The teaching of all-ceramic restorations in North American dental schools: materials and techniques employed

North American dental schools were surveyed to determine the types of clinical experiences and the extent of material use that predoctoral students encounter with restorative procedures that employ all-ceramic materials. The results were based on an overall response rate of 80% from the 64 surveyed schools. The majority (96%) of the 51 schools responding to the survey did offer an opportunity to become experienced with all-ceramic restorations. The selection of bases and liners for all-ceramic restorations included dentin adhesive agents, glass ionomer materials, and calcium hydroxide products, by a ratio of 5:4:1, respectively. The most commonly used impression material types were addition silicone and polyether. One or both of these materials were used by every school. Dicor glass ceramic and alumina core ceramic were the most commonly used materials by the responding schools for veneers, onlays, and crowns. Dicor glass ceramic and CAD/CAM ceramic were most commonly used for inlays. Crowns were made of more different all-ceramic material types than the other restoration classes. Fabrication of all-ceramic restorations was primarily by commercial laboratories and school technicians. Students have hands-on experience in the fabrication of all-ceramic restorations in 6% of the responding schools. Luting agents for all-ceramic restorations include dual-cured resin, in 96% of the responding schools, light-cured resin, 43%, and glass ionomer cement, 33%. Zinc phosphate, chemical-cured composite, and polycarboxylate were used by less than one fourth of the respondents. Only resin-based composite materials were used to lute ceramic veneers. Rubber dam was applied primarily during luting procedures involving all-ceramic inlays and onlays. Crowns and veneers were isolated by this method in less than 30% of the responding schools. Finishing procedures with all-ceramic restorations were accomplished with three or more instruments by 89% of the schools.