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Inside Dental Technology

December 2012, Volume 3, Issue 11
Published by AEGIS Communications


Traditional Processes Meet Innovative Materials

2 Perspectives: 1 Case*

By Robert Winkelman, CDT, MDT

As manufacturing science and technology advances the strength and esthetics of zirconia for dental restorations, its indications for clinical use have expanded. Today, the industry is experiencing a marked shift from traditional porcelain-fused-to-metal (PFM) restorations to all-ceramic. This step-by-step article demonstrates how simple it is to adapt the latest crown-and-bridge material
innovations to the traditional two-phase fabrication process.

The case presented represents a dental laboratory perspective on a provisionalization using DENTSPLY’s Radica® long-term provisional material, followed by a bridge of milled Cercon® ht zirconia and Cercon ht single zirconia units. The posterior section of the bridge was full-contour zirconia, while the anterior portion required a cutback, or reduction of the zirconia for porcelain layering. Additionally, the single units were layered with porcelain. The intent of this article is to show the feasibility of combining full-contour milled zirconia posterior teeth for strength and a coping design for a more esthetic porcelain layering technique in the anterior region.

Case Presentation

The patient presented to the San Antonio, Texas, restorative dentist, David A. Little, DDS, with a failing porcelain PFM bridge from teeth Nos. 3 through 8 (Figure 1). After a thorough clinical examination, Dr. Little and the patient agreed upon a treatment plan, which involved a full-contour zirconia bridge for the posterior and layered zirconia for the anterior restorations. This included single-unit zirconia substructure crowns for teeth Nos. 9 through 12 and a zirconia bridge from Nos. 3 to 8.

Provisionalization

The provisional restoration is an excellent tool for the patient, dentist, and laboratory technician (Figure 2 and Figure 3). It serves as a stepping stone for the final blue print in esthetics and shade.1 Radica is a visible light-cured (VLC) composite, can be easily contoured or added to, which satisfies the esthetic demands of most patients.2 It can also be used in the mouth for up to 2 years and can be used to temporize implant restorations (Figure 4 and Figure 5).

Before temporary cementation, the preparations were refined for acceptance of a zirconia restoration. As with most all-ceramic restorations, a chamfer margin with rounded contours was prepared to ensure the best designs. After refinement of margins, a final impression was taken. At that point, Dr. Little lined the provisional restorations with a Bis-GMA material, Integrity Multi-Cure (DENTSPLY Caulk, www.caulk.com), then trimmed, polished, and temporally cemented it in the patient’s mouth (Figure 6 through Figure 9).

Fabrication of Final Restoration

Cercon ht was used for the zirconia structuring. Previous generations of zirconia proved to be extremely strong, but they were lifeless in their esthetic value. Cercon ht is up to 26% more translucent than conventional zirconia. In addition, research shows that Cercon ht causes very low antagonist wear—compared to PFMs and conventional all-ceramics—as delivered, after adjustments, and after repolishing, increasing confidence in the clinical reliability of the system.3 Cercon® all-ceramic CAD/CAM is the method in which the bridge and copings were engineered.

The CAD designs were then sent to Compartis® (compartisusa.dentsply.com) outsourcing service for the milling and manufacturing of the zirconia restorations (Figure 10 and Figure 11). All contours and esthetics were computer-generated from a 3Shape digital scanner (3Shape, Inc., www.3Shape.com) (Figure 12). In the full-contour areas, the restorations were simply stained and glazed for customization (Figure 13 and Figure 14). In the cutback areas, Ceramco® PFZ, a low-fusing esthetic porcelain, was
applied in the traditional manner.

Conclusion

A combination full-contour posterior and cutback anterior zirconia bridge has been presented. While the fabrication process follows the traditional protocol for all-ceramics, these materials expand their applications and indications, with greater predictability in esthetic and functional outcomes.4

The full-contour zirconia posterior should be fracture-resistant and the anterior regions will be as esthetic as any traditional methods (Figure 15). As new generations of zirconia evolve, dental laboratories will likely produce more and more full-contour, full-arch bridges.

Robert Winkelman, CDT, MDT, is the owner of Fort Washington Dental Lab, Inc., located in Fort Washington, PA

Acknowledgement

The author would like to thank David A. Little, DDS, Connie Nguyen, CDT, and Christopher Stricker for their contributions.

References

1. Burns DR, Beck DA, Nelson SK. A Review of selected dental literature on contemporary provisional fixed prosthodontic treatment. J Prosthet Dent. 2003;90(5):474-497.

2. Ewoldsen N, Sundar V, Bennett W, et al. Clinical evaluation of a visible light-cured indirect composite for long-term provisionalization. J Clin Dent. 2008;19(1):37-41.

3. Preis V, Behr M, Handel G, et al. Wear performance of dental ceramics after grinding and polishing treatments. J Mech Behav Biomed Mater. 2012;10:13-22.

4. Little DA. A “Smart Ceramics” System for Expanded Indications. Inside Dentistry. 2012;8(12):72-75.

For more information, contact:
DENTSPLY Prosthetics
Phone 800-243-1942
Web prosthetics.dentsply.com
E-mail prosthetics.customerservice@dentsply.com

Disclaimer

The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dental Technology.

*To see the clinical perspective of this case by David A. Little, DDS, look to the December 2012 issue of Inside Dentistry or visit www.dentalaegis.com/go/idt310


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Image Gallery

Figure 1  The patient presented with a failing porcelain PFM bridge.

Figure 1

Figure 2  Prepare the existing stone model dentition.

Figure 2

Figure 3  Wax to the ideal parameters.

Figure 3

Figure 4 Heat Radica in DENTSPLY’s special warmer.

Figure 4

Figure 5 Inject Radica into the matrix and against the prepared stone teeth.

Figure 5

Figure 6 Finish, polish, and deliver the provisional for seating in the patient’s mouth.

Figure 6

Figure 7 Finish, polish, and deliver the provisional for seating in the patient’s mouth.

Figure 7

Figure 8 Finish, polish, and deliver the provisional for seating in the patient’s mouth.

Figure 8

Figure 9 Finish, polish, and deliver the provisional for seating in the patient’s mouth.

Figure 9

Figure 10  Design the restoration using 3Shape’s design software.

Figure 10

Figure 11  Transfer the case designs online to Compartis® for manufacturing.

Figure 11

Figure 12 The zirconia substructure is returned to the laboratory for porcelain application and final glaze.

Figure 12

Figure 13 Porcelain-for-zirconia build-up on the anteriors.

Figure 13

Figure 14 Glaze the restoration for final firing.

Figure 14

Figure 15 Patient with finished restoration.

Figure 15