DENTAL TEAM: Kazunobu Yamada, RDT, Cusp Dental Supply Co., Ltd., Nagoya, Japan and Dr. Yoshihiko Mutobe, Mutobe Dental Clinic, Osaka, Japan
RESTORATIVE PROBLEM: The patient had a full cast crown on tooth #30 but wanted a more esthetic appearance.
TREATMENT PLAN: The dental team opted for a full contour zirconia restoration using the new Katana Zirconia ML, a gradational multilayered zirconia disc with four layers of color--35% enamel, 15% of the first gradation layer, 15% of the second gradation layer and 35% dentin--that offers the look of layered porcelain.
The pre-colored multilayered shades provide esthetic results without manual dipping or staining and eliminate additional material costs. KATANA Zirconia ML discs are available in three shades: A-Light, A-Dark and B-Light (KATANA HT--a high translucent mono-colored zirconia--is also available in three shades: HT10, HT12 and HT13).
FABRICATION PROCESS: Since KATANA ML is a brand new material, the technician chose to fabricate...
DENTAL TEAM: Janet Jones, CDT, Technical Consultant, Ivoclar Vivadent and Jenny Sy-Munoz, DDS, MSD, University at Buffalo, Buffalo, NY
RESTORATIVE PROBLEM: A 36-year-old patient presented with a request to have teeth #30 and #31 restored as recommended by his general dentist. These molars had existing large pin-retained amalgam buildups that were starting to show signs of occlusal wear.
TREAMENT PLAN: Dr. Sy-Munoz prescribed monolithic crowns made from Zenostar full contour zirconia because of its strong physical properties, pleasing esthetics and optimal biocompatibility.
FABRICATION PROCESS: The teeth were prepared with minimal reductions (0.5mm axially, 1.0 occlusally, 0.5mm chamfer margins with rounded internal line angles), and impressions made. Provisional restorations were fabricated and cemented.
Casts were scanned using the 3Shape D810 scanner and the design was generated and approved. Jones chose the "Medium" shade of Zenostar Zr Translucent zirconia since the patient's shade...
DENTAL TEAM: Sven Jesse, Jesse & Frichtel Dental Labs and Dr. Edward Narcisi, DMD, both of Pittsburgh, PA
RESTORATIVE PROBLEM: The patient—the wife of one of the laboratory owners--had an existing all-ceramic restoration on tooth #30 that cracked (she had previously had a PFM crown that also chipped).
TREATMENT PLAN: Since functionality and esthetics were a priority, a Zirlux FC2 full contour zirconia crown was chosen. The laboratory prefers to use Zirlux FC2 because of its flexural strength and low wear against opposing dentition. The Zirlux FC2 system consists of five pre-shaded zirconia discs, 10 stains, six modifier pastes and a universal glaze. The pre-shaded discs allow you to produce all 16 VITA A-D shades as well as bleach shades with no dipping.
FABRICATION PROCESS: A custom shade was taken in the laboratory and Jesse completed a shade-mapping diagram, indicating the varying shades and characteristics in the occlusal, incisal, body and neck areas of the tooth. The...
DENTAL TEAM: Scott Gallacher, Precision Milling Center, West Valley City, UT, and Steven Barker, DDS, Salt Lake City, UT
RESTORATIVE PROBLEM: The patient was missing a second bicuspid (#12), didn't want an implant crown and was also concerned about the reduction of the adjacent healthy teeth.
TREATMENT PLAN: To address the patient's desire for the most minimally invasive solution, the team opted for a full contour bridge with minimal retention, using ORIGIN LIVE Plus zirconia since the case required both high strength (for minimal enamel removal) and high translucency (for full contour). Dr. Barker prescribed a DigitalPrep™ WellBeing™ bridge, a system that allows him to create a digital prep using a 3D image of the pre-op model; the restoration is fabricated before the tooth is actually prepped in the patient's mouth.
FABRICATION PROCESS: Using DigitalPrep software, the distal area of tooth #11 was minimally reduced in the digital file and a retention groove was created. The...
DENTAL TEAM: Dr. William Roddy and in-house technician Steve Coles, Flow Laboratory, Fort Worth, TX
RESTORATIVE PROBLEM: A 62-year-old female presented with implants on teeth #3, #4 and #5 and a PFM bridge placed by another dentist. The implants had been placed too far buccally and the patient was unhappy with the esthetics and thickness of the bridge. The patient's occlusal planes were also uneven, and she had another large-span anterior bridge on teeth #6 through #11 that was starting to show signs of decay at the margins.
TREATMENT PLAN: The team opted to remove both bridges and the remaining natural teeth in the arch. Additional implants were placed on teeth #6 and #11 through #14, and immediately loaded with a temporary bridge. After integration, the patient's final restoration would be a full contour, full arch, implant-supported bridge. KEROX ZircoStar zirconia in Extreme Translucent (ET) was chosen for its esthetics and ability to match natural teeth. Because of its small grain...
DENTAL TEAM: Manfred Pörnbacher and Clemens Schwerin, Dentallabor Steger, Brunico, Italy and Dr. Lyndon Cooper, Professor and Chair at the University of North Carolina, School of Dentistry, Department of Prosthodontics
RESTORATIVE PROBLEM: A young female patient lost teeth #7 through #14 in a car accident and was already wearing a provisional restoration that had resulted in pronounced jawbone atrophy.
TREATMENT PLAN: The team opted for a fixed superstructure supported by six implants at sites #7 and #8 and #11 through #14. Due to inadequate bone structure, the restoration would be an occlusally screw-retained, full contour Prettau® Bridge with a gingival flange. Prettau Zirconia was chosen because it resists chipping and is ideally suited for implant-supported restorations, situations with limited space and restorations with a gingival flange.
FABRICATION PROCESS: The casts, waxup and articulated study casts were scanned using the S600 ARTI scanner. The articulator scan is used...
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DENTAL TEAM: Cindy Vuong and Dr. Michael DiTolla, both of Glidewell Laboratories, Newport Beach, CA
RESTORATIVE PROBLEM: The patient presented with a pre-existing discolored PFM restoration on tooth #8.
TREATMENT PLAN: Dr. DiTolla prescribed a full contour BruxZir® crown, and decided to take the opportunity to test the translucency of Glidewell Laboratories' new BruxZir™ Shaded material, which offers complete color penetration all the way through the restoration for greater shade consistency. The new material also prevents shade changes or white "show-through" after occlusal adjustment. BruxZir™ Shaded Milling Blanks are available in four base shades that can be stained to match all 16 shades in Vident's VITA Classical Shade Guide range.
FABRICATION PROCESS: The case was scanned on the 3Shape D700 and milled with the BruxZir™ Milling System using a BruxZir™ Shaded Milling Blank 200 to achieve the base shade of A2. The pre-shaded blocks were sintered and finished...
DENTAL TEAM: Gyu Cho, CDT, 3D BioCAD Milling Center, Renton, WA and Dr. Ronald Bryant, Seattle
RESTORATIVE PROBLEM: The patient presented with severe occlusal wear on his natural teeth; the lower anterior teeth were also very crooked and discolored. The existing crowns also exhibited wear, tissue retraction, dark margins and uneven shades from one crown to the next. Teeth #5, #12 and #14 were missing, requiring implants.
TREATMENT PLAN: A full-mouth restoration with 28 units was proposed and had full compliance from the patient. The team opted to use gold-hue abutments to provide a very natural, warm appearance beneath the restorations—full contour 3D BioCAD zirconia for all the molars and 3D BioCAD zirconia copings with layered porcelain for all bicuspids and anterior units. 3D BioCAD was chosen because of the material's esthetics and translucency; the discs are manufactured using isostatically pressed Tosoh zirconia powder under high pressure from all directions, versus uniaxially-pressed...
DENTAL TEAM: Ken Upright, Oxford Crown & Bridge, LLC and Dr. Shelley Olson, DDS, FICD, Granville Family Dentistry, both in Oxford, NC
RESTORATIVE PROBLEM: A female patient fractured the entire facial surface and buccal cusp of tooth #4, which had an old MOD amalgam restoration. Due to a 2mm diastema, the entire mesial aspect of the crown would be exposed in the patient's smile, so shade quality was a foremost concern.
TREATMENT PLAN: Because of her positive experiences with the material, Dr. Olson prescribed a Delta Zirconia full contour crown to restore tooth #4. High Translucent Delta Zirconia, used for fabricating full contour restorations, full contour bridges, inlays and onlays offers excellent translucency for these types of restorations. High Strength Delta Zirconia is also available for copings and two- to 14-unit bridges.
FABRICATION PROCESS: Dr. Olson performed the appropriate build-up and prepared the tooth per suggested guidelines. Upright sent the articulated model...
DENTAL TEAM: Scott Atkin, Creative Dental Laboratory and Dr. Michael Foley, both in Scottsdale, AZ
RESTORATIVE PROBLEM: A 79-year-old male patient with an existing PFM full mouth rehab needed a classic A3 shade replacement bridge for teeth #11 through #15.
TREATMENT PLAN: A five-unit Crystal Diamond full contour bridge was prescribed. Crystal Diamond was chosen for its excellent translucency and strength, ideal for highly esthetic anterior and posterior metal-free restorations.
FABRICATION PROCESS: The case was scanned using a 3Shape D710 scanner and milled using Delcam software on a DentMill 4 milling machine from Digital Dental Lab. After milling, Atkin infiltrated the non-colored zirconia with a combination of Tanaka Zircolor and Zirkonzahn's Color Liquids Prettau® Aquarell shading liquids using green micro-brushes to ensure uniform application of the shading liquids. The technique, based on the instructional Shading Techniques DVD provided by Dental Laboratory Milling Supplies,...