case report the use of newer high translucency zirconia in...

Case ReportThe Use of Newer High Translucency Zirconia in Aesthetic Zone

Zishan Dangra1 and Mahesh Gandhewar2

1 Private Practice Mumbai 400703 India2Department of Prosthodontics ACPM Dental College Dhule 424001 India

Correspondence should be addressed to Zishan Dangra zeeshandangragmailcom

Received 26 November 2013 Accepted 16 January 2014 Published 4 March 2014

Academic Editors A I Abdalla and M Dundar

Copyright copy 2014 Z Dangra and M Gandhewar This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Loss of anterior tooth causes aesthetic and functional disharmony Although no restorative material can approach the appearanceof intact tooth enamel glass ceramic at the increased risk of brittle fracture can mimic original tooth color better than the otherrestorative options The newest zirconia material comes with unparalleled individualization in aesthetics and optimal physicalproperties One of the basic principles of tooth preparation is conservation of tooth structure This clinical report describes thereplacement of maxillary and mandibular incisor with latest generation zirconia adhesive fixed partial denture The authors haveachieved unmatched aesthetics with newer high translucency zirconia

1 Article Proper

In the field of indirect restorativematerials it has always beendesirable to have the right blend of aesthetics and durabilityThe zirconia material conquers all domains of dental restora-tions where extreme precision strength and aesthetics arerequiredThe recently introduced high performance zirconiaadds to its appearance by having improved translucency thatis although inferior to glass ceramic but of course without asmuch as two thirds reduction in flexure strength

With respect to dental restoration aesthetics means colorthat is matched perfectly in lightness to its adjacent teeth andtranslucency Translucency refers to having the appearancebetween complete opacity and complete transparency Inorder to produce lifelike restoration the light must betransmitted and reflected as it does with the natural tooth anditrsquos done

Lava plus high translucency zirconia is recently intro-duced by 3M ESPE (3M ESPE St Paul MN) It is an aftercomer of original Lava zirconia which is considered as oneof the most successful ceramic systems The newer versioncan be fabricated with hand layered pressed or monolithicoptions This material is available with the widest range ofdyeing liquids and Lava plus effect shades for excellent colormatch with VITA classical shade guide and unprecedented

customization It is claimed to have the only zirconia systemwith direct conversion to VITA system 3D-MASTER shadesThe translucency of zirconia material is determined byimpurities and structural defects as it causes light absorptionand scattering respectively The high quality processing ofLava plus minimizes the effects of impurities and structuraldefects The translucency of zirconia material is reducedby different refractory index and segregation nature of thealumina which is added into zirconia for aging stability InLava plus zirconia the alumina content is reduced to 01 wtand distribution is improved while maintaining the agingstability of the material [1 2]

The strength of new zirconia material is no way inferiorto Lava zirconia The high strength of the material allowsthinner walled restorations to add to the translucency andconserves the tooth structure of course

The anterior restorations in the following case illustratethe use of this material to achieve highly aesthetic result

2 Clinical Report

A 52-year-old man was diagnosed with partial anodontiawith missing maxillary and mandibular right central incisor(Figure 1) Various prosthetic treatments were suggested all

Hindawi Publishing CorporationCase Reports in DentistryVolume 2014 Article ID 432714 3 pageshttpdxdoiorg1011552014432714

2 Case Reports in Dentistry

Figure 1 Frontal pretreatment view

ceramic adhesive fixed partial denture (FPD) was acceptedby the patient Apart from the conventional FPD an implantsupported single crown is considered viable treatment alter-native to resin bonded FPD [3] Although implant supportedcrown is noninvasive to teeth adjacent to edentulous area(s)it may not be advisable due to anatomic limitations andeconomic constraints Metal-ceramic resin bonded FPDshave disadvantage of grayish hue on incisal third of abut-ments due to the cast metal retainers [4 5] For zirconiumresin bonded FPDs patient selection is limited to thosewith sound abutments with minimal or no restorations andstable occlusion [6] Before proceeding with actual toothpreparation diagnostic waxing was performed on diagnosticcasts and presented to the patient Tooth preparation wasmade by flame shaped and round end shoulder diamondpointsThe lingual and palatal surfaces of the abutment teethwere reduced to 05mm Shoulder finish line with roundedinternal angle and 51015840 degrees horizontal divergence extendssupragingivally The proximal reduction of the preparationshould end just lingual to the labioproximal line angle onthe edentulous side and on the dentulous side as far asaccess permits [7] The proximal grooves were prepared onthe edentulous side with flat end tapered diamond to increaseretention of the final prosthesis [8] (Figures 2 and 3) Gingivalretraction was not carried out as preparation margins weresupragingival An impression was made with vinyl polysilox-ane heavy bodylight body impression material (Imprint 33M ESPE St Paul MN) Final shade was taken for theprostheses Provisional restorations were fabricated usingdiagnostic wax-up and Bis-acrylic composite temporizationmaterial (Protemp Plus 3M ESPE St Paul MN)

In the next appointment the provisionals were carefullyremoved The Lava plus zirconia frameworks fabricatedwith CADCAM were evaluated intraorally for marginalfit occlusion and so forth Subsequently traditional handlayered technique was applied to allow restorations thatexactly mimic the nature (Figure 4)

The intaglio surface of the prostheses was grit blastedwith lt50120583m aluminium oxide grain and treated with alloyprimer The prepared enamel surfaces were isolated cleanedwith prophylaxis paste rinsed with water air-dried andetched with 37 phosphoric acid for 20 seconds The dualcure adhesive resin cement (Panavia Fluoro KurarayMedicalInc) was used for luting the restorations to the abutmentteeth Excess cement was removed by handwaving technique

Figure 2 Abutment maxillary tooth preparation

Figure 3 Abutment mandibular tooth preparation

Figure 4 Definitive restorations

after brief tack light cure for 1 second while holding therestoration in place Restorations were light- cured accordingto manufacturerrsquos recommendations for 20 seconds from allpossible aspects (Figures 5 and 6) The patient was examinedtwice in a preceding year The Lava plus zirconia adhesiveFPDs were found satisfactory in aesthetics

3 Discussion

High translucency zirconia is an optionworth considering forrestorations that need to be aesthetically superior and servepatient well for years For Lava plus anterior adhesive bridgethe selected case should not have deep bite heavy bruxism

Case Reports in Dentistry 3

(a) (b)

Figure 5 Lingual view of cemented restorations

Figure 6 Frontal view of cemented restorations

and mobile abutments The clinical protocol described inthis article is straightforward and exactly the same as recom-mended Considering laboratory protocol the recommendedconnector cross section is 7mm2 Veneering of Lava pluszirconia restoration has three options as discussed aboveTheLava plus monolithic veneering technique is selected whenthe clinical situation demands high strength or when there isreduced interocclusal space The technique for bonding therestoration is essentially the same as with any other zirconiamaterial However conventional cements can be used withtraditional anterior FPD made of high translucency zirconiawhich is an added advantage over glass ceramics

4 Summary

This clinical report illustrates a conservative treatment withLava plus zirconia adhesive FPD for the replacement ofmaxillary and mandibular incisor The mechanism behindoptimized translucency and color is describedwith case selec-tion specific tooth preparation steps and clinical procedureinvolved in the newer high translucency zirconia adhesiveFPD

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] R Dittmann M Urban G Schechner et al ldquoWear behavior ofa new zirconia after hydrothermal accelerated agingrdquo Journal ofDental Research vol 91 abstract 1317 2012

[2] R Dittmann M Urban P Braun et al ldquoWear behaviorof zirconia after hydrothermal accelerated agingrdquo Journal ofDental Research vol 90 abstract 307 2011

[3] Y Hagiwara H Matsumura S Tanaka and J B Woelfel ldquoSin-gle tooth replacement using a modified metal-ceramic resin-bonded fixed partial denture a clinical reportrdquo The Journal ofProsthetic Dentistry vol 91 no 5 pp 414ndash417 2004

[4] C J Goodacre G Bernal K Rungcharassaeng and J Y K KanldquoClinical complications in fixed prosthodonticsrdquoThe Journal ofProsthetic Dentistry vol 90 no 1 pp 31ndash41 2003

[5] S B Turker S Y Guvenli and A Arikan ldquoReplacement of twomandibular central incisors using a zirconium resin-bondedfixed partial denture a clinical reportrdquoThe Journal of ProstheticDentistry vol 94 no 6 pp 499ndash503 2005

[6] S F Rosenstiel J Fujimoto andM F LandContemporary FixedProsthodontics Mosby St Louis Mo USA 3rd edition 2001

[7] G Barrack ldquoRecent advances in etched cast restorationsrdquo TheJournal of prosthetic dentistry vol 93 no 1 pp 1ndash7 2005

[8] A A Saad N Claffey D Byrne and D Hussey ldquoEffects ofgroove placement on retentionresistance of maxillary anteriorresin-bonded retainersrdquoThe Journal of Prosthetic Dentistry vol74 no 2 pp 133ndash139 1995

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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2 Case Reports in Dentistry

Figure 1 Frontal pretreatment view

ceramic adhesive fixed partial denture (FPD) was acceptedby the patient Apart from the conventional FPD an implantsupported single crown is considered viable treatment alter-native to resin bonded FPD [3] Although implant supportedcrown is noninvasive to teeth adjacent to edentulous area(s)it may not be advisable due to anatomic limitations andeconomic constraints Metal-ceramic resin bonded FPDshave disadvantage of grayish hue on incisal third of abut-ments due to the cast metal retainers [4 5] For zirconiumresin bonded FPDs patient selection is limited to thosewith sound abutments with minimal or no restorations andstable occlusion [6] Before proceeding with actual toothpreparation diagnostic waxing was performed on diagnosticcasts and presented to the patient Tooth preparation wasmade by flame shaped and round end shoulder diamondpointsThe lingual and palatal surfaces of the abutment teethwere reduced to 05mm Shoulder finish line with roundedinternal angle and 51015840 degrees horizontal divergence extendssupragingivally The proximal reduction of the preparationshould end just lingual to the labioproximal line angle onthe edentulous side and on the dentulous side as far asaccess permits [7] The proximal grooves were prepared onthe edentulous side with flat end tapered diamond to increaseretention of the final prosthesis [8] (Figures 2 and 3) Gingivalretraction was not carried out as preparation margins weresupragingival An impression was made with vinyl polysilox-ane heavy bodylight body impression material (Imprint 33M ESPE St Paul MN) Final shade was taken for theprostheses Provisional restorations were fabricated usingdiagnostic wax-up and Bis-acrylic composite temporizationmaterial (Protemp Plus 3M ESPE St Paul MN)

In the next appointment the provisionals were carefullyremoved The Lava plus zirconia frameworks fabricatedwith CADCAM were evaluated intraorally for marginalfit occlusion and so forth Subsequently traditional handlayered technique was applied to allow restorations thatexactly mimic the nature (Figure 4)

The intaglio surface of the prostheses was grit blastedwith lt50120583m aluminium oxide grain and treated with alloyprimer The prepared enamel surfaces were isolated cleanedwith prophylaxis paste rinsed with water air-dried andetched with 37 phosphoric acid for 20 seconds The dualcure adhesive resin cement (Panavia Fluoro KurarayMedicalInc) was used for luting the restorations to the abutmentteeth Excess cement was removed by handwaving technique

Figure 2 Abutment maxillary tooth preparation

Figure 3 Abutment mandibular tooth preparation

Figure 4 Definitive restorations

after brief tack light cure for 1 second while holding therestoration in place Restorations were light- cured accordingto manufacturerrsquos recommendations for 20 seconds from allpossible aspects (Figures 5 and 6) The patient was examinedtwice in a preceding year The Lava plus zirconia adhesiveFPDs were found satisfactory in aesthetics

3 Discussion

High translucency zirconia is an optionworth considering forrestorations that need to be aesthetically superior and servepatient well for years For Lava plus anterior adhesive bridgethe selected case should not have deep bite heavy bruxism


(a) (b)




4 Summary




References
















Biomaterials












Journal of




















(a) (b)




4 Summary




References
















Biomaterials












Journal of


























Biomaterials












Journal of



















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