive insurance but clenching and or grinding still happen during the day. Periodic reviews can find warning signs like polished facetting on porcelain. I think it worthwhile to use the patient's natural function to help refine the bite excursions and then repolish with appropriate ceramic polishing instruments. When all seems well, have you tried listening to the sounds made during closure and excursive movements? This is an experience like listening to your own teeth coming together. A stereo stethoscope can help reveal unexpected sounds and allow extra refinements that may help avoid fractures. Depending on the extent of the restoration, a degree of 'freedom in centric' could help avoid excessive cusp slope loading....

We actually had an interesting related discussion about this back in 2008, with a post, Porcelain Fractures: How To Approach?

Occlusal trauma is a real SOB. I give all fixed prosthetic implant cases a soft night gard. Drs Peter Dawson and Eugene McCoy have addressed this topic in text and manuscript. I had one patient that broke three CrCo overdentures bars in the same place. I increased VDO a little and referred him for Botox treatment to quiet down the temporal is muscles. I believe all the theories about pare function and TMD are correct but not all the time. The occlusal schemes are nice to follow but they go out the window when a blouse is in the mouth. However, the occlusal schemes do help when the teeth meet, such as eating, clenching and parafunction.

i think as everyone knows that implant doesn't have PDL so what's way to get similar effects of PDL cushioning. Well i am trying to work lower posterior crowns with resin fused to metal (adoro from Ivoclar) and upper posterior with PFM. upper and lower anterior with PFM for aesthetic reasons. As resin is softer so it can give little cushioning. as well as it is intraorally repairable also. 2nd alternative is screw retained but again after removing and re layering requires additional lab cost and effort............ so choice is yours .. we can discuss it upfront or later

Occlusion, the crux of most everything done in prosthetic dentistry, rarely taught with any effectiveness today in most schools. Understanding the basic principles not dogma has been recommended by several outstanding clinicians. As a prosthodontist I have had few material failures as I evaluate each patients occlusion carefully. Unfortunately schools have dropped the ball at the expense of our patients.

For decades I have routinely provided soft night guards for all patients who have received complex or vulnerable restorative treatment - and stressed that this protection be used However I am now pretty certain that restorations will still stress / flex as the soft night guard still inevitably allows some degree of force transmission to opposing teeth I now always provide a hard / soft guard to hopefully provide better protection . Always

One very simple way to solve the problem may be to reduce the size of the oclusal table and to reduce the sharpness and height of the tubercules of the molar and premolars but this ofcourse more or less prevents proper chewing function.