In this issue:
The Beautiful Zirconia That Enables You to Renew Smiles for a Lifetime
Author
With each patient I meet, I am reminded of what an immense privilege it is to serve in this life-changing profession. As dentists, we are at the confluence of patients’ well-being, their goals for improving their smiles, and their trust in our clinical expertise.
Sometimes an upcoming wedding, career advancement or, as you will see in this case study, a child’s graduation can be a personal catalyst for a patient to seek treatment within a specific time frame. The stakes are high for such time-sensitive cases. Fortunately, we have cutting-edge materials, effective methods and our clinical creativity to beat the clock and efficiently give patients the restorations they seek.
A FAMILY'S MILESTONE
Anthony, 52 years old, shared with us that he was the father of a soon-to-be high school graduate. Hoping to rejuvenate his smile in time to celebrate his daughter’s commencement, Anthony preferred a bridge rather than implant treatment for his missing tooth #7. As I assessed the condition of his teeth, I could see that the patient’s issues were far more substantial than just the need for esthetic improvements.
My immediate concern was the extensive anterior tooth destruction. Occlusal interferences had restricted the functional movements of the jaw and had severely damaged the tooth structure. In fact, due to the severe wear of his maxillary anterior teeth, canine and protrusive guidance no longer existed. I went over the scope of challenges with Anthony to ensure he understood that esthetics were only one facet of his needs. We needed to rehabilitate his occlusion.
Due to the substantial occlusal wear of Anthony’s teeth, PFMs, composite and lithium disilicate were not promising options for long-term durability. Fortunately, the newly introduced BruxZir® Esthetic Solid Zirconia was. At 870 MPa of flexural strength, BruxZir Esthetic zirconia is stronger than lithium disilicate by a staggering 74 percent. This remarkable strength, along with the material’s lifelike vitality and high-performing translucency, has quickly made BruxZir Esthetic zirconia my new material of choice for demanding anterior cases like this one.
At 870 MPa of flexural strength, BruxZir Esthetic zirconia is stronger than lithium disilicate by a staggering 74 percent.
To transform Anthony’s smile, I planned a 3-unit BruxZir Esthetic bridge for teeth #6–8, BruxZir Esthetic crowns for teeth #9 and #10, and Vivaneer™ BruxZir Esthetic Veneers for teeth #5 and #11. Check out the following case photos to see his journey to a renewed smile.
Figures 1a, 1b: It was evident that Anthony had lost posterior disclusion and that movement of the mandible in protrusion was damaging the incisal edges. The longer the current situation continued, the greater the risk for full destruction of the teeth. Caries needed to be removed from teeth #8 & #10, and his missing teeth #3 & #13 needed to be replaced with bridges.
Figures 1a, 1b: It was evident that Anthony had lost posterior disclusion and that movement of the mandible in protrusion was damaging the incisal edges. The longer the current situation continued, the greater the risk for full destruction of the teeth. Caries needed to be removed from teeth #8 & #10, and his missing teeth #3 & #13 needed to be replaced with bridges.
Figures 2a, 2b: To reinvigorate Anthony’s smile, we chose a final shade of A2. During a later appointment we applied Opalescence® Boost in-office bleaching (Ultradent Products, Inc.; South Jordan, Utah) on the lower teeth to achieve congruous shading.
Figures 2a, 2b: To reinvigorate Anthony’s smile, we chose a final shade of A2. During a later appointment we applied Opalescence® Boost in-office bleaching (Ultradent Products, Inc.; South Jordan, Utah) on the lower teeth to achieve congruous shading.
Figures 3a, 3b: The most urgent treatment goals were to remove the caries, stop the destructive occlusal pattern, restore canine guidance, and start evaluating the occlusal forces and VDO. Success in anterior wear cases depends upon the development of proper anterior guidance to allow for posterior disclusion. I acted quickly to provide Anthony with an interim restoration in one visit. I used the articulated models to wax up the missing structure for teeth #6–9 and then reached for Capture® clear bite registration material, a clinical essential from the Capture VPS Impression System (Glidewell Direct; Irvine, Calif.). In mere minutes, I created a matrix from the Capture material.
Figures 3a, 3b: The most urgent treatment goals were to remove the caries, stop the destructive occlusal pattern, restore canine guidance, and start evaluating the occlusal forces and VDO. Success in anterior wear cases depends upon the development of proper anterior guidance to allow for posterior disclusion. I acted quickly to provide Anthony with an interim restoration in one visit. I used the articulated models to wax up the missing structure for teeth #6–9 and then reached for Capture® clear bite registration material, a clinical essential from the Capture VPS Impression System (Glidewell Direct; Irvine, Calif.). In mere minutes, I created a matrix from the Capture material.
Figures 4a, 4b: I applied a Ribbond® fiber reinforcement ribbon (Ribbond, Inc.; Seattle, Wash.) to the palatal surfaces of teeth #6 & #8 to reinforce the planned 3-unit bridge. Then, I injected Camouflage® NanoHybrid Composite (Glidewell Direct) through prefabricated holes in the matrix and light-cured for 20 seconds, starting with tooth #9. This interim composite bridge effectively lengthened the worn-out anterior teeth, reestablished canine and protrusive guidance, and reconstructed the incisal edges. Subsequent appointments for Anthony were focused on delivering 3-unit bridges for teeth #2–4 and #12–14, followed by final restorative care in the anterior region of the mouth.
Figures 4a, 4b: I applied a Ribbond® fiber reinforcement ribbon (Ribbond, Inc.; Seattle, Wash.) to the palatal surfaces of teeth #6 & #8 to reinforce the planned 3-unit bridge. Then, I injected Camouflage® NanoHybrid Composite (Glidewell Direct) through prefabricated holes in the matrix and light-cured for 20 seconds, starting with tooth #9. This interim composite bridge effectively lengthened the worn-out anterior teeth, reestablished canine and protrusive guidance, and reconstructed the incisal edges. Subsequent appointments for Anthony were focused on delivering 3-unit bridges for teeth #2–4 and #12–14, followed by final restorative care in the anterior region of the mouth.
Figures 5a–5c: After preparing the anterior teeth and taking impressions for the final restorations, it was time to deliver the BioTemps® Provisionals. To aid in proper orientation of BioTemps Provisionals during reline, I recommend ordering a fast seating matrix from the lab.
Figures 5a–5c: After preparing the anterior teeth and taking impressions for the final restorations, it was time to deliver the BioTemps® Provisionals. To aid in proper orientation of BioTemps Provisionals during reline, I recommend ordering a fast seating matrix from the lab.
Figures 5a–5c: After preparing the anterior teeth and taking impressions for the final restorations, it was time to deliver the BioTemps® Provisionals. To aid in proper orientation of BioTemps Provisionals during reline, I recommend ordering a fast seating matrix from the lab.
Figure 6: After two weeks, the 7-unit BioTemps provisional was removed, and the preps were cleaned of temporary cement and pumiced. Next, the final restorations were tried in to evaluate marginal fit, esthetics, occlusion and phonetics. The BruxZir Esthetic restorations reflected the guidelines of the BioTemps Provisionals, so only minimal adjustments were needed at delivery. After trying in the restorations, the intaglio surfaces of the restorations were cleaned with Ivoclean® (Ivoclar Vivadent, Inc.; Amherst, N.Y.) and blasted with CoJet™ sand, 30-µm silicatized sand, using the CoJet system (3M™ ESPE™; St. Paul, Minn.).
Figures 7a, 7b: For delivery of the final restorations, I chose to seat all the units with Variolink® Esthetic DC (Ivoclar Vivadent, Inc.), a dual-curing luting composite. I applied pressure and cured the cement for two seconds, which resulted in a gel state that was easy to remove with an explorer. Thread seal tape also served to streamline cleanup, as the tape conveniently isolated the adjacent teeth and those hard-to-reach sites where cement overflow can collect, such as under the pontic or interproximal areas. In the final stages of delivery, I checked occlusion, made some minor adjustments, and smoothed and polished the restorations.
Figures 7a, 7b: For delivery of the final restorations, I chose to seat all the units with Variolink® Esthetic DC (Ivoclar Vivadent, Inc.), a dual-curing luting composite. I applied pressure and cured the cement for two seconds, which resulted in a gel state that was easy to remove with an explorer. Thread seal tape also served to streamline cleanup, as the tape conveniently isolated the adjacent teeth and those hard-to-reach sites where cement overflow can collect, such as under the pontic or interproximal areas. In the final stages of delivery, I checked occlusion, made some minor adjustments, and smoothed and polished the restorations.
Figures 8a, 8b: The BruxZir Esthetic restorations dramatically renewed Anthony’s smile, from reconstructing healthy function to providing a natural appearance that looked outstanding from every angle. Prescribing the remarkably strong BruxZir Esthetic material for the bridge, crowns and Vivaneer BruxZir Esthetic Veneers enabled seamless results.
Figures 8a, 8b: The BruxZir Esthetic restorations dramatically renewed Anthony’s smile, from reconstructing healthy function to providing a natural appearance that looked outstanding from every angle. Prescribing the remarkably strong BruxZir Esthetic material for the bridge, crowns and Vivaneer BruxZir Esthetic Veneers enabled seamless results.
Before
After
After
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
CONCLUSION
The proven durability and lifelike vitality of BruxZir Esthetic zirconia were essential to the success of this case, giving Anthony a spectacular new smile designed to last for years to come. With his smile transformed, Anthony was ready to attend his daughter’s graduation — a memorable occasion where this proud father had plenty of reasons to smile.
